TENS & IFC

Question 1

TENS and ICF

What might be a reason IFC (quadripolar) might be used over TENS?

Answer 1

larger surface areas

Question 2

TENS and ICF

TENS Patients with rate responsive pacemakers or ICDs

Answer 2

no, contrainidicated

Question 3

TENS and ICF

TENS Over metal implants?

Answer 3

no, contrainidicated, causes unnecessary pain due to electrical current-induced overheating of implants

Question 4

TENS and ICF

What are the stimulation levels of TENS?

Answer 4

• Sensory: large A-beta fibers. Gate system
• Motor: Large Diameter afferents (A-beta) & efferent motor (alpha)
• Noxius: Large Diameter afferents (A-beta) & efferent motor (alpha) & nociceptive (A- delta and C fibers)

Question 5

TENS and ICF

Should you see muscle contractions when applying TENS on the burst mode?

Answer 5

yes, sensory and motor estimulation. A-delta, C and Alpha fibers

Question 6

TENS and ICF

Can a pt use NMES or TENS if muscle contractions are contrainidicated?

Answer 6

• No NMES
• TENS only on the sensory threshold

Question 7

TENS and ICF

TENS Over or around the lumbar, abdominal area and hips of pregnant women?

Answer 7

no, contraindicated, induces labor

Question 8

TENS and ICF

Low frequency, amplitude modulated electrical current that interference between 2 (or 3) currents consisting of differing medium carrier frequencies (usually 3000-5000MHz).

Answer 8

ICF, interferencial current

Question 9

TENS and ICF

Where does the interference of current occurs with a
quadripolar set up?

Where does the interference occurs with a
bipolar set up?

Answer 9

• quadripolar set up: in the tissues
• bipolar set up: in the machine

Question 10

TENS and ICF

TENS over the anterior cervical area?

Answer 10

no, contrainidicated

Question 11

TENS and ICF

TENS over cranial area?

Answer 11

no, contrainidicated

Question 12

TENS and ICF

TENS over damaged skin?

Answer 12

no, contrainidicated

Question 13

TENS and ICF

TENS stimulates what type of nerve fiber?

Answer 13

• Sensory: Large A-Beta
• Motor: A alpha
• Nociceptive: Small A-delta & C fibers

Question 14

TENS and ICF

TENS decreases pain via…

Answer 14

peripheral nerve depolarization.

Question 15

TENS and ICF

Should you see muscle contractions when applying TENS on the brief intense mode? Why?

Answer 15

Yes, depolarization of all nerve fibers

Question 16

TENS and ICF

TENS in presence of thrombophlebitis?

Answer 16

no, contrainidicated

Question 17

TENS and ICF

What ate the 5 types of TENS Modes:
nerve fibers affected?
mechanism for pain modulation?
threshold?

Answer 17

1. —Conventional: large A-beta, gate system, sensory
2. Acupuncture-like: A-delta, C and A-Aplha fibers, opiate, sensory/motor
3. Brief Intense: A-delta and C fibers, opiate, noxius
4. Burst: A-delta, C and A-Aplha fibers, Opiate, sensory motor
5. Modulation: variable

Question 18

TENS and ICF

TENS over thoracic area?

Answer 18

no, contrainidicated, affects heart function

Question 19

TENS and ICF

Claimed main therapeutic effects of ICF:

Answer 19

• Management of pain (via gate closing)
• Management of urinary incontinence (via pelvic floor contraction)
• Management of muscle weakness (via evoked tetanic muscle contraction)

Question 20

TENS and ICF

General Dangers and Precautions for Using Electrical Stimulation

Answer 20

• Confused and unreliable patients
• Muscle Damage: with repeated mechanical stress in same motor units during electrical
  stimulation
• Near functioning shortwave diathermy devices
  
  • Keep all electrical stimulators at least 3 m (10 feet) away from any functioning SWD devices
• Burns
• Skin reaction to electrodes: try a different type of electrode
• Pain: increase current slowly

Question 21

TENS and ICF

TENS over impaired sensation?

Answer 21

no, contrainidicated

Question 22

TENS and ICF

Types of TENS devices:

Answer 22

• portable, battery-operated
• cabinet, line-powered

Question 23

TENS and ICF

Should you see muscle contractions when applying TENS on the acupunture-like mode?

Answer 23

Yes, This mode implies the preferential and concomitant depolarization of afferent large-diameter A-beta and efferent alpha motor fibers innervating skeletal muscles.

Question 24

TENS and ICF

IFC Modes

Answer 24

• The constant mode: Selection of a preset beat frequency, which is kept constant for the entire treatment duration
• The sweep mode (helps to avoid habituation to current):—  Selection of a predetermined beat frequency range, e.g. 80 to 150 bps — 
  
  • The beat frequency automatically sweeps within the range

— No scientific evidence suggests that one mode is better than another for any given pathological condition

Question 25

# TENS and ICF Mechanisms for pain modulation: associated fibers? what is the duration of pain relief for each?

Answer 25

1. **Gate system:** A-beta fibers; sensory threshold * \<30 min 2. **Opiate system:** A-delta (shrap/prick) and C fibers (dull/achy) * motor or noxius threshold * a few hours

Question 26

# TENS and ICF TENS

Answer 26

Transcutaneous Electrical Nerve Stimulation

Question 27

# TENS and ICF Indication for TENS:

Answer 27

* Symptomatic pain only

Question 28

# TENS and ICF The most common TENS waveform is...

Answer 28

biphasic and symmetrical, thus balanced

Question 29

# TENS and ICF TENS over hemorrhagic area?

Answer 29

no, contrainidicated

Question 30

# TENS and ICF In selecting TENS mode, first you must decide what?

Answer 30

First decide if you want: * Immediate pain-relief onset/ short analgesic duration or —  * Slow pain-relief onset/ longer analgesic duration —  To further select → Trial an Error → Based on patient response

Question 31

# TENS and ICF Prime physiological effect of ICF:

Answer 31

—  Depolarizes peripheral sensory and motor nerve fibers

Question 32

# TENS and ICF Should you see muscle contractions when applying TENS on the **conventional mode**? Why?

Answer 32

**No**, convectional mode stimulates A-beta fibers, gate system, in the sensory threshold

Question 33

# TENS and ICF TENS Electrode Placement — 

Answer 33

* On the painful area * Around the painful area * Along dermatomes corresponding to painful area * Over acupuncture points or trigger points

Question 34

# TENS and ICF Application of pulsed electrical current to induce “electroanalgesia”

Answer 34

TENS

Question 35

# TENS and ICF TENS electrode configuration and placement:

Answer 35

Much has been written and discussed about electrode configuration and placement relative to the treatment of pain using TENS therapy. The controversy still exists as to which configuration and placement are best to use for pain modulation. Evidence from the published literature indicates that **bipolar, quadripolar, and multipolar** electrode configurations are routinely used in clinics. Practically speaking, **the larger the painful area, the greater the number of electrodes used for treatment**. As far as electrode placement is concerned, the evidence suggests the following four options. First, electrode placement may be over, or on top of, the painful area. Second, placement may be around the painful area. Third, electrode placement may be along the dermatome(s) associated with the painful area. Fourth, placement may over acupuncture points and trigger points. There is still no evidence to show that one placement is better than the other. Until more evidence is provided, practitioners must continue to rely on trial and error when considering the best electrode placement with their patients.

Question 36

# TENS and ICF TENS over cancerous area?

Answer 36

no, contrainidicated

Question 37

# TENS and ICF true or false: technically **all** electrical current that goes through skin is “Transcutaneous electrical nerve stimulation”

Answer 37

true

Question 38

# TENS and ICF TENS with patients with epilepsy?

Answer 38

No, contrainidicated