PTAS 2190 - Physical Therapy Procedures 3-Lecture

Credit Hours: 1.00

Objectives: The student will:

1. Identify and discuss the basic principles of nerve and muscle physiology.
2. Identify the characteristics of nerve and muscle excitation with electrical stimulation associated with normal physiological responses.
3. Compare and contrast the characteristics of nerve and muscle excitation that occur in normal physiology with those that occur in selected pathologies.
4. Describe the general indications and contraindications of electrotherapy in Physical Therapy.
5. Identify the role and function of the Physcial Therapy Assistant in the application of electrotherapy treatments.
6. Identify the various diagnostic tests associated with the use of electrical stimulation that are administered by a physician.

Outcome 2: Upon completion of this course, students will be able to describe principles of various forms of DC (direct current) electricity that are related to the therapeutic process.

Objectives: The student will:

1. Identify the indications/contraindications and rationale of medical galvanism (Direct Current) in physical therapy practice.
2. Identify, discuss, and state rationale of HVGS (High Voltage Galvanic Stimulation) as an electrotherapeutic intervention.
3. Identify, discuss and state rational of HVGS (High Voltage Galvanic Stimulation) in wound healing
4. Identify the advantages and disadvantages of HVGS as part of the PT plan of care.
5. Identify, discuss, and state rationale of the procedure of iontophoresis in electrotherapeutic intervention.
6. Identify the advantages and disadvantages of iontophoresis as part of the PT plan of care.

Outcome 3: Upon completion of this course, students will be able to describe the principles of various forms of AC (Alternating Current) electricity that are related to the therapeutic process.

Objectives: The student will:

1. Identify the indications/contraindications and rationale of AC (Alternating Current) in physical therapy practice.
2. Identify, discuss, and state the rationale of Russian Current as an electrotherapeutic intervention.
3. Identify the advantages and disadvantages of Russian Current as part of the pT plan of care.
4. Identify, discuss, and state the rationale of FES (Functional Electrical Stimulation) as an electrotherapeutic intervention.
5. Identify the advantages and disadvantages of FES as part of the pT plan of care.
6. Identify, discuss, and state the rationale of IFC (Interferential Current) as an electrotherapeutic intervention.
7. Identify the advantages and disadvantages of IFC as part of the pT plan of care.

Outcome 4: Upon completion of this course, students will be able to describe the relationship between electrical stimulation and pain management.

Objectives: The student will:

1. Identify and state the principles and conditions, which indicate the use of TENS (Transcutaneous electrical nerve stimulation) as part of the PT plan of care.
2. Discuss the rationale and procedure for TENS.
3. Describe the various treatment protocols performed with TENS.

Outcome 5: Upon completion of this course, students will be able to describe various biophysical agents in electrotherapeutic plan of care.

Objectives: The student will:

1. Discuss the role and purpose of biofeedback as it relates to the patient’s plan of care.
2. Define and identify the role and purpose of light therapy as it relates to the patient’s plan of care.
3. Define and identify the role of Microcurrent Electrical Neuromuscular stimulation as it relates to the patient’s plan of care.

Outcome 6: Upon completion of this course, students will be able to as part of the discharge plan, develop and instruct in an electrotherapeutic home device.

Objectives: The student will:

1. Identify the indications and contraindications of a discharge plan with electrostimulation equipment.
2. Develop an instructional program for the patient who is discharged with an electrostimulation unit.

Outcome 7: Upon completion of this course, students will be able to collaborate, research, and present a topic on various alternative treatment approaches with the use of electrotherapeutic principles.

Objectives: The student will:

1. Work with a team utilizing the group process and appropriate teaching strategies to develop a presentation on a special topic in physical therapy associated with electrotherapeutic principles.
2. Demonstrate basic information competency by accessing project related materials through Internet resources.

1. Therapeutic Principles of Electricity
   1. Ion flow with electrical stimulation
   2. Critical factors for nerve excitation using electrical stimulation
      1. Stimulation parameters ‐‐ significance to stimulation
         1. Intensity
         2. Pulse duration
         3. Speed of rise
         4. Pulse rate
      2. Electrode size and orientation, monopolar vs. bipolar
      3. Impedance
   3. Healthy muscle response to electrical stimulation
      1. Excitability
      2. Accommodation
      3. Strength duration curve
   4. Compensation of characteristics of nerve excitation with electrical stimulation and normal physiological stimulation
   5. General uses of electrical stimulation ‐‐ direct current vs. alternating current
   6. Role of the PTA in electrotherapy treatment and modification of treatment parameters
2. Medical Galvanism (Low Volt DC)
   1. Medical galvanism ‐‐ definition
   2. Wallerian degeneration
      1. Description ‐‐ degrees of injury
      2. Changes in muscle ‐‐ physiologically and electrically
   3. Treatment
      1. Equipment type and waveform
      2. Motor point
      3. Techniques of stimulation
         1. Motor point
         2. Nerve trunk
         3. Mass stimulation
      4. Treatment guidelines
      5. Treatment goals
   4. Indications
   5. Contraindications
   6. Chemical effects at polus
   7. Other uses
3. Functional Electrical Stimulation (FES)
   1. FES ‐‐ definition, waveform, characteristics of current
   2. Indications/common diagnosis
   3. Contraindications
   4. Equipment ‐‐ characteristics of stimulation
   5. Techniques/uses of FES
      1. Maintain range of motion
      2. Correction of contractures
      3. Reeducation
      4. Inhibition of spasticity
      5. Strengthening
      6. Orthosis
4. Combined Ultrasound with Electrical Stimulation and Moist Heat with Electrical Stimulation (ES)
   1. Ultrasound with ES ‐‐ definitions
      1. Indications
      2. Contraindications
      3. Effects
      4. Equipment
      5. Patient preparation
      6. Technique
   2. Moist health with ES
      1. Indications
      2. Precautions and contraindications
      3. Effects
      4. Patient preparation
      5. Technique
5. Electrical Stimulation for Wound Healing
   1. Wound care with ES ‐‐ definition
      1. Indications
      2. Contraindications
      3. Effects
      4. Equipment
      5. Patient preparation
      6. Technique
   2. Wound care with ES
      1. Treatment steps and protocol
      2. Ulcer preparation and concomitant therapy
      3. Documentation
6. High Voltage Galvanic Stimulation (HVGS)
   1. Definition
   2. Pulse parameters
      1. Pulse duration
      2. Peak current
      3. Pulse rate ‐‐ modes
      4. Pulse charge ‐‐ average current
   3. Comparison to previous stimulators
   4. Physiological responses and advantages or parameters in treatment
   5. Disadvantages
   6. Indications
   7. Contraindications
   8. General guidelines
   9. Techniques ‐‐ protocols
7. Transcutaneous Electrical Nerve Stimulations (TENS)
   1. Pain
      1. Definition
      2. Causes
      3. Types of pain
      4. Perception of pain
   2. Spasms
      1. Definition
      2. Causes
      3. Pain spasm cycle
   3. Pain theories
   4. TENS
      1. Definition
      2. Role of TENS
      3. Effectiveness
      4. Indications
      5. Contraindications/precautions
   5. Stimulation parameters and equipment
   6. Types of stimulating modes and techniques
8. Interferential Current (IFC)
   1. Interferential Current (IFC) ‐‐ definition
   2. Concepts or principles
      1. Constructive interference
      2. Destructive interference
      3. “BEAT” frequency
   3. Patterns of interference
      1. Static
      2. Scanning
      3. Stereodynamic
   4. Advantages
   5. Indications
   6. Contraindications
   7. Treatment parameters
9. Iontophoresis
   1. Iontophoresis ‐‐ definition
   2. Review of ion migration and Ohm’s law
   3. Review of skin function as pathway of current
   4. Principles
      1. Relationship of force to intensity and resistance
      2. Continuous DC current for ion migration and activity under electrodes
      3. Ion transfer effectiveness
   5. Advantages
   6. Indications
   7. Contraindications
   8. Equipment
   9. Techniques and medications
10. Electrodiagnostic Tests
    1. Electrodiagnostic tests - definition/purpose of tests and general description of setup
       1. Evoked potential
       2. Nerve conduction velocity
       3. Centrally evoked potential
       4. EMG
    2. Physician tests
    3. PT tests
    4. Role of PTA
11. Biofeedback
    1. Definition
    2. Goal
    3. Mechanisms or how it works
    4. Indications or uses of biofeedback
       1. Relaxation
       2. Muscle reeducation
    5. Requirements for success of biofeedback
    6. Equipment
    7. Conditional. Therapeutic Principles of Electricity
    8. Ion flow with electrical stimulation
    9. Critical factors for nerve excitation using electrical stimulation
       1. Stimulation parameters ‐‐ significance to stimulation
          1. Intensity
          2. Pulse duration
          3. Speed of rise
          4. Pulse rate
       2. Electrode size and orientation, monopolar vs. bipolar
       3. Impedance
    10. Healthy muscle response to electrical stimulation
        1. Excitability
        2. Accommodation
        3. Strength duration curve
    11. Compensation of characteristics of nerve excitation with electrical stimulation and normal physiological stimulation
    12. General uses of electrical stimulation ‐‐ direct current vs. alternating current
    13. Role of the PTA in electrotherapy treatment and modification of treatment parameters
12. Medical Galvanism (Low Volt DC)
    1. Medical galvanism ‐‐ definition
    2. Wallerian degeneration
       1. Description ‐‐ degrees of injury
       2. Changes in muscle ‐‐ physiologically and electrically
    3. Treatment
       1. Equipment type and waveform
       2. Motor point
       3. Techniques of stimulation
          1. Motor point
          2. Nerve trunk
          3. Mass stimulation
       4. Treatment guidelines
       5. Treatment goals
    4. Indications
    5. Contraindications
    6. Chemical effects at polus
    7. Other uses
13. Functional Electrical Stimulation (FES)
    1. FES ‐‐ definition, waveform, characteristics of current
    2. Indications/common diagnosis
    3. Contraindications
    4. Equipment ‐‐ characteristics of stimulation
    5. Techniques/uses of FES
       1. Maintain range of motion
       2. Correction of contractures
       3. Reeducation
       4. Inhibition of spasticity
       5. Strengthening
       6. Orthosis
14. Combined Ultrasound with Electrical Stimulation and Moist Heat with Electrical Stimulation (ES)
    1. Ultrasound with ES ‐‐ definitions
       1. Indications
       2. Contraindications
       3. Effects
       4. Equipment
       5. Patient preparation
       6. Technique
    2. Moist health with ES
       1. Indications
       2. Precautions and contraindications
       3. Effects
       4. Patient preparation
       5. Technique
15. Electrical Stimulation for Wound Healing
    1. Wound care with ES ‐‐ definition
       1. Indications
       2. Contraindications
       3. Effects
       4. Equipment
       5. Patient preparation
       6. Technique
    2. Wound care with ES
       1. Treatment steps and protocol
       2. Ulcer preparation and concomitant therapy
       3. Documentation
16. High Voltage Galvanic Stimulation (HVGS)
    1. Definition
    2. Pulse parameters
       1. Pulse duration
       2. Peak current
       3. Pulse rate ‐‐ modes
       4. Pulse charge ‐‐ average current
    3. Comparison to previous stimulators
    4. Physiological responses and advantages or parameters in treatment
    5. Disadvantages
    6. Indications
    7. Contraindications
    8. General guidelines
    9. Techniques ‐‐ protocols
17. Transcutaneous Electrical Nerve Stimulations (TENS)
    1. Pain
       1. Definition
       2. Causes
       3. Types of pain
       4. Perception of pain
    2. Spasms
       1. Definition
       2. Causes
       3. Pain spasm cycle
    3. Pain theories
    4. TENS
       1. Definition
       2. Role of TENS
       3. Effectiveness
       4. Indications
       5. Contraindications/precautions
    5. Stimulation parameters and equipment
    6. Types of stimulating modes and techniques
18. Interferential Current (IFC)
    1. Interferential Current (IFC) ‐‐ definition
    2. Concepts or principles
       1. Constructive interference
       2. Destructive interference
       3. “BEAT” frequency
    3. Patterns of interference
       1. Static
       2. Scanning
       3. Stereodynamic
    4. Advantages
    5. Indications
    6. Contraindications
    7. Treatment parameters
19. Iontophoresis
    1. Iontophoresis ‐‐ definition
    2. Review of ion migration and Ohm’s law
    3. Review of skin function as pathway of current
    4. Principles
       1. Relationship of force to intensity and resistance
       2. Continuous DC current for ion migration and activity under electrodes
       3. Ion transfer effectiveness
    5. Advantages
    6. Indications
    7. Contraindications
    8. Equipment
    9. Techniques and medications
20. Electrodiagnostic Tests
    1. Electrodiagnostic tests - definition/purpose of tests and general description of setup
       1. Evoked potential
       2. Nerve conduction velocity
       3. Centrally evoked potential
       4. EMG
    2. Physician tests
    3. PT tests
    4. Role of PTA
21. Biofeedback
    1. Definition
    2. Goal
    3. Mechanisms or how it works
    4. Indications or uses of biofeedback
       1. Relaxation
       2. Muscle reeducation
    5. Requirements for success of biofeedback
    6. Equipment
    7. Conditions