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Tens slide share - Coggle Diagram

- - - - Initially-
        
        stimulation of non-nociceptive nerve fibres
        like A-alpha, A beta fibres
        which have low threshold of stimulation
        causing tingling
      - Followed by
        
        activation of A-delta and C- fibres
        causing pain
      - Low intensity current
        
        Pulse duration more than 500 micro seconds
        
        activates small diameter fibres
        
        with pulse duration 50-500 micro seconds
        
        stimulates larger diameter fibres (A beta)
        
        without activation of smaller diameter fibres (A delta and C)
      - Typical features of TENS
        
        parameters
        
        Techniques of TENS application
        
        Conventional or High Frequency TENS
        
        Acupuncture or Low Frequency TENS
        
        Brief Intense TENS
        
        Burst Mode TENS
        
        Modulated TENS
        
        2.Low frequency
        / Acupuncture like TENS
        
        Activation of descending pain suppression pathway activating endorphins
        -
        
        Longer lasting pain relief but slower to start
        
        Application
        
        Frequency usually- 1-5 Hz (below 10 Hz)
        
        Pulse width: 200-300 micro16
        
        3.Brief, Intense TENS
        hyper-stimulation analgesia
        
        Similar to high frequency TENS
        
        Highest rate (100 Hz)
        
        pulse width: 200 micro sec
        
        Intensity to a very strong but tolerable level 18
        
        Treatment time is only 15 minutes, if no relief then treat again after 2-3 minutes
        .
        
        Mono or biphasic current give a “bee sting” sensation
        .
        
        Utilize motor, trigger or acupuncture points.
        
        Burst TENS
        
        Carrier frequency is at a certain rate with a built in duty cycle
        .
        
        Similar to low frequency TENS
        .
        
        Carrier frequency of 70-100 Hz packaged in bursts of about 7 bursts per second 21
        -
        
        Pulses within burst can vary
        .
        
        Burst frequency is 1-5 bursts per second
        .
        
        Strong contraction at lower frequencies
        .
        
        Combines efficacy of low TENS with the comfort of conventional TENS
        
        application
        
        Pulse width: high 100-200 micro seconds
        
        Pulse rate: 70-100 pps modulated to 1-5 burst/sec
        
        Intensity: strong but comfortable
        
        treatment length: 20-60 minutes
        
        Modulated Stimulation
        
        Keeps tissues reactive so no accommodation occurs
        .
        
        Simultaneous modulation of amplitude and pulse width; Frequency can also be modulated
        .
        
        As amplitude is decreased,
        pulse width is automatically increased
        to deliver more consistent energy per pulse
        
        Conventional or High Frequency TENS
        
        Paresthesia is created without motor response
        .
        
        A-Beta filers are stimulated to SG enkephlin interneuron (pure gate theory)
        .
        
        Applied 30 minutes to 24 hours 12
        .
        
        Creates the fastest relief
        .
        
        Relief is short lived (45 sec 1/2 life)
        .
        
        May stop the pain-spasms cycle
        
        Application of High TENS
        
        Pulse rate: high 75-100 Hz (generally 80) constant
        
        pulsed width: less than 300 msec- generally 6- microsec
        
        Intensity: comfortable to tolerable
        
        USES of TENS
        
        Biophysical Effects
        
        Primary use is to control pain through Gate Control Theory
        
        May produce muscle contractions
        
        Various methods
        
        High TENS (Activate A-delta fibers)
        
        Low TENS (release of beta-endorphins)
        
        Brief-Intense TENS (noxious stimulation to active C fibers)
        
        Common conditions where TENS is used
        
        Relief of Acute Pain
        
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        Relief of Chronic Pain
        
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        Other conditions where TENS is used
        
        Non-analgesic effects
        
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        Antiemetic effects:
        
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        Electrode placement
        
        Directly over painful sites: trigger points
        
        Dermatomes, Myotomes
        
        Accupunture points
        
        Spinal nerve roots
        
        May be crossed or uncrossed
        
        Horizontal or vertical
        
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        Contraindications:
        
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