PHYSICAL AGENT & ELECTROTHERAPY VIVA QUESTIONS

Q1. What do you know about TENS?

TENS is the application of low frequency current in the form of pulsed rectangular current through surface
electrode on the patient's skin to reduce pain.

Q2. Give parameters of TENS?

1. Pulse width ----- 100 − 200 μs or 50-300 μs
2. Pulse shape------ Usually rectangular
3. Frequency -------- 2Hz – 600 Hz Commonly used 150 Hz
4. Intensity----------- 0-60mA OR up to pt. comfort level

Q3. Give types if TENS based on frequency?

1. High TENS
2. Low TENS
3. Burst TENS
High TENS
In this High frequency and low intensity electrical stimulation is applied. The stimulation will cause impulse to
be carried along with the large diameter afferent fibers and produce presynaptic inhibition of transmission of
nociceptive A-delta and C-fibers at substantia gelatinosa of the pain gate.
Frequency --- 100-150Hz
Pulse width---- 100- 500μs
Intensity---- 12- 30 mA
Low TENS
In this low frequency and high intensity electrical pulses are applied, it gives a sharp stimulus and like a muscle
twitch. The encephalin.and endorphins have the effect of blocking forward transmission in the pain circuit.
Frequency --- 1-5Hz
Pulse width---- 100- 150μs
Intensity---- 30 mA or more
Burst TENS
In this high frequency, short pulse, high intensity electrical current is used. Burst TENS is a series of impulse
repeated for 1-5 time per second. Each train (burst) lasts for about 70 ms. The benefits for the burst TENS are
that it combines both the conventional and acupuncture like TENS and thus provide pain relief by the both
routes.

Q4. What are the advantages of SDC (strength duration curve)?

It is simple, reliable and shows proportion of denervation.

Q5. Why we use Faradic Current Test?

FDC is used to produce contraction in dennervated muscles. The faradic type current provides impulses with a
duration of 0.1-1ms and a frequency of 50-100 Hz. These short duration impulses are applied to patient which
stimulates the nerve and thus cause a pricking sensation. The stimulated nerve causes a reaction in the motor
fibers which makes the muscle contract.

Q6. What is PAIN GATE THEORY?

This theory suggests that for pain to pass through the gate there must be unopposed passage for nociceptive
information arriving at the synapses in substantia gelatinosa. If the gate concurrently receive impulse produced
by stimulation of Thermoreceptors or Mechanoreceptors, then this traffic predominates with resultant pre-
synaptic inhibition of small diameter nociceptive information. Consequently, for gate to be open for nociceptive
traffic, input has to be of small diameter nociceptive information. If large diameter afferent information is
superimposed then the gate is closed to nociceptive traffic.
Many physiotherapeutic agents are used such as TENS, Interferential current, Heat, Ice, Massage, Vibration
and movement, which can cause reduction of pain by closing pain gate.
Q7. Show the SDC for partial dennervated muscles?
For partial dennervated muscles a kink is formed in the curve. The kink produce shows the partial denervation
which disappear after 10 -20 days or month.

Q8. Define motor points?

Motor point is defined as the point with the highest excitability of the muscle or the point on the skin where
muscle contraction can be observed by the least electrical stimulation. Motor points are present frequently at
the junction of upper & middle one third of the fleshy belly muscles. (Almost midpoint of fleshy belly of muscle)

Q9. Differentiate electrical reaction in all three degrees of injury?

i. Neurapraxia (First Degree Injury)
During electrical reaction test, normal response is obtained, but there is loss of response to the stimulus
applied to the nerve trunk above the lesion
Ex; Joint dislocation or fracture a limb
ii. Axonotmesis (Second Degree Injury)
Once the nerve fibers are degenerated, alternation in the electrical reactions occurs.
Ex; Radial Nerve Palsy along with fractured shaft of humerus.
iii. Neurotmesis (Third Degree Injury)
The fibers degenerate below the site of the lesion and cause same alteration in the electrical reaction as in
axonotmesis.
Ex; ulnar nerve severed by a cut on the front of the wrist.

Q10. What is reflex sympathetic dystrophy?

RSD is a chronic condition characterized by severe burning pain, most often affecting one of the extremities
(arms, legs, hands, or feet). There are often pathological changes in bone and skin, excessive sweating, tissue
swelling and extreme sensitivity to touch
Physical therapy treatment: Applying TENS

Q11. What is phantom limb pain? How to treat it?

In phantom limb syndrome, pain is felt in the area where an arm or leg has been cut off or detached. Although
the limb is gone, the nerve endings at the site of the detachment continue to send pain signals to the brain that
make the brain think the limb is still there.
Treatment: TENS can be used in night for treatment of Phantom limb pain.

Q12. Write Indication of TENS?

TENS can be used for the treatment of:
1. Chronic pain syndrome
2. Phantom limb pain
3. Reflex sympathetic dystrophy
4. Post operative pain

Q13. What is fibrillation Potential and which type of EMG graph is made in it?
These are bi- or tri-phasic, of 1-2ms duration and 50-300V amplitude. They are due to spontaneous excitation
of individual muscle fibers and appear 10-20 days after nerve degeneration. Fibrillation and positive sharp-
waves both Indicate denervation of muscle.
Q14. PAG stands for?
Periaqueductal area of grey matter (PAG)

Q15. Can we use SDC test to find the site of lesion?

No, SDC test cannot show the site of lesion. Instead EMG or NCS is used for this purpose.

Q16. What is optimum timing of SDC?

SDC test can be done 10 – 14 days after the lesion has occurred (Maximum up to 21 days).

Q17. How to apply electrode in TENS?

TENS electrodes can be placed over
1. Area of greater intensity of pain
2. Superficial nerve proximal to the site of pain
3. The appropriate dermatome.
4. motor point or trigger point.

Q18. What is the purpose of using biofeedback in clinics?

Biofeedback is used to help refine a movement sequence or activation pattern to assist patients to achieve a
goal. This technique a number of forms, but one of the most commonly used is to apply surface EMG
electrodes over particular muscles and present the patient with an auditory or visual measure of the muscle's
activity.

Q19. Explain turning off of TENS unit?

The TENS unit has 2 control knobs. One control knob makes the electrical signals strong or weak. The other
control knob makes the electrical signals fast or slow. Turn the control knobs to the off position after using it
and plug out the electrode wire from the TENS unit.

Q20. Define Electrodiagnosis? Name the tests involve in it.

When there is disease or injury of motor nerves or muscles, alterations are liable to occur in response to
electrical stimulation. These altered electrical reactions may be of considerable assistance in diagnosing the
type & extent of the lesion, this process is called electrodiagnosis.
• Strength Duration Curve
• Nerve conduction tests
• Rheobase
• Chronaxie
• Faradic & I.D.C Test
• Electromyography
• Biofeedback

Q21. Explain SDC for innervated muscles.

When all the nerve fibers supplying the muscles are intact, the strength duration curve has a shape
characteristic of normally innervated muscles. The same strength of stimulus is required to produce a response
with all the impulses of longer duration, while those of shorter duration require an increase in strengths of the
stimulus (Intensity) each time the duration is reduced.

Q22. What is clinical EMG?

Diagnostic or clinical electromyography is used for the study of diseases of muscles, neuromuscular junctions
and nerves. It is used for the purpose of electrodiagnosis

Q23. Write types if EMG.

Types of Electromyography
1. Diagnostic or clinical electromyography
2. Kinesiological electromyography
Diagnostic or clinical electromyography: It is used for the study of diseases of muscles, neuromuscular
junctions and nerves. It is used for the purpose of electrodiagnosis.
Kinesiological electromyography: It is used in the study of muscle activity and to establish the role of
various muscles in specific activities

Q24. When does pathological block in conduction occurs?

Nociceptive stimulus is carried to cord via posture route. I.e., slow conducting (non-myelinated C fibers) or fast
conducting (myelinated A delta fibers). Both of these fibers have a maximum frequency at which they conduct.
(C- 15 pulses per sec and A delta- 40 pulses per sec). So, if higher frequency of stimulation is applied, a
pathological block to conduction might occur.

Q25. Which type of EMG is used in sports?

kinesiological electromyography is used in sports for the study of muscle activity and to establish the role of
various muscles in specific activities.

Q26. If nociceptive information is allowed through the gate the traffic will continue up____?
For gate to be open for nociceptive traffic, input has to be of small diameter nociceptive information.

Q27. Which type of electrical reactions occurs in hysterical paralysis?

In hysterical paralysis (functional disorder) there is no alteration in the electrical reactions.

Q28. What is fasciculation potential?

These are spontaneous discharges from motor units not under voluntary control. They consist potentials
repeating at a lower rate than fibrillations. Fasciculation potentials may be of three phases or may be highly
complex, and although a single one maintains its own characteristic appearance on the screen. They differ
widely in size and shape from one to another. They are usually from 0.5 to 3mV in amplitude and 7 to 20 ms
duration.
Fasciculation occurs in benign myokymia, particularly in the extensor muscles of the forearms or in eye. But it
is usually an indication of pathology at spinal cord or root level.
Q29. In which case SDC is used?
SDC is used to identify denervation, partial innervation, and compression.

Q30. What is medical electrode?

Medical electrode is a device such as a small metal plate or needle that carries electricity from an instrument to
a patient for treatment or surgery. Electrodes can also carry electrical signals from muscles, brain, heart, skin,
or other body parts to recording devices to help diagnose certain conditions.

Q31. Write principle of biofeedback?

The principle upon which the measure of activity is based is that the signal produced by the EMG apparatus
relates directly to the level of contractile activity taking place in the muscle, and that changes in activity will
produce a corresponding change in the EMG feedback.

Q32. What is Neurapraxia?

It is first degree injury. It is a condition in which bruising or pressure renders the nerve incapable of
conducting impulses past the site of the lesion. But damage is not severe enough to cause degeneration of the
fibers. If electrical reactions are tested on affected muscles, normal response is obtained.
Example. Joint dislocation or fracture of limb.

Q33. What is positive sharp wave and which type of EMG graph is formed in it?
It gives a sharp initial positive deflection followed by prolonged negative phase. The amplitude varies widely,
being mostly between 50 and 2000uV. These potentials occur in denervated muscle, often with fibrillation.

Q34. What is Rheobase?

The rheobase is the smallest current that will produce a muscle contraction if the stimulus is of infinite duration;
in practice an impulse of 100 ms (0.1 sec) is used. In denervation the rheobase may be less than that of
innervated muscle, and it often rises as re-innervation commences.

Q35. What are the factors that affect rheobase?

The rheobase varies due to
• Different muscles
• Skin resistance and temperature of the part
• Rise may be due to fibrosis of the muscle
Q36. What are the disadvantages of SDC (strength duration curve)?
• In large muscles it cannot shows the full pictures but only a proportion of muscle fibers can be
stimulated.
• It cannot show the site of lesion.
• It is Qualitative rather than Quantitative test.
Q37. Differentiate between slow and fast conducting fibers?
Slow conducting (non-myelinated C fibers)
Fast conducting (myelinated A delta fibers)

Q38. Explain volitional activity of normal muscle in EMG?

From slides
Q39. How you can increase or decrease the muscle tone through biofeedback?
To decrease muscle tone the patient can attempt to reduce the level of feedback which will gradually reduce
the tone.
To increase muscle tone, the patient attempts to increase the amount of feedback.

Q40. What is the treatment for hyperhidrosis?

Constant DC current is seldom (rare) used in treatment of hyperhidrosis (excessive sweating)

Q41. Side effects of Iontophoresis?

• Drying of mouth and throat
• Restricted general body sweating
• Pt advised not to do strenuous activities

Q42. Name some motor points of upper limb?

Deltoid middle fiber, deltoid anterior fiber pectoralis major, triceps, bicep brachii, brachioradialis, pronator
teres, extensor carpi radialis, extensor carpi ulnaris, radial nerve, ulnar nerve etc...

Q43. Name some motor points of lower limb?

Gluteus maximus, gluteus Medius, semitendinosus, semimembranosus. Sartorius, femoral nerve, rectus femoris,
adductor longus, gastrocnemius, sciatic nerve, vastus externus, vastus internus, gracilis, extensor digitorum
longus, peroneus brevis, peroneus longus etc...

Q44. Name some motor points of face?

Occipital frontalis, procerus, orbicularis oculi, zygomaticus minor, zygomaticus major, orbicularis oris, levetor
anguli oris, mentalis, rhisorius etc...

Q45. How nociceptive nerve endings are stimulated?

These nerve ending may be stimulated by chemical released by tissue injury or as a result of metabolic activity,
thus creating an electrical potential.

Q46. Explain pathway of pain?

For pain to perceived there is usually a chain whereby peripheral receptors are stimulated by a noxious
physical or chemical agent and this stimulus is carried by peripheral nerves to spinal cord, through the
brainstem and so to cerebral cortex where the pain is appreciated at conscious level. This route involves a
number of synapses and inhibition of impulses. Where pain can be modulated.
Noxious physical or chemical agents (Stimulates) Peripheral receptors Peripheral Nerve
Spinal Cord Brainstem Cerebral Cortex (Pain)
Q47. How we can detect electrical signals form EMG?
To detect electrical signals from EMG different types of electrodes are used
1. Surface electrodes
2. Fine – wire indwelling electrodes
3. Needle electrodes
Recording is made through a coaxial needle electrode and diagnostic electromyography (EMG) cannot be
carried out with surface electrodes. Electrical activity is examined first with the muscle at rest and then during
voluntary activity. A motor unit consists of an anterior horn cell, the nerve and its divisions arising from that
cell, and the muscle fibers supplied by these divisions. • The fewer the fibers in a unit, the more precise the
voluntary control. (Inverse relation).

Q48. Clinical indications of iontophoresis?

• Local anesthesia
• Inflammation
• Treatment of tendonitis, arthritis, adhesive capsulitis and bursitis etc...
• Skeletal muscle spasm
• Headache and pain relief

Q49. Difference between Rheobase and Chronaxie?

Rheobase
The rheobase is the smallest current that will produce
a muscle contraction if the stimulus is of infinite
duration; in practice an impulse of 100 ms (0.1 sec) is
used.
In denervation the rheobasc may be less than that of
innervated muscle, and it often rises as re-innervation
commences.
Chronaxie
“The Chronaxie is the duration of the shortest impulse
that will produce a response with a current of double
the rheobase.” Chronaxie is double the rheobase
current.
The chronaxie of innervated muscle is appreciably less
than that of denervated muscle, the former being lets
and the latter more than 1 ms if the constant voltage
stimulator as used with the constant current stimulator
the values are higher, but heal a similar relationship to
each other

Q50. Which type of graph is formed in denervated muscles?

For all impulses with duration of 100 ms or less the strength of the stimulus must be increased each time the
duration is reduced and no response is obtained to impulses of very short duration. The curve rises steeply and
is shifted to the right than that of normally innervated muscle.

Q51. TENS electrode can be placed over _______?

TENS electrodes can be placed over
1. Area of greater intensity of pain
2. Superficial nerve proximal to the site of pain
3. The appropriate dermatome.
4. motor point or trigger point.

Q52. Describe volitional activity in EMG?

from slides.

Q53. What is high frequency discharge and what type of EMG graph is made in it?
They give a characteristic 'dive-bomber' sound on the loudspeaker. It occurs in myotonia, especially
dystrophies and occasionally with polymyositis.

Q54. Define faradic current.

Faradic current is a short-duration interrupted current, with a pulse duration ranging from 0.1 and 1 msec and a
frequency of 50 to 100 Hz, used for the stimulation of innervated muscles.

Q55. What do you know about Current surging?

Current surging means the gradual increase and decrease of the peak intensity.

Q56. What are the indications of Faradic current?

• Facilitation of muscle contraction inhibited by pain
• Muscle re-education or relearning
• Training a new muscle action
• When a nerve is severed
• Improvement of venous and lymphatic drainage
• Replacing Orthosis
• Prevention and loosening of adhesions
• Inhibition of quadriceps contraction by pain

Q57. Write contraindications of faradic current.

• Skin lesions
• Unstable fracture
• Impaired cognitive ability
• Pregnancy (1st trimester)
• Over Carotid sinus
• Loss of sensation
• Cancer
• Cardiac pacemakers
• Superficial metal

Q58. Define Sinusoidal current.

“Sinusoidal currents are evenly sine wave alternating currents with a frequency (LFC) of 50 Hz” Rarely used
nowadays in modern Physiotherapy.

Q59. What is sine wave?

The sine wave or sinusoid is a mathematical curve that describes a smooth repetitive oscillation.
Q60. Give advantages of sinusoidal current?
• Supplies greater stimulation & deeper penetration.
• Soothes the nerves & penetrates into deeper muscle tissue
• Is best suited for the nervous client
• It relieves pain and reduces edema

Q61. What are contraindications of TENS?

• Continuous application of high TENS may result in some electrolytic reaction below the skin surface.
• TENS is contraindicated in patients having cardiac pacemakers may be because of possible interference
with the frequency of pacemaker.
• TENS should be avoided in first Trimester.
• TENS should be avoided in hemorrhagic conditions.
• TENS should be avoided over upon open wounds, carotid sinus, over the mouth, near the eyes, etc.

Q62. What is iontophoresis?

This term is used to describe the technique in which medically useful ions are driven through the patient’s skin
into the tissues.

Q63. Write indications of faradic current test.

• Testing with faradic type and interrupted direct currents was widely used in the past, but it is very
inaccurate.
• Faradic type current provides impulses with a duration of 0.1-1 ms and a frequency of 50-100 Hz.
• These cause a tetanic contraction of innervated muscle, but with a faradic coil it is difficult or impossible
to elicit a response from denervated muscle owing to the short duration of the stimulus.
• With modern stimulators, however, a response can usually be obtained from denervated muscle with
impulses of this duration, owing to the greater output and more tolerable forms of current than that
provided by the older equipment.
• Inaccuracies due to variations in the form and duration of the impulses have also been eliminated.

Q64. Write indications of IDC test.

• Interrupted direct current was used in impulses with a duration of approximately 100 ms repeated 30
times per minute.
• These usually produce a brisk contraction of innervated muscle fibers, but a sluggish contraction of
denervated fibers.
• Innervated muscles may, however, respond sluggishly if their temperature is below normal, or in certain
conditions such as myxedema, while the contraction of denervated muscle becomes brisker as its
temperature rises.

Q65. Define NCS.

Nerve conduction study (NCS) is a test commonly used to evaluate the function of the motor and sensory
nerves of the human body.

Q66. What is NCV?

Nerve conduction velocity (NCV) is a common measurement made during nerve conduction study test.