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Section I Neurophysiologic Bases for 1 (48)
Application of Therapeutic Electricity
Principles of Neuromuscular Excitation 3 (23)
Carl G. Kukulka
Properties of Electrically Excitable Cells 4 (7)
Electrical Concepts Specific to 4 (2)
Bioelectrical Phenomena
Membrane Properties of Excitable Tissues 6 (2)
The Resting Potential 8 (1)
The Action Potential 9 (2)
Nerve and Muscle Excitation Induced by 11 (8)
Externally Applied Stimulation
Stimulation of Peripheral Nerves 11 (2)
Reflex Activation and Synaptic 13 (1)
Transmission
Afferent Fiber Types 14 (2)
Excitation of Neurons Based on Size 16 (2)
Clinical Implications of Size Dependence 18 (1)
in Afferent Excitation and Order of
Neuron Recruitment
Excitation of Alpha Motoneurons 19 (5)
Direct and Reflex Activation of 20 (1)
Motoneurons
Mechanical Consequences of Motoneuron 21 (2)
Recruitment
Clinical Implications of Direct versus 23 (1)
Reflex Excitation of Motoneuron
Summary 24 (1)
References 24 (1)
Suggested Readings 25 (1)
Principles of Nociception 26 (23)
James L. Hanegan
Clinical Definitions of Pain 27 (4)
Acute Pain 27 (2)
Chronic Pain 29 (1)
Somatic and Visceral Pain 29 (1)
Referred Pain 30 (1)
Emotional or Psychogenic Pain 31 (1)
Pain Theories 31 (3)
Specificity Theory 31 (1)
Pattern Theory 32 (1)
Gate Control Theory 32 (2)
Pain Receptors 34 (3)
Skin 34 (2)
Muscle 36 (1)
Joints 36 (1)
Afferent Input and Dorsal Horn Cells of the 37 (2)
Spinal Cord
Spinal Cord Pathways to Higher Center 39 (2)
Central Nervous System Components of Pain 41 (1)
Modulation
The Application of Electrical Stimulation 42 (1)
for Pain Relief
Summary 43 (1)
References 44 (3)
Suggested Readings 47 (2)
Section II Application of Electrical Currents 49 (294)
Electrodiagnostic and Electrotherapeutic 51 (50)
Instrumentation: Characteristics of Recording
and Stimulation Systems and Principles of
Safety
Barbara M. Myklebust
Luther C. Kloth
Diagnostic Systems for Recording Electrical 52 (21)
Signals
Applied Stimulus 52 (1)
Types of Stimulating Electrodes 52 (3)
Size of Stimulating Electrodes 55 (1)
Orientation of Stimulating Electrodes 55 (1)
Constant Current versus Constant Voltage 56 (1)
Recording Electrodes 57 (1)
Placement of Recording Electrodes 57 (1)
Materials of recording Electrodes 57 (2)
Orientation of Recording Electrodes 59 (4)
Connecting the Patient to ``Ground'' 63 (1)
Signal Processor 64 (1)
Signal Amplification 64 (1)
Differential Amplification 64 (2)
Signal Averaging 66 (1)
Integration 66 (1)
Bandpass Filtering 67 (2)
Analog-to-Digital (A/D) Conversion 69 (2)
Data Output: Display and Storage Devices 71 (1)
Relationship between the Characteristics 72 (1)
of the Recorded Signal and the Data
Acquisition System
Physiologic Signal Characteristics 72 (1)
Characteristics of the Recording System 72 (1)
Therapeutic Electrical Stimulation System 73 (14)
Signal Generator 74 (1)
Applied Stimulus 75 (1)
Constant Current versus Constant Voltage 75 (1)
Stimulus Parameters 75 (2)
Time-Dependent Parameters 77 (1)
Frequency-Dependent Properties 78 (1)
Amplitude-Dependent Properties 79 (1)
Current Modulations 80 (3)
Computation Method for Describing Current 83 (1)
Flow
Electrode Systems 83 (1)
Types of Stimulating Electrodes 83 (1)
Size of Stimulating Electrodes 84 (1)
Orientation of Stimulating Electrodes 85 (2)
Relationship between the Physiologic 87 (1)
Properties of Excitable Tissue and the
Properties of the Stimulation System
Electrical Safety 87 (12)
Definition of Electrical Hazards 89 (1)
Hazards of Alternating Current 90 (1)
Hazards of High Frequency AC 91 (1)
Hazards of Direct Current 91 (1)
Grounding and Ground Faults 91 (1)
Leakage Current 92 (2)
Methods of Patient Isolation 94 (2)
Guidelines for Evaluation of the Safety 96 (1)
of Electrodiagnostic and
Electrotherapeutic Devices
Clinician's Responsibilities 96 (1)
Routine Maintenance 96 (1)
Oscilloscope Verification of Signal 97 (1)
Characteristics
Other Safety Measures 98 (1)
Use of Operator's Manuals 98 (1)
Manufacturer's Responsibilities 98 (1)
The Role of Biomedical Engineering 99 (1)
Summary 99 (1)
References 100(1)
Electrical Evaluation of Nerve and Muscle 101(48)
Excitability
Charlene Nelson
Historical Review 101(1)
Neurophysiologic Principles of Electrical 102(1)
Evaluation
Contraindications and Precautions 102(1)
Traditional Clinical Electrical Evaluation 103(8)
Tests
Reaction of Degeneration Test 103(1)
Indications for Reaction of Degeneration 104(1)
Testing
Case Study 1, JL 105(1)
Strength-Duration Curve and Chronaxie Test 105(3)
Indications for S-D Curve and Chronaxie 108(1)
Testing
Case Study 1, JL (continued) 109(1)
Galvanic Twitch-Tetanus Ratio Test 110(1)
Nerve Excitability Test 111(1)
Contemporary Electrical Evaluation 111(30)
Techniques
Nerve Conduction Tests 112(1)
Motor Nerve Conduction 113(4)
Indications for Motor Nerve Conduction 117(1)
Testing
Case Study 1, JL (continued) 117(1)
F-Wave Nerve Conduction 118(3)
Neuromuscular Junction Transmission: 121(2)
Repetitive Stimulation Test
Sensory Nerve Conduction 123(3)
Case Study 1, JL (continued) 126(1)
H Reflex Response 126(2)
Clinical Evoked Potentials 128(1)
Somatosensory Evoked Potentials 129(2)
Visual Evoked Potentials 131(1)
Auditory Evoked Potentials 131(1)
Clinical Electromyography (EMG) 132(2)
Normal EMG 134(1)
Abnormal EMG 134(5)
Indications for Electromyographic 139(1)
Evaluation
Case Study 1, JL, (continued) 139(2)
Cotraindications and Precautions for 141(1)
Electromyographic Evaluation
Planning a Clinical Electrical Evaluation 141(3)
Case Study 2, LMD 142(2)
Summar 144(1)
References 144(4)
Suggested Readings 148(1)
Transcutaneous Electrical Nerve Stimulation 149(48)
(TENS) for Management of Pain and Sensory
Pathology
Meryl Roth Gersh
Biophysical Principles 150(2)
Clinical Applications of TENS 152(16)
Acute Pain Conditions 152(1)
Postoperative Incisional Pain 152(4)
Orthopedic Pain 156(1)
Pain of Gynecologic Origin 157(2)
Orofacial Pain 159(1)
Chronic Pain Conditions 160(1)
Low-Back Pain 161(1)
Arthritis 162(1)
Osteogenesis 163(1)
Pain of Neurologic Origin 163(2)
Additional Clinical Applications 165(1)
Circulatory Facilitation 165(1)
Angina Pectoris 166(1)
Headache 167(1)
Microcurrent for Pain Control 167(1)
Considerations for Application 168(15)
Electrode Systems 168(1)
Determination of Electrode Placement 168(2)
Selection of Preferred Stimulation Sites 170(1)
Modes of Stimulation 171(1)
Waveform 171(2)
Stimulus Parameters 173(1)
High Rate Conventional TENS 173(1)
Low Rate Acupuncturelike TENS 174(2)
Brief Intense TENS 176(1)
Patient Evaluation 176(3)
Application of TENS 179(2)
Recommendations for Home Programs 181(2)
Contraindications and Precautions 183(1)
Adverse Responses to TENS 183(1)
Factors Affecting Response to Treatment 184(7)
Placebo Response 184(2)
Other Factors 186(1)
Case Study 186(3)
A Look toward the Future 189(1)
The Clinician 189(1)
The Industry 189(1)
The Researcher 190(1)
Summary 191(1)
Appendix: Manufacturers' Addresses for 191(1)
Table 5 -- 3
References 191(6)
Sugested Readings 196(1)
Electrotherapeutic Alternatives for the 197(21)
Treatment of Pain
Luther C. Kloth
Biophysical and Electrophysiologic 198(4)
Principles
Low and High Voltage Devices 198(3)
Modes of Stimulation 201(1)
Low Voltage Current Alternatives to 202(8)
Traditional TENS
Interference Current (IFC) 202(3)
Transcutaneous Electrical Stimulation of 205(1)
Acupuncture Points
Impulse Currents 206(1)
Diadynamic Currents 207(1)
Alternating Currents 208(2)
High Voltage Pulsed Current (HVPC) 210(1)
Clinical Decision Making 211(3)
Contraindications and Precautions for 212(2)
Electrical Stimulation for Pain Control
A Look toward the Future 214(1)
Summary 214(1)
References 215(3)
Neuromuscular Electrical Stimulation (NMES) 218(51)
in Rehabilitation
Julie DeVahl
Historical Perspective 218(3)
Neurophysiologic Effects of NMES 221(3)
Physiologic Changes in Muscle Following 223(1)
Stimulation
Animal Studies 223(1)
Human Studies 223(1)
Principles of Application 224(9)
Electrode Systems 224(1)
Types of Electrodes 224(1)
Electrode Size and Placement 224(2)
The Electrical Stimulus 226(1)
Polarity 226(2)
Waveforms 228(1)
Amplitude (Intensity) 228(1)
Phase Duration 228(1)
Frequency (Pulse Rate) 229(1)
Duty Cycle 230(1)
Ramp Time 231(1)
Patient Safety Guidelines 231(2)
Clinical Applications 233(25)
Disuse Atrophy 234(3)
Range of Motion 237(2)
Muscle Re-education and Facilitation 239(3)
Spasticity Management 242(2)
Orthotic Substitution 244(1)
Gait Training 244(1)
Idiopathic Scoliosis 245(4)
Shoulder Subluxation 249(2)
Augmentation of Motor Recruitment in 251(1)
Healthy Muscle
Low Voltage, Low Frequency NMES 251(1)
Medium Frequency NMES 252(1)
Training Intensity 253(1)
Fatigue