Innovating Instructional Unit on Electrotherapy
Juliann Plimpton
Educational Practice and Innovation
Dr. Wilcox
June 17th, 2011
Textbook:
Knight, K. L., & Draper, D. O. (2008). Therapeutic Modalities: The Art and Science. Baltimore:
Lippincott Williams & Wilkins.
Class: Therapeutic Modalities
Level: College: Second Year Athletic Training Students
Standard: Electrotherapy as a modality that aids in healing and rehabilitation of athletic injuries
Indicator:
1. Students identifies electricity
2. Students identify types of electrostimulation
3. Students demonstrate how each type of stimulation affects the body
Objectives
a.
b.
c.
d.
e.
f.
Assessment of how electricity works
Explains how it affects the body
Apply modalities in a given situation
Be able to compare and contrast the types of electrostimulation
Correctly set up each modality correctly
Underline key components of each modality
Day 1: Chapter 9: Principles of Electricity for Electrotherapy
Class: Therapeutic Modalities
Unit: Electrotherapy
Level: College. Second Year Athletic Training Students
Standard: Electrotherapy as a modality that aids in healing and rehabilitation of athletic injuries
Indicator:

Students identify and comprehend electricity
Objectives:
a. Assessment of how electricity works
b. Compares different types of current
c. Explains tissue response to E-stim
I.
At the beginning of the semester a syllabus was given out regarding tasks students must
perform. For each unit covered, the students must write a 2-3 page reflection paper on
any modality covered in the unit. They must summarize the paper and the paper must be
of primary research. It must be in MLA format. The student will then present their
findings to the class. It is also important to note this class takes place three days a week.
II.
Prior to class the chapter should have been read
III.
Start class with a demonstration
a. Materials:
i. Six balloons
ii. Six different groups
iii. Battery
iv. Light bulb
v. Covered copper wire
b. The demonstration:
i. Students will get into groups of six
ii. Students will blow up their balloons
iii. Students will rub balloon on each other’s heads and see what happens
iv. This part demonstrates electrical components of electricity.
v. I will then tell then to touch a door knob or another person. Ideally the
student should feel a shock, this demonstrates static flow of electricity
vi. To further my demonstration of flow of electricity I will ask the physics
department for a battery, light bulb, copper wire to create a circuit. If not
these can easily be bought at a store.
vii. I will place the copper wire on the positive and negative terminals of the
battery. I will then connect the wire to a light bulb.
viii. Have students get back in their seats
IV.
Lecture using a PowerPoint- To make sure communication is taking place I must
allow enough time between slides for the students to take good notes. I cannot go too
slow or too fast. I need to make sure that I am making eye contact with the students to
see if I am reading any confusion with the subject matter. The PowerPoint with
include:
a. Basics of Electricity
i. Define electricity using the text but then other sources like Webster
dictionary or a physics book
ii. Two types of electricity: static and current as demonstrated at beginning of
class.
1. Discuss two types of current:
a. Direct Current: steady and continuous, unidirectional flow
of electrons
b. Alternating Current: continuous flow of electrons that are
rhythmically changing directions
iii. Current flow and Ohm’s Law
1. Current=force/resistanceamp(A)=volt(V)/ohm(Ω)
b. Electrical Equipmenti. The generator: converts some other form of energy into AC current or a
medical device that converts an input electrical current into various output
currents
ii. Define terminals, electrical circuits, closed and open circuits
iii. Two classes of electrotherapy devices used for rehab
1. Neuromuscular electrical stimulator (NMES)- delivers current to
the body to cause sensory and motor nerve depolarization
2. Transcutaneous electrical nerve stimulator (TENS)- causes sensory
nerve depolarization
iv. Mention safety devices: circuit breakers and ground-fault interrupter
c. Generation of Electricity
i. Why is it important to understand how electricity it generated?
1. Understanding the different processes, thermal, chemical,
mechanical, and solar, will help you understand current flow and
the therapeutic use of electrical current.
ii. Chemical generation- battery
1. Plate put in a solution
2. Causes a chemical reaction, electrons are liberated from one plate
and go to other plate
3. Wire attached causes a flow of electrons
4. Discuss figure 9.4 to illustrate how it works
5. Then show a YouTube video of how a battery works
http://www.youtube.com/watch?v=CJK2kwF6Am4
6. Wet cell battery: consists of two metals and an electrolyte solution
7. Dry cell- use electrolyte paste instead of a solution
iii. Mechanical Power Generation
1. Relates to electricity and magnetism- a force is produced when a
substances ionizes molecules polarity. This causes the positive end
to line up in one direction and the negative to line up in the other
direction. Creating a magnetic field
2. Electromagnetic Induction-
a. When a coil of insulated wire is moved towards or away
from a magnet, electricity flows in the wire. This also
creates a magnetic field around the wire.
b. Conversion of mechanical to electrical and electrical to
mechanical
3. Alternating Current Terms
a. Impulse-the portion of a graph representing current flow
from the baseline to the maximum in one direction and
back to the baseline
b. Cycle- two impulses- represents electron flow during the
time the magnet rotates 360
c. Frequency- The rate of passage of crests on a wave form.
Expressed as cycles per second
iv. Output Current Characteristic
For this part of the PowerPoint it will be mostly of slides of the
different characteristics current can have. I will show pictures of these
characteristics and describe each one to the students. Terms they will
need to know are: pulse, phases, phase duration, amplitude, and wave
forms.
v. Tissue Response to Electrical Stimulation
1. Four types of response in tissue: thermal, chemical, magnetic, and
kinetic. Thermal talked about in later chapter
2. Chemical effects: driving ions into the body.
a. Early proof of this working was done by LeDuc.
b. The experiment was cutting holes in a potato and filling the
holes with potassium iodine. After this he put wires at each
end of the potato and connected them to a battery. When
the DC current passed through the potato it attracted the
ions. The positive K ions to the negative and the negative
ions from the iodine to the positive end.
c. He also did this with rabbits- explain to the class how
d. Discuss how ions migrate
e. Iontophoresis- Uses DC current for transporting negatively
and positively charged ions from drug solution into the
patients tissue
3. Magnetic Effects on Tissue
a. Not much is known about the magnetic affects on tissue
4. Kinetic Effects
a. Sensation and muscle contraction
b. Affects the polarization and action potential of muscles
fibers. For nerves to be stimulated they have to be
polarized. Ions allow this to happen when there is an
unequal balance between the inside and outside of a
membrane.
i. Polarization occurs with active transport of Na ions
across a membrane when polarized membranes
have an electrical potential
ii. Stimulation causes the membrane to depolarize a
rush and exchange of positive and negative ions
occur across the whole membrane causing tissue
depolarization this is known as an action potential
iii. YouTube video to show an action potential
http://www.youtube.com/watch?v=SCasruJT-DU
iv. Can be nerve or muscle action potentials- goes
across the synapse, stimulates postsynaptic nerve or
muscle cell
v. Fibers:
1. A: largest and conduct AP the fastest some
are sensory and others are motor
2. B: middle size, autonomic motor nerves
3. C: smallest and slowest, sensory
vi. Discuss tissue resistance with classic current
density, motor points,
V.
vi. Electrodes:
1. Types
2. Physical Characteristics
3. Cross-contamination
4. Electrode function
5. Placement technique
6. Polarity
vii. Therapeutic Uses of Electrical Stimulation
1. Ion Migration
2. Sensory Twitch
3. Fused Response
4. Twitch contraction
5. Tetanic contraction
Homework
a. Chapter Reflection- Listed below
b. Read Ch. 10: Application Procedures: Electrotherapy
Reflection Questions from Day 1 of Chapter 9
1. Why is there confusion about the therapeutic use of electrical current?
There is a lack of communication about the therapeutic understanding of the
modality. For a long time there was no common language associated with the
therapeutic use of electrical current. With the establishment of a common language
we can better understand how to use it
2. Give three examples of why an understanding of chemistry and physics is important for
understanding electricity.
Having an understanding of chemistry and physics is important for understanding
electricity because as we have seen electricity is something we use in the athletic
training profession. Part of the study of physics is using electricity, knowing how it
works and how to construct circuits that produce electricity. For chemistry it is
important to understand chemical compounds that are conductors of electricity.
3. Explain the relationship between electricity and magnetism.
The relationship between electricity and magnetism was discovered by faraday. He
found that when a coil of insulated wire was moved toward or away from a magnet,
electricity flowed through the wire. When electricity moved through the wire it also
created a magnetic field. This is known as electromagnetic induction.
4. Summarize how electricity is generated and converted.
Electricity is the process of converting another form of energy into electrical energy.
There are two types of electrical generation: chemical and mechanical. Chemical is
mostly seen with batteries. With a battery two metal plates are placed into an ionized
solution. When a wire connected the two different rods, there is a flow of electrons
between the rods and it creates a current. Mechanical electricity is generated on the
relationship between electricity and magnetism.
5. Define each of the following as they apply to electrical stimulation: impulse, cycle,
frequency, pulsed current, current modulation, phase, phase duration, phase shape, pulse,
monophasic pulse, biphasic pulse, polyphasic pulse, phase change, pulse change, pulse
symmetry, burst, interpulse interval, period, pulse rate, duty cycle, amplitude, peak current,
and average current.
6. Describe LeDuc’s experiments, and explain their relevance to electrical stimulation
Cut a hole in a potato and filled it with KI which K is positive ions and I is negative
ions. They stuck wires into either ends and attached them to a battery. Found that the
ions were attracted to the positive and negative poles of the potato. With rabbits same
thing expect he used KCN which is poisonous. Ran it through the rabbits and it killed
them. This is important to electrostimulation because we discovered with this that
drugs can be administered through the skin.
Day 2
Class: Therapeutic Modalities
Class: Therapeutic Modalities
Unit: Electrotherapy
Level: College. Second Year Athletic Training Students
Standard: Electrotherapy as a modality that aids in healing and rehabilitation of athletic injuries
Indicator:

Students identify types of electrostimulation
Objectives
a. Be able to compare and contrast the types of electrostimulation
b. Underline key components of each modality
I.
II.
III.
Students will break off into groups and discuss the opening scene on page 153 with the
questions: Why should we care, as athletic trainers, if the parameters are correct or not
when treating an injury? What risks do you have in not using a modality correctly on a
patient? What would prevent the set up of wrong settings?
a. Scene from book: Jose, a clinic director, is reviewing the day’s treatment forms
after an unusually busy day. Patients have come in for the treatment of acute and
chronic pain, muscle spasms, and acute and chronic edema and for the prevention
of postoperative muscle atrophy. In fact, a soccer player has even been in for
treatment of a slow-healing strawberry (abrasion) on her thigh caused by sliding
on the turf in a game. Jose noticed that when the staff used electrotherapy for
these conditions, they often chose the wrong parameters. He decided it is time for
a refresher course on standard operating procedures for electrotherapy modalities.
Lecture using PowerPoint and provide PowerPoint handouts so students can take notes on
Ch. 10. I plan on doing this class in the athletic training room instead of in the classroom.
PowerPoint
a. Overview
i. It is important to understand that electrotherapy modality may work for a
certain indication but it might not be the best modality to treat the
indication.
ii. Standard Operating Procedures
1. TENS for pain relief
2. IFC for pain relief
3. NMES muscle reeducation, preventing disuse atrophy, decreasing
muscle spasm, and decreasing edema
4. Iontophoresis for transcutaneous drug delivery
5. High-volt pulsed current stimulation for wound healing and edema
b. Transcutaneous Electrical Nerve Stimulation (TENS)
i. Uses surface electrodes to deliver a pulsed electrical current through the
skin to stimulate nerves for the purpose of controlling and relieving pain.
ii. Physiological Effects of TENS
1. Is selective depolarization of afferent nerves it changes the
patients perception of acute and chronic pain
iii. TENS Modes
1. Sensory TENS: treat acute pain by stimulating large-diameter
sensory nerves
a. 80-200pps
b. Reports buzzing or tingling traditional TENS
2. Motor TENS: treat chronic pain by stimulating small-diameter
afferent nerves
a. 1-5pps higher intensity then sensory
b. Reports burning, needling sensation, and a slight muscle
twitch
3. Brief-intense TENS: Treat chronic pain before rehab by
stimulating C fibers
a. Beat frequency varies between low and high
b. Reports burning, needling sensation, and twitch and titanic
muscle contraction
iv. How TENS Works
1. Pain modulation achieved either through the gate control theory or
they opiate system
v. Research on TENS
vi. Making TENS Therapy more effective
1. Do not treat all your patients the same
2. Be flexible
3. TENS by itself is not a cure for pain
c. Interferential Current Therapy for Pain Relief (IFC)
i. Application of two separate medium-frequency sinusoidal currents of
different frequencies to the same area
ii. Theory of IFC Therapy
1. Lower frequency electrical stimulation of muscle and nerve tissue
causes less pain
iii. Using IFC Therapy
1. Used for pain relief can be used for edema control, muscle
reeducation, and bone stimulation
2. Covers a large area
3. Uses two channels carrier and beat frequency
4. Electrodes are crossed creating a vector
a. Static vector
b. Dynamic vector
iv. Effectiveness of IFC Therapy
1. Increase blood flow
2. Good with chronic injuries
d. Neuromuscular Electrical Stimulation (NMES)
i. Eliciting a muscle contraction with electrical currents
ii. Used for
1. Muscle reeducation
2. Preventing atrophy
3. Decreasing muscle spasm
4. Decreasing edema
iii. Give history
iv. Effects on reeducation used on patients that can’t create a voluntary
muscle contraction
v. Effects of NMES on injured muscles
1. Depolarization of alpha-motor neuron causes muscles to
involuntarily contract
2. After doing repeatedly, the CNS receives and processes afferent
feedback from muscle
3. Improves patients proprioception and visual sense of motion
4. Patient relearns
5. Must isometrically contract his muscle during stimulation why?
vi. Avoid replacing strength training with NMES why?
vii. NMES for decreasing muscle spasm
1. Define spasm
2. Break pain-spasm pain cycle
3. Increase local circulation
4. Remove metabolic wastes
5. Mechanically stimulate muscle fatigue
viii. Decreased edema
e. Iontophoresis
i. Driving – or + charged ions of a drug solution into a patients skin
ii. Like charges repel so drug ions are pushed or repelled into tissue via direct
current
iii. Positively charge electrode delivers + charged drug into the skin
iv. Negatively charge electrode delivers – charged drug into skin
v. Benefits of Ionto
1. Reduces pain and inflammation
vi. Drug ions used in orthopedic medicine
1. Dexamethasone (- ion): reduces inflammation by inhibiting
biosynthesis of prostaglandins
2. Acetate (- ion): Helps dissolve calcium deposits and scar tissue in
muscle and tendons
3. Hydrocortisone (+ ion): helps decrease tissue inflammation by
inhibiting the biosynthesis of prostaglandins and other substances
4. Lidocaine (+ ion): helps decrease local pain by blocking nerve
impulse transmission
vii. Negative effects of using ionto
1. Skin irritation
IV.
2. Mast cells could release histamine
3. Redness and hives
f. High-Volt pulsed current stimulation
i. Twin-peak, monophasic, pulsed current, use – or + polarity
ii. Used for:
1. Wound management
2. Edema
3. Muscle reeducation
4. Pain modulation
iii. Characteristics
1. Generates 150-500 V
2. Twin peak
3. Pulse rates of 1-200Hz
iv. Allows for one to select the polarity
v. Wound management
vi. How HVPC stimulates wound repair
1. Increase natural healing process by increasing tissue regeneration
by increasing bioelectricity of the muscle cells
vii. HVPC for Edema management
1. Used to curb edema formation and resolving edema once it is
found
2. Go over what edema is
viii. HVPC for muscle reeducation and spasm reduction
1. Not as good as NMES because it is at a low-volt stimulators
2. Involve high-frequency, high-amplitude, surged stimulation that
generate a tetanic contraction
g. Microcurrent Electrical Nerve Stimulation
i. Therapeutic use of constant and pulsed current in which the stimulus
amplitude is in microamperage range
ii. Theory behind it: injured cells from skin, nerve, and muscle are theorized
to posses their own injury current in the microamperage range that might
play a role in healing the injury, thus an electrical signal applied to an
injury site may enhance the injury process
iii. Effectiveness of MENS
1. Pressure ulcers
2. Diabetic ulcers
3. TMJ disorders
Homework
a. Hand out persuasion map. Direct attention to graphic organizer. Read the
directions to them; give them an example of how I want it done. Ask if anyone
has questions. Homework due next class period. See next page for the graphic
organizer.
b. Make sure students read all the application processes covered in Ch. 10. This is
important for the next class periods lab
NAME:__________________________________________________ Date:________________
Write the modalitiy you least understand in the goal box. Your objective is to prove that this
modality is more effective than any of the other modalities at treating its indication. You will
provide three reasons and explain each reason.
Explain 1
Reason 1
.
Explain 2
.
Reason 2
Explain 1
.
Modality
.
Explain 2
Reason 3
Explain 1
Day 3
Class: Therapeutic Modalities
Level: College. Second Year Athletic Training Students
Standard: Electrotherapy as a modality that aids in healing and rehabilitation of athletic injuries
Indicator:


Students identify types of electrostimulation
Students demonstrate how each type of stimulation affects the body
Objectives
a.
b.
c.
d.
Apply modalities in a given situation
Be able to compare and contrast the types of electrostimulation
Correctly set up each modality correctly
Underline key components of each modality
I. Start with a pop quiz- write the quiz (5pt questions short answer)
1. Students will walk in to the class and take their seats. At this time I will give
direction for them to clear their desks. The students will have 10 minutes to
complete their quiz and hand it in to me. (see next page for quiz outline and
answers)
2. Pop quiz is subject to cover everything lectured in the previous class as well as
what was assigned for that class period
II. Work book assignments to take students through how to apply and fully understand how to
use each modality (see additional pages) activities in the book: 4-6,8,9
a. Make sure they understand pad placement
b. Give scenarios in which they have to correctly pick the modality and defend why
they pick the modality.
c. Partner up 2 or 3 to a group
d. Make sure the indication, contraindications, and precautions are understood while
applying the pads
NOTE: It is the student’s responsibility if they do not finish the activities in class
to finish it on their own. I will have stressed with the class at the beginning of the
semester that the syllabus states that all activities are due prior to the final exam.
I will remind the class of this before starting the lab as well as when they leave
the class.
Quiz on Chapter 10: Application Procedures:
Electrotherapy
Name:_________________________
1.
Date:____________
Give two of the three contraindications for ICF electrotherapy (2 pts)
Answer: 1.) Do not use on a person who has an implanted pacemaker or a history of
heart disease. 2.) Do not treat the transthoracic area. 3.) Discontinue use if a skin
irritation develops.
2.
What do athletic trainers primarily use NMES for and describe how this increases
proprioception, kinesthetics, and sensory input? (2pt)
Answer: Although NMES has several functions in electrotherapy rehab, it’s
primarily used for muscle reeducation. It increases proprioception, kinesthetics, and
sensory input within the muscle by depolarizing the α-motor neurons causing an
involuntary contraction. After several repeated contractions the CNS receives and
processes afferent feedback from the muscle. The athletes then can start relearning
motion.
3.
Lidocaine is a _______
Answer: Positive Ion
________ orthopedic medicine? (1 pt)
Lab: Unit IV: Electrotherapy
Activity 4
Electrical Stimulation Electrode Application Parameters
Textbook Reference: Part IV, Ch. 9-10
Name:_____________________________
CONTEXT
Many parameters affect electrical stimulation, and the way that electrodes are applied influence those parameters.
PURPOSE
Your objective is to compare the sensation of and muscular contraction during various neuromuscular electrical
application stimulation parameters.
MATERIALS


An electrical neuromuscular stimulation unit
A pair of bipolar electrodes
DIRECTIONS
1.
2.
3.
4.
5.
Using bipolar electrodes, firmly attach one electrode on one forearm. Lay the second electrode on the table
with the active side up.
Place the palm of your hand firmly on the second electrode.
Set up
a. Wave form: Bipolar
b. Frequency: 2-3 cps
Increase the output intensity until you feel a moderate current.
Explore the following. Return to the above conditions after each activity so that each activity begins the
same way.
a. Current density- slide your hand from the second electrode until only the tip of your index finger
is in contact with the electrode. How did the current sensation change at the forearm and at the
finger? Why? Would this still be considered a bipolar application?
b. Effect of the pulse rate- gradually increase the pulse rate until you invoke a titanic contraction, and
then decrease to 2-3 cps. At what pulse rate did you feel the strongest contraction.
c. Electrode application- (you must have non-adhesive electrodes for this activity). Place your
second forearm on the table.
i. Lay the second electrode on the forearm. Note the current intensity and strength of
contraction
ii. Firmly attach the second electrode to the forearm with an elastic belt or elastic wrap.
Note the current intensity and strength of contraction.
iii. Place a moistened paper towel or sponge on the forearm and then firmly attach the
second electrode to the forearm with an elastic belt or elastic wrap. Note the current
intensity and strength of contraction
iv. How did the current intensity and strength of the contraction change from Step 5. C. (i) to
5. c (iii)? What part of Ohm’s law changed as you progressed through these steps? Why
is it important to firmly attach electrodes?
Lab: Unit IV: Electrotherapy
Activity 5
Finding Optimal Electrode Placement Sites (Motor points)
Textbook Reference: Part IV, Ch. 9-10
Name:_____________________________
CONTEXT
IT IS OFTEN DIFFICULT TO FIND THE BEST PLACE TO APPLY AN ELECTRODE. Many clinicians will
place one on the muscle belly and another distal or proximal to it, only to find very little current flowing through the
area. He/she then has to move the electrode, turn up the intensity and try again. There is a faster, more effective way
to find motor points.
PURPOSE
This lab will assist you in finding the best place to apply electrodes for optimal current flow.
MATERIALS



E-stim unit
Alcohol swabs
Electrodes
DIRESTIONS
1.
2.
3.
4.
5.
Using the alcohol swab, clean the area on your partner where you want to apply the two electrodes.
Apply one electrode on your partner’s muscle belly.
Apply the other electrode to the back of your hand or arm.
Apply a liberal amount of electrode or ultrasound gel to your second and third finger.
Using your second and third fingers, touch the muscles attachment of the muscles you want to stimulate.
(For example, if you want to cause wrist extension, the electrode would be on the wrist extensor’s muscle
belly and you would touch this muscle’s attachment just distal to the lateral epicondyle).
6. Slowly turn up the intensity until you see the muscle twitch
7. Slowly move your fingers around searching for the strongest sensation of contraction.
8. The site of the strongest sensation or contraction is the second motor point
9. Turn the intensity back to zero
10. Attach the second electrode to this spot and slowly turn up the intensity
Questions
1.
2.
What did you learn from this experience?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
What did you have to do to complete the circuit?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Lab: Unit IV: Electrotherapy
Activity 6
Comparing Old and New Reusable Electrodes
Textbook Reference: Part IV, Ch. 9-10
Name:_____________________________
CONTEXT
Many clinicians get into the habit of using self-adhering reusable electrodes well beyond their shelf life. After 7 to
10 uses, these not only lose their adhesive properties but they might also lose the ability to conduct an adequate
current to the patient.
PURPOSE
This lab will help you to realize the importance of using fairly new, properly maintained electrodes.
MATERIALS




E-stim unit
Alcohol swabs
Reusable self-adhering electrodes (same size):
o New
o Used 10 or more times
Chart with the following listed:
o µamps to sensation
o µamps to muscle twitch
o µamps to muscle contraction
DIRECTIONS
1.
2.
3.
4.
5.
6.
7.
8.
9.
Using the alcohol swab, clean an area on your partner where a muscle stimulation unit or TENS might
produce a muscle contraction
Apply two new electrodes of the same size to the area. Attach the electrode to the leads and the leads to the
unit.
Adjust the pulse frequency to 80-100 pps
Slowly adjust the intensity (µamps) until your partner first notice a muscle twitch. Write the µamps on your
chart by muscle twitch.
Slowly adjust the intensity until you and your partner first notice a muscle twitch. Write the µamps on your
chart by muscle contraction.
Slowly adjust the intensity until you and your partner first notice a full muscle contraction. Write the
µamps on your chart by muscle contraction.
Turn the intensity to zero and the unit off. Replace the electrodes with the used electrodes and repeat steps
3-6.
Turn the intensity to zero and the unit off.
Clean off the treatment area and put the unit away.
Questions:
1.
2.
What did you learn from this experience?
______________________________________________________________________________________
How can you apply what you have learned in your future setting?
______________________________________________________________________________________
______________________________________________________________________________________
Lab: Unit IV: Electrotherapy
Activity 8
Iontophoresis to Reduce Scar Tissue/ Adhesions
Textbook Reference: Part IV, Ch. 9-10
Name:_____________________________
CONTEXT
Acetic acid is used with iontophoresis to soften scar tissue. This might be difficult to demonstrate on a student
without scar tissue. One possible way might be by using a substance very close to acetic acid- vinegar.
PURPOSE
The objective of this lab is to demonstrate the procedure used to deliver vinegar via iontophoresis and determine
whether this will soften calluses.
MATERIALS







Iontophoresor
Electrodes
Alcohol swab
Pen
Vinegar
Syringe
Cotton swab
DIRECTIONS
1.
2.
3.
4.
5.
With a partner, take a cotton swab and find an area on the palms of the hands or bottom of the feet where
there are some calluses.
a. Probe this area with the cotton swab to determine the hardness of a callus.
b. Clean this area with an alcohol swab.
Use the syringe to extract 1 ml of vinegar from a bottle of vinegar
a. Apply vinegar to the delivery electrode
b. Attach delivery electrode to the skin over and around the callus
c. Attach dispersive electrode about 6’’ away on a fleshy area
d. Attach electrode clips on electrodes and unit
Increase power to patient tolerance
Deliver the treatment dose (10-20 min depending on intensity)
When the machine shuts off:
a. Quickly remove drug delivery electrode
b. Probe the callus with the cotton swab using the same amount of pressure as you did before
c. Clean up the entire area and put the unit away
Questions
1.
2.
3.
Did the callus get softer?
______________________________________________________________________________________
Did the treatment area feel any softer to your partner?
______________________________________________________________________________________
How could you use this technique to help your patients?
Lab: Unit IV: Electrotherapy
Activity 9
Iontophoresis to Produce Numbness
Textbook Reference: Part IV, Ch. 9-10
Name:_____________________________
CONTEXT
Pain relief is a very difficult thing to measure. One possible way is to see how much of an area can be numbed.
PURPOSE
The objective of this lab is to see if iontophoresis with lidocaine can produce numbness of a muscle.
MATERIALS








Iontophoresor
Electrodes
Alcohol swab
Pen
Lidocaine
Syringe
Paperclip
Visual analog or numerical scale
DIRECTIONS
1.
2.
3.
4.
5.
6.
Using a partner, take an alcohol swab and clean an area of the wrist extensors on the muscle of the forearm
about 2’’ distal to the lateral epicondyle.
Open an end of the paperclip.
a. Provide firm pressure on the muscle of the forearm with the paperclip, mark this spot with a pen.
b. Have your partner rate how much pain he/she experienced using the VAS or numerical scale
Use the syringe to extract 1 ml of lidocaine from the bottle.
a. Apply lidocaine to the delivery electrode.
b. Attach delivery electrode to the skin when the pen mark is.
c. Attach dispersive electrode about 6’’ away on the deltoid area.
d. Attach electrode clips on electrode and unit (positive delivery method).
Increase power to patient tolerance.
Deliver the treatment dose (10-20 min. depending on intensity)
When the machine shuts off:
a. Quickly remove drug delivery electrode
b. Apply the same amount of pressure with the paperclip as you did before
c. Have your partner rate how much pain they are now experiencing using the VAS or numerical
scale
Questions
1.
2.
Did the area decrease in sensation from the treatment?
______________________________________________________________________________________
______________________________________________________________________________________
How could you use this technique to help your patients?
______________________________________________________________________________________
______________________________________________________________________________________
Day 4- Day 5
Class: Therapeutic Modalities
Level: College. Second Year Athletic Training Students
Standard: Electrotherapy as a modality that aids in healing and rehabilitation of athletic injuries
Indicator:
4. Students identifies electricity
5. Students identify types of electrostimulation
6. Students demonstrate how each type of stimulation affects the body
Objectives
g.
h.
i.
j.
k.
l.
Assessment of how electricity works
Explains how it affects the body
Apply modalities in a given situation
Be able to compare and contrast the types of electrostimulation
Correctly set up each modality correctly
Underline key components of each modality
I.
Students were given an assignment. The assignment was to use primary research to
summarize any article of choice pertaining to electrostimulation. Rubric was given to the class
on the requirements of the 2-3 page paper. The students are also to report their findings to the
rest of the class. Each presentation should be about 10-15 minutes in length.
II.
Rubrics will be on the next few pages.
Research Report: Electrotherapy Research Paper
Student Name:
________________________________________
4
3
2
1
Organization
Information is very
organized with wellconstructed
paragraphs and
subheadings.
Information is
organized with wellconstructed
paragraphs.
Information is
organized, but
paragraphs are not
well-constructed.
The information
appears to be
disorganized. 8)
Amount of
Information
All topics are
addressed and all
questions answered
with at least 2
sentences about
each.
All topics are
addressed and most
questions answered
with at least 2
sentences about
each.
All topics are
One or more topics
addressed, and most were not addressed.
questions answered
with 1 sentence
about each.
Quality of
Information
Information clearly
relates to the main
topic. It includes
several supporting
details and/or
examples.
Information clearly
relates to the main
topic. It provides 1-2
supporting details
and/or examples.
Information clearly
Information has little
relates to the main
or nothing to do with
topic. No details
the main topic.
and/or examples are
given.
Paragraph
Construction
All paragraphs
include introductory
sentence,
explanations or
details, and
concluding sentence.
Most paragraphs
include introductory
sentence,
explanations or
details, and
concluding
sentence.
Paragraphs included
related information
but were typically not
constructed well.
Mechanics
No grammatical,
spelling or
punctuation errors.
Almost no
A few grammatical
grammatical, spelling spelling, or
or punctuation errors punctuation errors.
Many grammatical,
spelling, or
punctuation errors.
Sources
All sources
(information and
graphics) are
accurately
documented in the
desired format.
All sources
(information and
graphics) are
accurately
documented, but a
few are not in the
desired format.
Some sources are
not accurately
documented
CATEGORY
Source: Rubistar www.rubistar.4teachers.org
All sources
(information and
graphics) are
accurately
documented, but
many are not in the
desired format.
Paragraphing
structure was not
clear and sentences
were not typically
related within the
paragraphs.
Oral Presentation Rubric: Electrotherapy Research
4
3
2
1
Enthusiasm
Facial expressions
and body language
generate a strong
interest and
enthusiasm about
the topic in others.
Facial expressions
and body language
sometimes generate
a strong interest and
enthusiasm about
the topic in others.
Facial expressions
and body language
are used to try to
generate
enthusiasm, but
seem somewhat
faked.
Very little use of
facial expressions or
body language. Did
not generate much
interest in topic
being presented.
Attire
Business attire, very Casual business
professional look.
attire.
Casual business
attire, but wore
sneakers or seemed
somewhat wrinkled.
General attire not
appropriate for
audience (jeans, tshirt, shorts).
Preparedness
Student is
completely prepared
and has obviously
rehearsed.
Student seems
pretty prepared but
might have needed a
couple more
rehearsals.
The student is
Student does not
somewhat prepared, seem at all prepared
but it is clear that
to present.
rehearsal was
lacking.
Listens intently but
has one distracting
noise or movement.
Sometimes does not
appear to be
listening but is not
distracting.
Sometimes does not
appear to be
listening and has
distracting noises or
movements.
CATEGORY
Listens to Other Listens intently.
Does not make
Presentations
distracting noises or
movements.
Time-Limit
Presentation is 5-6
minutes long.
Presentation is 4
minutes long.
Presentation is 3
minutes long.
Presentation is less
than 3 minutes OR
more than 6 minutes.
Speaks Clearly
Speaks clearly and
distinctly all (10095%) the time, and
mispronounces no
words.
Speaks clearly and
distinctly all (10095%) the time, but
mispronounces one
word.
Speaks clearly and
distinctly most ( 9485%) of the time.
Mispronounces no
more than one word.
Often mumbles or
cannot be
understood OR
mispronounces more
than one word.
Stays on Topic
Stays on topic all
(100%) of the time.
Stays on topic most Stays on topic some It was hard to tell
(99-90%) of the time. (89%-75%) of the
what the topic was.
time.
Posture and Eye Stands up straight,
looks relaxed and
Contact
Stands up straight
and establishes eye
confident.
contact with
Establishes eye
everyone in the room
contact with
during the
everyone in the room presentation.
during the
presentation.
Sometimes stands
up straight and
establishes eye
contact.
Slouches and/or
does not look at
people during the
presentation.
Content
Shows a full
Shows a good
Shows a good
understanding of the understanding of the understanding of
topic.
topic.
parts of the topic.
Does not seem to
understand the topic
very well.
Volume
Volume is loud
enough to be heard
by all audience
members throughout
the presentation.
Volume often too
soft to be heard by
all audience
members
Volume is loud
enough to be heard
by all audience
members at least
90% of the time.
Volume is loud
enough to be heard
by all audience
members at least
80% of the time.
Reflections on five key components
I have found in the few graduate classes I have taken that there are key components that
help educators construct a functioning unit in the classroom. Critical thinking is a very important
component to have when constructing a unit. Critical thinking uses metacognition as a means of
connecting material. In the field of athletic training is it crucial that the athletic training student
make the material covered in the textbook connect to real life. Now if the student doesn’t get this
experience on the field it is my job to make it happen in the classroom. Critical thinking is how I
make the connection from the text to real life. In the syllabus critical thinking is processing
information by actively applying, analyzing, synthesizing, and evaluating. By creating scenarios
that relate to real life situations in a controlled environment I am able to allow the students to
think critically about a situation and understand how important it is in the field of athletic
training. This is why critical thinking is so important when constructing a unit.
As I construct my unit I must consider the ethics behind creating my unit. I think the
easiest way to go about making a unit ethical to the learner is by putting me into their shoes and
reminding me of how they are feeling and thinking. When I do this I find myself being
sympathetic, respectful, honest, and balanced. Students, no matter if it is in a second grade class
or a college class, want to be treated as equals. They don’t want to be looked down on. Some
would argue the possibility of losing control of their classroom by doing this. I think if a teacher
can establish respect that the students will not up rise but rather see it as a chance to be
responsible. It is only in this that they can grow. This is all possible with being ethical. I do have
one principle I question in the syllabus idea of ethical. I question the idea of fairness as ethical.
In my opinion there is no such thing as fairness. The world is a harsh place and I’m not about to
baby my students. Now if fairness is referring to how paper, tests, and student work is evaluated
then I will grade everything on the same scale.
The third important component in construction a unit is leadership. There is nothing I
enjoy more than learning. Learning is one of the most powerful things we can ever give our
students. As mentors/ leaders it is our job to motivate these students to want to learn. In my unit I
plan on motivating my students to want to learn by making it fun. All too often students get to
class and dread it. Now making it fun doesn’t mean I decrease the level of difficulty, but rather
by making it fun the students won’t mind working through the material. For example, in my unit
I plan on combining aspects of physics and basic chemistry. The first day will be introducing
electricity as a means of therapy. Before I can do this I have to make sure the students
understand electricity. I plan on demonstrating simple static electricity between a balloon and a
person’s head. After that I plan on showing the electricity that goes through a ball of electricity. I
will give time for the students to play with the elements. It is my hope this will motivate them.
Another aspect of being a leader in constructing a unit is being able to take responsibility for
your actions and the actions of the students in teaching the unit. It is important that if I see a unit
isn’t motivating the students learning that I make changes to encourage their learning.
One thing I have found in my years of study is that if anyone person lacks
communication skills chances are there will be a misinterpretation of what is wanted and needed.
Communication has always been something I struggle with because of some slight learning
disabilities that I have. It is detrimental that I can communicate my lectures, tasks, and projects
to my class clearly. One way I plan on communicating well with my class is stating rules and
expectations at the beginning of every class. I plan on telling the class the objectives of each
lesson as well as the homework I am assigning to them. I feel one of the best ways to
communicate is through PowerPoint. Not only with the students hear what I am saying but if
they are having a hard time figuring out what I am saying I can show them the words on the
power point screen and then picture to go along with it. One thing that I have adopted from my
professors is using research to communicate the importance of a particular. I know that in my
stubborn ways I sometimes didn’t believe what my teachers were telling me until I did the
research assigned to me. These are ways I plan on communicating to my students in my lesson.
It is my hope that in taking this course and not having a large knowledge of teaching that
I will be able to teach class relevant information to the profession they want to be in. When I
look at my professors, my mentors, I can only hope that I will be as good as they have been to
me.