PT 9539 – Assignment Sept-October 2010

Submit to Dr. PE Houghton

DIRECTIONS: Work in your learning teams to complete this assignment. Attached is a list
of clinical scenarios that describe a practice setting that has an indication for a therapeutic
modality. You have been asked to select an ideal machine that will fulfill your needs. For
EACH of the 5 clinical scenarios listed on the next page, your team must design the best
machine that has an appropriate range of stimulus parameters as well as the key features that
will help you and your patients reach your goals. With your selections be sure to provide
sound rationale to support your decisions (twice as many marks are assigned to reward
appropriate rationale rather than listing specific parameters). Remember unnecessary
features can require more maintenance or complicate patient use. Be specific and request
only what you need. There is often many correct answers for each scenario. Each
assignment should be completed independently within your groups - No comparing answers
between groups.

The chart provided is meant to guide the completeness of your answers. Use additional
paper as required.

The assignment must be handed in by your team at the beginning of class on Thursday
October 14, 2010. This assignment will be taken up in class after all assignments are
handed. Answers will be taken up in class on Oct 14th. No late assignments will be
accepted.
Clinical Scenarios

1. Outpatient Orthopaedic Clinic: You work in a clinic that services clients of orthopaedic
surgeons who perform elective knee surgeries (example: ACL repair). Included in the post
operative rehabilitation protocol is NMES used to improve the rate of recovery of
quadriceps strength. Many of your clients are young athletes wishing to return to sports as
soon as possible. This clinic supports the local high school foot ball team.
Clinical Indication: Muscle strength

2. Stroke Rehabilitation: A regional rehabilitation center where many individuals who have
sustained a stroke undergo their rehabilitation programs. Many individuals are discharged
back into the community with residual motor deficits including hand dysfunction and gait
abnormalities. You wish to provide an out patient service that includes electrical
stimulation that will increase rate of recovery of muscle strength and assist motor function
(hand use and gait speed and coordination). Depending on the clinical scenario, they will
either utilize the machine when they attend the clinic regularly or you may wish to rent the
machine to these individuals on a monthly basis so they can take them home.
Clinical Indication: Muscle re-education

3. WCB Clinic: You are the owner of a private clinic that services a number of clients who
have sustained work related injuries resulting in problems with chronic pain in particular
low back pain. Most of these clients have work related insurance payers that will fund the
cost to purchase a portable electrical stimulation machine. Your role is to select and train
the client on the proper use of the device and to set and adjust the stimulation parameters
that are appropriate for that client.
Clinical Indication: Chronic pain

4. LTC Consultant: You are a Physiotherapy consultant who works in the community and
services a number of local long term care facilities. Many of these facilities have elderly
residents who have chronic wounds of mixed etiology – pressure sores due to limitations in
cognition and mobility and/or leg ulcers due to PVD (mixed venous arterial insufficiency).
You visit the facilities weekly and wish to provide electrical stimulation therapy (EST) to
assist with wound closure. Your role is to train the nursing staff who do regular dressing
changes how to incorporate EST into their wound management program.
Clinical Indication: Improved blood flow and accelerated healing

5. Sports Medicine Clinic: Your clinic is associated with a university athletic department
with many varsity teams. Many therapists use manual and manipulative therapy techniques
to help mobilize joints and restore normal joint movement. Tenderness after your
assessment, your manual adjustments, and after exercise programs is a common symptom
that you wish to manage prior to clients leaving the clinic. Select the best Electrical
stimulation device that would service this clinical setting.
Clinical Indication: Acute pain
Use this chart to describe the best equipment for the clinical scenarios
Range of Available Outputs Rationale for Choice/Decisions
PARAMETER Adjustable/Fixed
WAVEFORM(s)

MODULATION

Pulse
DURATION/Width (us)
Pulse FREQUENCY/Rate
(Hz)
TOTAL POWER High/Medium/Low
(mA, Volts)
RAMP UP (seconds)

RAMP DOWN (seconds)

ON TIME (seconds)

OFF TIME (seconds)

Rx TIME (minutes)
Auto Shut off
No. of Channels
Alternate/ Reciprocal/Sequential
YES/NO
Continuous/Simultaneous
Programmable (save) IF YES, DESCRIBE

Patient Restricted YES/NO

(Locking)
Compliance Meter YES/NO

Auxiliary Input YES/NO

(EMG/Heel switch)
Pre set Protocols IF YES, DESCRIBE
Constant Stim. Button YES/NO

OTHER