BPA Unit 7: E-Stim for Functional Activities

Question 1

How are NMES and FES used with patients with Neurological conditions?

Answer 1

NMES: Used to activate intended muscles via intact motor neurons
FES: Is the use of NMES to promote functional activities

Question 2

What are the Indications of using NMES with patients with Neurological conditions?

Answer 2

• Muscle strengthening
• Increased ROM
• Decrease spasticity
• Decrease urinary incontinence

Question 3

What are the Considerations for using NMES to increase ROM?

Answer 3

• Parameters should be set to follow the stretching principles: low load and prolonged application
• Parameters should be set to minimize fatigue due to longer application goal: Low frequency and amplitude

Question 4

What are the Considerations for using NMES to decrease Spasticity?

Answer 4

• Applied in the antagonist of the agonist spastic muscle – reciprocal inhibition.

OR

• Applied directly to the spastic muscle by fatiguing the muscle or by providing recurrent inhibition by Renshaw cells

Question 5

What are the most common indications of using FES?

Answer 5

• Shoulder subluxation
• UE function
• Foot drop
• Gait
• UE and LE cycling

Question 6

With NMES and FES, what should we instruct the patient?

Answer 6

Instruct the patient:
- Purpose and procedure.
- explain the anticipated sensation and effect of the stimulation.
- explain that you need a strong muscle
- Make a familiarization session to familiarize the patient with the electrical stimulation sensation.
- E. Stim in Kids - you must distract them with a game, video, or other activity.

Pre-inspection:
- Intact skin and sensation

Question 7

With NMES and FES, what should we monitor during treatment, and what should be done post-treatment?

Answer 7

Treatment monitoring:
- Monitor the patient’s response to treatment
- Adjust the amplitude if needed
- Obtain patient feedback regarding the sensation and strengthening of muscle contractions.
- Patients with cognitive deficits need additional supervision, removing and adding the electrodes once or twice during treatment to check the skin may be required.

Post-inspection:
- Inspect the skin after removing the electrodes
- Make sure there is no skin irritation or adverse effects.
- Slight redness is normal and may disappear in 24 hours