E-Stim Spasticity Flashcards
methods of reducing spasticity
NMES to antagonist
NMES to agonist
Reciprocal Stimulation
Sensory Stimulation
what physiological response does NMES to agonist muscle
reciprocal inhibition
what causes reciprocal inhibition to occur on a cellular level
A-motor neurons are stimulated of antagonist muscle group
inhibitory interneurons relax the spastic muscle
discuss ramp time for NMES to antagonist muscle
want to have a slower contraction so that spasticity doesn’t happen
explain the waveform used in NMES to antagonist muscle
symmetrical or asymmetrical biphasic pulsed
OR
Russian
explain the parameters of NMES to antagonist muscle in regards to:
- pulse duration
- frequency
- amplitude
- ramp up/down
- duty cycle
250-500 microseconds
20-60 pps
enough for a 3+/5 contraction
4-5 up and 2-3 down
varies –> consider fatiguing aspect
10-45 min/day
physiological response from NMES to spastic muscles
recurrent inhibition
explain recurrent inhibition
stimulation of motor units in spastic muscles results in Renshaw cells stimulaing
– causes the muscle to relax
waveform used in NMES to spastic muscle
symmetrical/asymmetric biphasic pulsed
OR
russian
protocol for NMES to spastic muscle in regard to:
- pulse duration
- frequency
- amplitude
- ramp up/down
- duty cycle
250-500 microseconds
50-80 pps
enough for a 3+/5 contraction
2-3 up/down
variable - maybe 1:1 for rhythmic contraction
10-45 min/day
main difference in NMES to spastic vs antagonist muscle protocol
frequency
antagonist - 20 to 60 pps
spastic - 50 to 80 pps
spastic has higher PPS because you want fatigue in that muscle, in antagonist you just want a contraction
how many circuits are needed in reciprocal stimulation
2
agonist and antagonist
waveform used in reciprocal stimulation
mono/biphasic waveforms
reciprocal stimulation protocol in regards to:
- pulse duration
- frequency
- amplitude
- duty cycle
300 microseconds
30 pps
tolerable muscle contractions
1:1 duty cycle of 5 sec on/off
explain how sensory stimulation eases spasticity
sensory habituation to a subcontraction stimulus via continuous delivery of higher frequency wavelengths
adjacent treatments for spasticity with e-stim
casting/bracing
immediate stretching of spastic muscle
explain the problems with research for e-stim in spasticity
few control/comparison groups
inconsistencies with:
- treatment of duration
- length of effect
- subjective reporting/measuring of spasticity
explain a muscle spasm
protective muscle reaction in response to pain
causes of muscle spasm
microtrauma
accumulation of metabolic irritants
pain
may increase with anxiety and tension
types of protocol for e-stim treatment of muscle spasms
intermittent
high frequency
explain intermittent e-stim
alternating contract/relax cycles
benefits of intermittent e-stim for spastic muscles
increased local circulation
removal of metabolic irritants
mechanical stimulation to muscle fibers
explain intermittent e-stim protocol
- electrode placement
-pulse duration - frequency
- amplitude
- duty cycle
bipolar electrodes
200-300 microseconds
30-50 pps
comfortable tetanic contraction
1:3 – 5/15
15-20
waveform for intermittent e-stim
biphasic
explain goal of high-frequency stimulation
elicit sustained/continuous contraction of muscle in spasm to fatigue it
what is important to consider when applying high-frequency stimulation
patient tolerance and any ischemia
explain effects of high-frequency treatment
may relieve for several hours after intervention
any adjacent treatments associated with high frequency stimlation
heat/ice
protocol for high frequency e-stim
- pulse duration
- wave form
- amplitude
- duration
200-300 microseconds
continuous
maximal tolerable muscle contraction
variable (15-20 min)
