ELECTRICAL STIMULATION FOR INNERVATED MUSCLES Flashcards by Rai Christiana

Intact peripheral nerves, including the motor
unit and neuromuscular junction

Innervated Muscles

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Innervated Muscles Usually manifests as

disuse atrophy

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Due to peripheral nerve injury

Denervated Muscles

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Denervated Muscles Usually manifests

denervation atrophy

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Use of ES to produce muscle contractions in
innervated muscles

Neuromuscular Electrical Stimulation
(NMES)

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Orthotic Substitution

Functional Electrical Stimulation (FES)

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Type of NMES that specifically enhances the
control of movement and posture

Functional Electrical Stimulation (FES)

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NMES integrated to functional activities

Functional Electrical Stimulation (FES)

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Volitional muscle contractions

Due to
command from upper
motor neurons

Recruits smaller to larger
motor units

Activates
first type I muscle
fibers

Asynchronous
recruitment of motor units

Slow onset of
muscle fatigue

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Electrically induced muscle contraction

Due to applied
electricity stimuli

Recruits larger to smaller
motor units

Activates
first type II muscle
fibers

Synchronous
recruitment of motor units

Rapid onset of
muscle fatigue

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Increase Muscle Strength

Overload principle
Specificity theory
Increased muscle size
Improved motor unit recruitment

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Overload principle

↑ current, ↑ frequency, ↓ pulse duration 🡪
increase externally-applied resistance

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Specificity theory

Targets type II muscle fibers which are reduced
after surgery, immobilization or any pathology

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Increased muscle size

↑ muscle mass usually takes several weeks to
occur

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Improved motor unit recruitment

Occur more rapidly
▪ Synchronized recruitment of more motor units

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Promotes Muscle Re-education

Improvement of motor control
Stimulates brain plasticity

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Therapeutic Effects of NMES& FES

Promotes Muscle Re-education
Inc Muscle strength
Prevents Disuse Atrophy
Reduces Muscle Spasm
Reduces Muscle Spasticity
Reduces Edema

Prevents Disuse Atrophy

Provides externally-induced muscle
contraction to prevent muscle wasting
▪ With adequate muscle strength, it serves as a
biofeedback to promote muscle contraction

Reduces Muscle Spasm

Over both agonist
▪ Fatigue the muscle 🡪 Relaxation

Reduces Muscle Spasticity

Over the antagonist
▪ Reciprocal inhibition of agonist muscle

Over both agonist and antagonist
▪ Sequential stimulation of agonist then followed by
antagonist
▪ Closely mimics normal motor activity or typical
behavior of individuals without CNS dysfunction

Reduces Edema

Through the muscle pumping effect

During Gait Training
For Idiopathic Scoliosis
During Gripping
Activity
For Shoulder
Subluxation’
During Cycling

Functional Electrical
Stimulation (FES

Commonly uses square, balanced, symmetrical,
biphasic PC; some use asymmetrical biphasic PC

Biphasic Pulsed Current

Uses medium frequency AC with a frequency of 2500
Hz delivered in 50 bursts per second

Russian Current

Alternating medium-frequency currents, which are slightly out of phase and amplitude-modulated at low frequency

Interferential Current

Electrode Placement

Active electrode over the motor point and Dispersive electrode about 2-inch away on the same muscle following the orientation of themuscle fiber (preferred) [bipolar if on same muscle; monopolar if on other area] ▪ Face and smaller muscles of the hand: motor point stimulation using a probe/motor pen ▪ Motor point between the 2 electrodes [bipolar] ▪ 4 electrodes over targeted muscle [quadripolar] ▪ Wider spacing 🡪 deeper stimulation

Strengthening Parameters

* Overload principle * Selected recruitment PD: 150-200 μsec (smaller muscles) and 200-350 μsec (larger muscles) A: ≥50% MVIC; maximum tolerated muscle contraction Ramp Up/ Down:At least 2s Freq:20 pps (smaller mms), 30 pps (larger mms), 35-50 pps (smooth tetanic), 50-80 pps (greater strengthening) Treatment: 10-20min (10-20 reps)A On:Off: 1:5 initially 🡪 1:3 🡪 1:1 Ratio: 10-sec on:50-sec off

Muscle Endurance Parameters

↑ contraction time & ↓ rest intervals PD:150-200 μsec (smaller muscles) and 200-350 μsec (larger muscles) Amplitude: 25-50% MVIC Ramp Up/Down: At least 2s Frequency: 30-50 pps TD: More Rep On&Off: 1:1

Motor level Spasticity

PD: 150-200 μsec (smaller muscles)A 200-350 μsec (larger muscles) Amp: At motor threshold; to visible contraction Ramp Up& Down: 0.5-3 s Freq:35-50 pps TD: 10-60 min Ratio: 1:1, 3:4

Sensory Level Parameters

PD: 20-100 μsec Amp:Below motor threshold Freq: 80-100 pps TD: 10-60 min

Muscle Spasms Motor

PD: 150-200 μsec (smaller muscles) 200-350 μsec (larger muscles Amp: At motor threshold; to visible contraction Ramp Up/Down: At least 1 sec Freq: 35-50 pps TD: 10-30 min Ratio: 1:1 (2-5 sec on; 2-5 sec off)

Edema Reduction (Muscle Pump)

PD: 150-200 μsec (smaller muscles) 200-350 μsec (larger muscles) Amp: At motor threshold; to visible contraction Ramp U&D:At least 1 sec Freq: 35-50 pps TD: 30 min Ratio: 1:1 (2-5 sec on; 2-5 sec off)

Duty Cycle

Duty Cycle = [ON ÷ (ON + OFF)] x 100

Channels 1 & 2 produces ON and OFF times together

Synchronous (co-contraction)

While channel 1 is ON, channel 2 is OFF

Reciprocal

Muscle contraction solely relies on electricity

NMES

Contraction produced by both the electrical stimulator and the patient

NMES plus volition

Electricity only serves as feedback for contraction

NMES as biofeedback for motion

Docu

NMES/FES using To < affected muscle > x < pulse frequency > x < pulse duration > x < duty cycle or On & Off time > x < treatment duration > to < rationale >.