Electrical Stimulation for Muscle Re-Education Flashcards
explain the effectiveness of NMES on denervated vs weakly innervated muscles
better efficacy with slightly innervated muscles
can be done on denervated, but there is a specific window
– higher likelihood of injury due to sensory disturbances associated with denervation
explain muscle fiber recruitment when using NMES
type 2 muscle fibers before type 1
what is a precaution regarding fiber type to consider when using NMES
type 2 recruited first
–> will fatigue faster than a normal voluntary contraction
regarding patient positioning, what is something to consider
allow for visual feedback if possible
use length tension relationship to help
do not break any ROM restrictions
when a patient is receiving NMES, explain the tone of muscle necessary
need to be relaxed and not tensed
– will actively fight against the signal of NMES
why does visual feedback matter in ESTIM application
it is an additional sensory input that pairs with an ideal contraction
educates patient on how the intensity of machine relates to a desired motor output
where in the ROM does a muscle need to be during NMES?
relaxed, slacked, mid-range position
- not in a fully lengthened or contracted state
what determines the quality of the muscle contraction
amplitude
pulse duration
frequency
duty cycle
what type of contraction is hoped for during NMES
normal / summative contraction
what does a “balanced” contraction mean
should look like what it would look like when done normally
- proper concentric/eccentric phase in the normal line of pull
what are some tricks to better achieve a balanced, quality contraction
can start on the unaffected side / muscle and see what settings allow for a proper contraction, then move to affected side
— may need more of a stimulus on affected side
explain muscle group size and type of wave form
larger = symmetrical biphasic
smaller = asymmetric biphasic
explain the relationship between mono/biphasic waveforms and polyphasic
mono/bi = more torque and less fatiguing
explain how to set amplitude during NMES
will vary from pt to pt due to resistance/impedance differences, but gradually increase until summative contraction occurs
relationship between amplitude and contraction type
greater amplitude = more tetanic contraction
less amplitude = twitch-like contraction
explain pulse duration and stimulus amplitude relationship
inversely related
– longer duration = less intensity needed for a contraction
what is the general range of pulse duration
200-500 microseconds
pulse rate of NMES
30-85 pps
Dr. Owens says 50-60
explain lower vs higher pulse rates
lower pulse rate = minimization of fatigue but less uncomfortable
higher = more comfortable
explain the process of ramping during NMES
for comfort and best simulation of volitional contraction
generally 2 seconds
ramp down will allow for a controlled eccentric contraction
explain ramp time and spasticity
longer ramp-up times will prevent quick stretch response that induces spasticity
when thinking of duty cycle during NMES treatment, where do we start / how do we progress
start at 1:3/5 on to off
want to progress to 1:1 by end of treatment
what is the max on time for NMES treatment
10 seconds
5-10 is ideal but will depend upon ramp time
on time of >10 seconds has these effects
fatigue the muscle
begin to feel like a cramp/charley-horse
