EStim and Muscle Re-education

Question 1

Muscle Re-Education

Answer 1

muscle inhibition after surgery is the primary reason for using e-stim for muscle re-education

Question 2

Central nervous system causes the issue due to…

Answer 2

1. local swelling
2. pain
3. atrophy of synaptic contacts

Question 3

Arthrogenic Muscle Inhibition

Answer 3

not a problem with the muscle, its a problem within the joint; technically a “protective mechanism”

Question 4

Addition of stimulation to the inactive synapses forces involuntary _____ ______

Answer 4

muscle contractions

Question 5

When you increase the sensory input to the muscle…

Answer 5

the patient feels the sensation of a contraction, neural pathways open, patient voluntarily contracts

Question 6

A normal joint moves…

Answer 6

100-200/1000 deg/sec

Question 7

Only use NMES when a patient…

Answer 7

is struggling to contract on their own

Question 8

Motor points are usually found..

Answer 8

near the midbelly of the muscle

Question 9

A spasm is..

Answer 9

a low grade contraction or tightness

Question 10

spasms can be caused by..

Answer 10

microtrauma, macrotrauma, accumulation of chemical irritants, muscle weakness, or pain

Question 11

Goal of e-stim for spasm is to…

Answer 11

break the pain-spasm cycle by trying to fatigue the muscle

Question 12

The goal of inducing involuntary tetanic contraction is to..

Answer 12

increase local circulation
remove metabolic waste
mechanically stimulate muscle fibers
induce muscle fatigue

Question 13

contraindications for e-stim with muscle spasm

Answer 13

acute injury, local instability

Question 14

Parameters for e-stim for muscle spasm

Answer 14

Electrode placement: Bipolar
Pulse: 50-60 pps
Intensity: contraction
Duty cycle: 10/10
Ramp: 1-2 sec
Duration: 10-20 min
*Try to not voluntarily contract

Question 15

E-stim for edema reduction

Answer 15

muscle contractions assist venous and lymphatic return by manually forcing fluids back towards the heart

Question 16

Motor level edema reduction

Answer 16

goal is to create a “milking effect”

agonist contraction followed by antagonist

Question 17

Parameters for e-stim for edema reduction

Answer 17

Pulse: 1-10 pps or 30-50 pps if unpainful
Intensity: visible contraction
*Agonist contraction for 5-10; followed by antagonist

Question 18

Parameters for e-stim for edema reduction w/out muscle contraction

Answer 18

High volt pulsed current
*May decrease leakage of WBCs out of capillaries into extracellular space
Monophasic negative charge

Question 19

HVPC for acute edema

Answer 19

Frequency: 120 pps
Intensity: sensory only, no contraction
Polarity: negative over injured acute tissue
Duration: 4x30 min with 60 min rest

Question 20

Russian Electrical Stimulation Parameters

Answer 20

Frequency: 2500 Hz
Amplitude (Intensity): muscle contraction
Frequency: 30-60 pps
Burst duty cycle: 50%
On/ Off duty cycle: 1:5
Treatment: 10/50/10

Question 21

Biphasic Parameters for Contraction

Answer 21

Frequency: 1-200 pps
Phase duration: 20-300 msec
Intrapulse interval: about 100 msec
Intensity: contraction
Burst duty cycle: 40-50% 
On/ off duty cycle: 1:5, 1:3
Ramp: 1-3 sec

Question 22

If you are trying to reduce the chance of atrohpy or re-education you…?

Answer 22

Need tetany (30-60 pps; on/ off 1:5 vs. 1:3)
Russian or biphasic AC

Question 23

If you are trying to fatigue a muscle in chronic spasm you…?

Answer 23

Need tetanty (30-60 pps; on/ off 1:1)
Russian or biphasic AC

Question 24

If you are trying to make an agonist/ antagonist reciprocal contraction you…?

Answer 24

Pumping to reduce edema

re-education post surgery

Question 25

If you are using acute edema-sensory HVPS you…?

Answer 25

120 pps
negative polarity over injured tissue
sensory only- no contraction