Exam II

Question 1

When is NMES for muscle strengthening used?

Answer 1

Healthy individuals
Post-ACL reconstruction
Post-TKA

Question 2

What is the examination, evaluation, and prognosis for using NMES?

Answer 2

Check history for contraindications and precautions
assess for innervation
assess STR, ROM, sensation, pain, and functional status

Question 3

What is the recruitment for voluntary contractions?

Answer 3

small motorneurons

small/slow motorunits recruited first

Question 4

What is the recruitment for NMES contraction?

Answer 4

larger motorneurons

large/fast motorunits may be recruited first (also consider distance)

Question 5

What is the firing rate for voluntary contractions?

Answer 5

asynchronous firing with varying frequencies

Question 6

What is the firing rate for NMES contractions?

Answer 6

synchronous firing with frequency of e-stim

Question 7

What is the type of contraction with voluntary contractions?

Answer 7

maintained and slowly fatiguing

Question 8

What is the type of contraction with NMES contractions?

Answer 8

greater tendency to fatigue

Question 9

How do you select a stimulator for NMES?

Answer 9

a portable stimulator may not be as effective d/t power source being a battery.

Question 10

What are the stimulation parameters for NMES?

Answer 10

current/waveform
amplitude/intensity
duration/pulse or phase
frequency (pulse rate)
on/off times
ramp times

Question 11

What are the types of waveforms used with NMES?

Answer 11

pulsed/biphasic symmetrical

pulsed biphasic asymmetrical unbalanced (used when you want one electrode to be more active)

Question 12

How do you set amplitude when using NMES?

Answer 12

increased intensity increases motorunits recruited

need > or = to 50-60% MVC for strengthening

Question 13

How do you set duration when using NMES?

Answer 13

200-300 microseconds
decrease duration increase the intensity
increase duration decrease the intensity

Question 14

How do you set frequency when using NMES?

Answer 14

> 20-30 pps for tetanic contraction

<50 pps to prevent fatigue

Question 15

How do you set on/off times?

Answer 15

1:1-2 with partial range
1:3-5 with fair to fair+ contraction
increase off time with stronger contractions

Question 16

How do you set ramp times when using NMES?

Answer 16

mainly for comfort and spasticity

large muscle groups need increased ramp times

Question 17

What is the original strengthening protocol (developed by Kots for Olympic athletes?

Answer 17

10 contractions per day
10 secs on 50 secs off (but 120 secs off necessary to prevent fatigue)
5 days a week
2-4 weeks
>60% MVIC

Question 18

How do you place electrodes when using NMES?

Answer 18

larger electrodes are more comfortable
place to optimize recruitment of motorunits
common use- monopolar or bipolar (monopolar target electrode is smaller)

Question 19

How do you monitor NMES treatment?

Answer 19

DOMS
skin reactions
patient’s response

Question 20

What are the stimulation parameters for EMS of denervated ?

Answer 20

interrupted DC
supramax amplitude
>1 microsec
abrupt or gradual rate of rise
frequency varies  (tetanizing contraction)
treatment times vary

Question 21

What kind of contraction could occur when directly stimulating muscle?

Answer 21

vermiform contraction (worm like)
muscle will stay muscle for 12-18 months without nerve innervation

Question 22

What are the waveforms used with EMS of denervated muscle?

Answer 22

square (will hit sensory, motor and pain of other nerves)

exponential (use for accommodation of intact nerves in the area-more comfortable)

Question 23

What is the clinical application of EMS of denervated muscle?

Answer 23

delay of atrophy
nerve regeneration
(could benefit SPC patients)