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Fall 2013- Electrotherapeutics > Functional Electrical Stimulation > Flashcards

Functional Electrical Stimulation Flashcards

1
Q

What is FES primarily used for?

A

to facilitate or improve purposeful movement; produces a functionally useful movement

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2
Q

What are the goals for FES?

A
  • Muscle reeducation
  • Address disuse atrophy
  • Address impaired ROM
  • Decrease muscle spasm
  • Manage spasticity
  • Act as an alternative for or a supplement to orthotics
  • Maintain postural alignment until recovery occurs

(the above are examples of impairments)

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3
Q

What are the 2 motor control theories that are used in FES?

A

sensorimotor integration theory, dynamical systems theory

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4
Q

FES is a technique where ___ level e-stim is used to enhance functional ability. This is unlike Russian where the goal is strength.

A

low

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5
Q

What are the 4 documented conditions to use FES for?

A
  • UE and hand function in CVA and SCI patients
  • Controlling the LE in CVA and SCI patients for drop foot, locomotion, standing
  • scoliosis
  • reduced spasticity
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6
Q

What are the assumptions of Dynamical Systems Theory?

A
  • A dynamical system is one that changes over time
  • A developmental organism is multidimensional
  • Movement develops as a result of many subsystems
  • Movements are performed and may be preferred, but are not obligatory and can be changed.
  • Movement changes from one form to another without stable intermediate states
  • Therapists attempt to influence movement patterns
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7
Q

What are the MC main protocols for FES?

A

The MC patient conditions for tx are:

  • SCI
  • CVA (stroke)
  • multiple sclerosis
  • cerebral palsy
  • TBI

Others include:

  • Shoulder subluxation due to CVA
  • Dorsiflexion assist in gait training & other gait protocols
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8
Q

What are the 5 indications for FES?

A
  • orthotic substitution
  • bracing in idiopathic scoliosis
  • gait re-education
  • UMN/LMN to assist with impaired body fx
  • shoulder subluxation due to flaccid paralysis s/p CVA
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9
Q

What are the contraindications for FES?

A
  • where active motion is contraindicated
  • over metal implants
  • malignancies
  • first trimester of pregnancy
  • over anesthetic skin whenever possible
  • extreme edema
  • thick scarring or adipose tissue
  • over laryngeal of pharyngeal muscles or carotid sinus
  • avoid open wounds and active bleeding
  • disorientated patients (patients should be able to provide feedback)
  • avoid areas of PVD such as DVT
  • Do not use with patients who have uncontrolled hyper/hypotension
  • Do no use in regions of pacemakers, spinal cord stimulators, near the bladder or phrenic nerve
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10
Q

What types of weakness and what muscles are affected with patients with CVA?

A

initial weakness or flaccid paralysis of m. supporting the GH joint, especially supraspinatus and posterior deltoid

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11
Q

What are the effects of gravity on the shoulder after a patient has CVA?

A

the unsupported extremity tends to stretch the ligamentous structures surrounding the GH joint that results in severe pain and decrease UE function

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12
Q

What is the wave form and modulation of FES?

A

wave form: asymmetrical biphasic square or biphasic rectangular
modulation: interrupted

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13
Q

What are the parameters of FES (waveform, rate, pulse width, ramp time, cycling)?

A

waveform: asymmetrical biphasic square or symmetrical biphasic rectangular
rate: 25 pps
pulse width: 300 micro sec
ramp time: 2 sec
cycling: synchronous

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14
Q

What is the electrode placement for shoulder subluxation using FES?

A

bipolar, electrodes on supraspinatus and posterior deltoid

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15
Q

What are the treatment parameters (amplitude, pulse rate, duration of tx, on/off ratio starting & progression, and times

A
  • amplitude: tetanic m. contraction to patient’s tolerance (turn it up high, unlike IFC to pt’s comfort). This is a MOTOR response (IFC was sensory response).
  • Pulse rate:12-25 pps
  • Duration of tx: 15-30 min
  • on/off ratio: 1:3 (2 sec : 6 sec) progressing to 12 : 1 (24 sec : 2 sec)
  • 15-30 min (three times/day)
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16
Q

What are the 2 muscles that prevent inferior humeral head subluxation?

A

supraspinatus & posterior deltoid

17
Q

What are the 2 disadvantages in using slings to prevent shoulder subluxation?

A
  1. most slings are not effective for subluxation prevention

2. the slings that do prevent subluxation, promote nonuse of the arm & may result in contracture

18
Q

If the supraspinatus and posterior deltoid cannot be stimulated, which muscle would you try next?

A

middle deltoid; it can be useful in preventing shoulder subluxation

19
Q

FES for the GH joint subluxation should be used for ______ a day.

A

3 times a day for a total of 4-7 hours; this means the patient or caregiver(s) need to be educated in the use of FES

20
Q

In FES electrode placement ___ electrodes are placed over small muscles and ___ electrodes are placed to stimulate titanic contraction of large muscle.

A

small (1.5 inch), large (3 inch or bigger)

21
Q

What do patients with hemiplegia sometimes exhibit?

A

paralyzed dorsiflexor and evertor muscles

22
Q

How does FES control foot drop?

A

by facilitating dorsiflexors and evertors during swing phase

23
Q

What are the ES characteristics (wave form, pulse duration, modulation) for dorsiflexion assist using FES?

A

wave form: asymmetric biphasic square
pulse duration: 20-250 micro seconds
modulation: interrupted by foot switch

24
Q

What is the electrode placement for dorsiflexion assist in FES?

A

peroneal (fibular) nerve near head of fibula or anterior tibialis muscle.

25
Q

What is the amplitude and pulse rate for dorsiflexion assist in FES?

A

amplitude: tetanic m. contraction sufficient to decrease plantar flexion
pulse rate: 30-300 pps

26
Q

What is the treatment mode for dorsiflexion assist when using FES?

A

heel switch contains pressure sensitive contact which stops stimulation during stance phase and activates stimulation during swing phase. Hand switch also allows therapist to control stimulation during gait.

27
Q

What is the dorsiflexion assist protocol?

  • wave form
  • modulation
  • pulse duration
  • electrode placement
  • amplitude
  • pulse rate
  • treatment times
A
  • wave form: asymmetrical, biphasic, square
  • modulation: interrupted by foot switch
  • pulse duration: 20-250 micro sec
  • electrode placement: bipolar, electrodes on peroneals (fibular) nerve near the head of the fibula and the anterior tibialis muscle
  • amplitude: tetanic contraction sufficient to decrease plantar flexion
  • pulse rate: 30-300 pps
  • treatment times: pressure sensitive heel switch stops stimulation on during stance & activates it during swing phase
28
Q

To assist with gait electrodes are placed on the ____ to assist with push-off

A

plantar flexors

29
Q

To assist with gait, electrodes are placed on the ___ to assist with the late swing phase

A

hamstrings & quadriceps

30
Q

To assist with gait, electrodes are placed on the ____ to assist with stance phase

A

quads & glutes

31
Q

FES in SCI patients to allow them to perform activities such as walking can help the patient improve CV function.

Two adaptive methods to maximize training in patients with incomplete SCI or stroke include:

A
  • partial body weight supported treadmill locomotion.

- stimulating flexor withdrawal reflex to get multi muscle activation during swing phase

32
Q

What are the limitations in using FES with patients who have had a stroke and do not have a functional gait pattern:

A
  • activating 3 or more muscle groups in a functional gait pattern is difficult
  • several support staff are needed to train one patient who does not have a functional gait pattern
33
Q

What are the 2 treatments that can produce a synergistic effect for hand recovery in stroke patients?

A
  • EMG-triggered NMES on the involved side

- voluntary wrist & finger extension on the uninvolved side

34
Q

What is the tx for hand therapy in stroke patients?

A

30 contractions done 2x/day; 3x/wk for 2 wks (360 contractions) to improve hand function

35
Q

What are the 2 grasps that can be produced with implantable neuroprosthesis:

A
  • lateral pinch grasp

- palmar grasp

36
Q

What nerve level is appropriate for implantable neuroprosthesis to restore grasp?

A

C5 & C6

37
Q

FES can be used in treating idiopathic scoliosis especially with curves of what degrees?

A

20-45

38
Q

What are the 2 set-ups for using FES to reduce spasticity?

A
  • place electrodes over the antagonist of spastic muscle to produce reciprocal inhibition
  • place electrodes over the spastic muscle to antidromically produce Renshaw cell inhibition of motor neurons to the spastic muscles

Fall 2013- Electrotherapeutics (11 decks)

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