Lect. 9 NMES

Question 1

What is important when you apply NMES on patients?

Answer 1

that the peripheral nerve is intact

Question 2

precautions?

Answer 2

• Elderly for CV reasons – monitor
• Pregnancy
• *Superficial metal – staples
• Decreased skin sensation

Question 3

Patients only get comfortable after how many minutes?

Why is Higher frequency needed ?

Answer 3

15 min

-for more comfort and tetany

Question 4

Increase of amps (current) = increase in number of

Answer 4

motor units recruited

Question 5

What is our BODY’S NMES build in PD (pulse duration=pulse width)?

Answer 5

300 u sec.

Question 6

What PD (pulse duration) do most NMES have?

Answer 6

20- 500 u sec.

Question 7

*Large suprerficial nerves with async firing is what type first?

Answer 7

Type 1 first

Question 8

Another term for Duty cycle?

ex. how many seconds off vs on?

Answer 8

ratio of on:off

ex. 4 sec on and 12 sec off= 1:3

Question 9

**What does off time allow muscle to do?

Answer 9

lets muscle recover for next contraction (linking molecules together)

Question 10

Rise time on most NMES is….. for patient comfort ?

Answer 10

2 sec.

Question 11

What is an important part of NMES other than applying current (stimulation) ?

What muscles/body parts for example are exercised?

Answer 11

exercise at the same time!!

• ACL
• quads
• hams
• ankle dorsiflexion (post CVA)

Question 12

( What does Strength and Endurance have to do with ?)

Answer 12

nervous system

Question 13

It is important to instruct the patient to ___ ____ at or just before the “on” time during NMES

Answer 13

(volitionally) voluntarily contract

Question 14

NMES might
a)
b)

Answer 14

• fatigue muscle

- breaks pain spasm cycle

Question 15

When patient has Edema you place NMES on muscle where?

Why is that?

Answer 15

in the area or slightly distal to edema

-to assist in moving the edema proximal

Question 16

Endogenous Opiate Liberation: duration is ?

Answer 16

30-45 min

• leads to pain reduction
• Frequency: 1-5 Hz to generate TWITCH: to decrease pain

Question 17

What are some electrode placements for EO (Endogenous Opiates)

Answer 17

motor points,
acupuncture points or trigger points, reflexology
(all overlap)

Question 18

What are 6 Contraindications for E.O ?

Answer 18

• pacemakes
• carotid sinus
• over eyes
• epilepsy
• malignancy (malignant cancer)
• loss of sensation

Question 19

What are 3 Precations for NMES?

Answer 19

• arrhythmias
• open wounds
• abdomen of pregnancy

Question 20

What is MOTOR POINT? (electrode placement)

Answer 20

a location where peripheral nerves enter the muscle

Question 21

What is a TRIGGER point?

What does pressure on trigger points lead to?

Answer 21

an area of increased excitability within a muscle

-referral of pain

Question 22

Describe Low Rate in NMES

Answer 22

For CHRONIC pain

• twitch
• treatment time: 30-45 min
• low frequency (rate), high P.W.
• endogenous opiates

Question 23

Describe High Rate in NMES:

Answer 23

For ACUTE pain

• More electrode placements
• More comfortable
• High frequency (rate), low P.W.
• Gating
• sensory analgesia

Question 24

Indication of NMEs (how to work it)

Answer 24

> First feel: tingling
Then: visible contraction (HAVE ON Continuous! NOT on ON/OFF at first)
Start strengthening: cycle it’ll be on (full contraction) then off (rest)