Neurology Flashcards
how do seizures occur?
due to an altered balance between excitatory and inhibitory input
leading to hypersynchronisation of neurons
what is a seizure?
an abnormal, uncontrollable, hypersynchronous electrical activation of a large group of neurons
what are the types of seizure?
isolated seizure
cluster seizure
status epilepticus
what is an isolated seizure?
a seizure lasting less than 5 minutes
what is a cluster seizure?
2 or more seizures within a 24 hour period with complete recovery in-between
what is status epilepticus?
seizure lasting longer than 5 minutes
OR
2 seizures without complete recovery in-between
what type of seizure is an emergency?
status epilepticus
what are partial/focal seizures?
asymmetric - one part of the brain is affected
what are the signs of a partial/focal seizure?
facial twitching
hypersalivation
behavioural changes
consciousness maintained
what type of seizure produces no change in mentation?
simple
what type of seizure produces a change in mentation?
complex
what is a generalised (tonic/clonic) seizure?
a seizure with bilateral cerebral hemisphere involvement
what are the signs of a generalised (tonic/clonic) seizure?
autonomic signs (U/D)
loss of consciousness
identifiable pre-ictal, ictal and post-ictal phases
what is the pre-ictal phase? how can it be identified?
phase before seizure onset
may see behavioural changes, altered mentation, attention-seeking behaviour
what is the ictal phase? how can it be identified?
active seizure phase - loss of consciousness, muscle contraction, U/D, salivation
what is the post-ictal phase? how can it be identified?
minutes to days post-seizure - mainly see abnormal neurological signs and behavioural changes but will vary greatly between patients
what are the 2 main types of extracranial seizure triggers/causes?
toxins and metabolic factors
which toxins can lead to seizures?
methaldehyde (slug bait) ethylene glycol (antifreeze) permethrin in cats pesticides ivermectin (collie breeds) human drugs
what metabolic factors can lead to seizures?
portosystemic shunt (blood toxins)
hypoglycaemia
hypocalcaemia
what are the types of intracranial factors which can cause seizures?
structural - brain tumour, inflammation, hydrocephalus
functional - idiopathic epilepsy
what is the most common cause of seizures?
idiopathic epilepsy
what age dogs are more commonly diagnosed with idiopathic epilepsy?
6 months - 6 years
how is a diagnosis of idiopathic epilepsy concluded?
normal inter-ictal neurological exam
normal metabolic investigation
normal MRI scan of brain
normal CSF
what diagnostics should be performed if a patient is experiencing seizures?
thorough history
blood tests MRI scan (IV gadolinium contrast) CSF analysis videos monitoring and recording
retinal exam and blood pressure measurement
if possible
which blood tests are performed when investigating seizures?
haematology biochemistry fasted blood glucose pre- and post-prandial bile acids possibly ammonia
which other conditions/disorders can mimic seizures?
narcolepsy/cataplexy fly-catching movement disorder syncope 3rd degree AV block canine epileptoid cramping syndrome peripheral vestibular disease
what is narcolepsy/cataplexy? how does it present?
a sleep-wake disorder with flaccid collapses
loss of muscle tone but no autonomic signs
what is fly catching and how does it present?
unknown cause - dog appears to be chasing/trying to catch imaginary flies (mins-hours)
normal mentation, no autonomic signs
what is movement disorder? how does it present?
an episodic disorder - patient remains conscious and performs involuntary movements that are spontaneous and uncontrolled
neurologically normal between episodes
what is syncope? how does it present?
temporary loss of consciousness (‘fainting’) due to reduced oxygenation to the brain
what can cause syncope?
cardiac-related (most common)
neurological
hypoglycaemia
hypocalcaemia
how does 3rd degree AV block present?
prolonged hypoxic event with partial seizure-like episodes
what is canine epileptoid cramping syndrome? how does it present?
movement disorder affecting mostly border terriers
patient conscious and responsive with no autonomic signs and normal mentation
what is involved in emergency management of seizures?
oxygen therapy place IV catheter (if possible) administer diazepam assess circulation and temperature intubate if required active cooling if hyperthermic mannitol if seizure >15 mins or suspected cerebral oedema collect full bloods
how do you triage a seizuring patient (over the phone)?
stay calm and reassure owner
enquire into previous history, toxin exposure, head trauma
establish how long patient has been seizuring and how many times
ask if patient is conscious and responsive
any U/D
advise to travel when safe to do so
what kennel considerations should be made with seizure patients?
minimise noise and light in kennel
bottom kennel/easily accessible
seizure plan on kennel with doses calculated/medication drawn up
sign on door to limit staff numbers/traffic
what steps should you take if a patient seizures?
stay calm and note the time, call clinician in charge for help
remove any dangers
dim lights and reduce noise as much as possible
limit handling
monitor vital signs
follow seizure plan if one in place
do not put hands in/near patients mouth!!
what steps should you take when the patient comes into the practice after seizuring?
reassure the owner triage - ABC provide oxygen therapy obtain IV access ASAP administer anticonvulsants check temperature and actively cool if required consider mannitol consider intubation and CRI if frequent/extended seizures
what is the first line treatment for managing seizures?
Phenobarbital (epiphen) tablets
how does phenobarbital work?
acts on GABA receptors in the brain to increase frequency of synaptic inhibition and reduce neuronal excitability
what are the advantages of phenobarbital?
high efficacy and safety, low cost
what are the disadvantages of phenobarbital?
takes ~2 weeks for steady state plasma concentration to be reached
requires regular blood tests
many side effects
what are the side effects of phenobarbital?
hepatotoxicity in high doses sedation polyuria/polydipsia polyphagia ataxia
what else can be used in first line management of seizures?
potassium bromide (libromide) - can be used alone or in conjunction with another antiepileptic drug
what are the disadvantages of potassium bromide?
side effects
takes ~ 4 months to achieve steady state plasma concentration
renally excreted - not good for px with renal compromise
regular blood rests required
causes lung issues in cats
what are the side effects of potassium bromide?
gastric irritation nausea polydipsia/polyuria sedation pancreatitis (rare)
what is levetiracetam (keppra)?
used as an adjunct to other AEDs - unknown method of action
what are the advantages of levetiracetam?
primarily excreted unchanged in urine
excellent oral bioavailability
well-tolerated
what are the side effects of levetiracetam?
ataxia
vomiting
sedation
which drug is licensed specifically for idiopathic epilepsy?
imepitoin (pexion)
which dogs cannot take imepitoin?
those with seizures caused by anything other than idiopathic epilepsy
dogs with impaired hepatic/renal/cardiovascular function
what are the side effects of imepitoin?
ataxia
vomiting
polyphagia
what home care considerations are relevant for patients that seizure?
family situation
financial situation
type of property dog is living in
good communication
what kind of disease is polyradiculoneuritis?
immune-mediated musculoskeletal disease
how does polyradiculoneuritis present?
short-strided gait that progresses to tetraparesis
patient can be ambulatory or non-ambulatory
dysphonia
how long does it take to recover from polyradiculoneuritis?
within 1-4 months once signs stabilise
how is polyradiculoneuritis diagnosed?
accurate patient history
physical and neurological exam
EMG, NCV
muscle and nerve biopsies
how is polyradiculoneuritis treated?
intensive nursing care and physiotherapy
what is myasthenia gravis?
disease of neuromuscular transmission affecting the NMJ
what causes myasthenia gravis?
can be congenital or acquired
how does myasthenia gravis present?
muscle weakness and fatigue (more obvious when patient is exercising)
focal, generalised or acute
regurgitation commonly seen due to oesophageal weakness
how is myasthenia gravis diagnosed?
presumptive based on history and presentation
thoracic radiographs (megaoesophagus)
tensilon test
how is myasthenia gravis treated?
anticholinesterase therapy plus corticosteroids at immunosuppressive doses
intensive nursing care and support
what is polymyositis?
immune-mediated inflammatory myopathy
what causes polymyositis?
idiopathic but can be associated with systemic disease
how does polymyositis present?
exercise intolerance and stiffened gait
muscle weakness and atrophy
dysphonia, dysphagia, regurgitation
signs often wax and wane in initial period
how is polymyositis diagnosed?
criteria not well defined - diagnosis of exclusion
main diagnostics are clinical history, biochemistry, electrodiagnostic testing and muscle biopsy
how is polymyositis treated?
corticosteroids at immunosuppressive doses
intensive nursing care and support
azothrioprine can be used alongside steroids
what are the clinical signs of aspiration pneumonia?
coughing
tachypnoea
harsh lung sounds
crackles on auscultation
which neuromuscular diseases carry the most risk of aspiration pneumonia?
myasthenia gravis
polymyositis
which neuromuscular disease carries the most risk of pressure sores?
polyradiculoneuritis
which neuromuscular disease carries the most risk of contracture?
polyradiculoneuritis (esp in young)
how can you prevent severe aspiration pneumonia?
careful and close monitoring of patients
early administration of antibiotics
IV fluids + oxygen therapy
walking/turning patients regularly very important
feeding balls of food from a height
severe cases may require mechanical ventilation
how do pressure sores form?
recumbency leads to increased pressure over bony prominences, which then leads to ischaemia and necrosis
how can you prevent pressure sores?
thick padded bedding turn every 2-4 hours donut bandages physiotherapy monitor patients closely
how does muscle contracture occur?
recumbency and immobilisation
–> leads to adaptive shortening of the muscle and soft tissues, and inelasticity of the soft tissues
how is contracture treated?
massage
PROM
proprioceptive exercises
neuromuscular stimulation
what is ataxia?
uncoordinated gait
what does -paresis/-paretic mean?
weakness, decreased voluntary movement
what does -paralysis/-plegic mean?
no voluntary movement?
what does mono- mean in regards to gait?
one limb affected
what does hemi- mean in regards to gait?
both limbs on one side affected
what does para- mean in regards to gait?
both pelvic limbs affected
what does quadra/tetra- mean in regards to gait?
all 4 limbs affected
when would you perform a neurological exam on a patient?
seizures
behavioural changes
gait abnormalities
change in posture/positioning
why might you perform a neurological exam?
identify if nervous system involvement
identify specific location/localisation
aid diagnosis and prognosis
continuous assessment of condition/comparisons
what do the upper motor neurons do?
send signals to the lower motor neurons
what do the lower motor neurons do?
connect the CNS to the effector organ (muscle) and send a signal to make them contract
what factors should you assess during a neurological examination?
mentation
gait and posture
cranial nerve function
postural reactions
spinal reflexes
sensory evaluation
palpitation of head/spine/limbs
what does head tilt look like?
one ear is below the other
what does head turn look like?
nose is turned towards body
what does ventroflexion of the neck look like?
low head carriage
what is scoliosis?
lateral deviation of the spine
what is lordosis?
ventral deviation of the spine
what is kyphosis?
dorsal deviation of the spine
what is decerebrate rigidity?
extension of all limbs, head and neck
what is decerebellate rigidity?
extension of the thoracic limbs, head and neck
what are the common postural tests for spinal cord injury?
proprioceptive positioning (paw placement)
hopping
visual placement
tactile placing
hemi-walking
wheelbarrowing
what spinal reflexes should be present in the thoracic limbs?
withdrawal reflex
extensor carpi radialis
biceps brachii and triceps reflex
what spinal reflexes should be present in the pelvic limbs?
patella reflex
cranial tibial and gastrocnemius
which spinal reflexes are part of the trunk?
perineal reflex
panniculus reflex
what is the panniculus reflex?
pinching either side of the spinal column to see if skin twitches
how do you perform a pain evaluation?
pinching/pressure applied to digits on each limb - looking for reaction from patient (turning, vocalising, trying to bite)
what is the important thing to remember about pain evaluation?
it is not the same as withdrawal reflex
what are the acute causes of spinal injury?
intervertebral disc disease (IVDD)
trauma (fracture/luxation)
infarction (fibrocartilagenous embolism)
what are the chronic causes of spinal injury?
degenerative disc disease
degenerative myelopathy
cervical stenotic myelopathy (wobblers)
what are the other possible causes of spinal injury (aside from primary acute/chronic)?
atlanto-axial subluxation vertebral anomalies neoplasia inflammatory diseases discospondylitis
what is discospondylitis?
infection of the vertebrae/vertebral disc spaces
what additional diagnostics can be used to identify spinal disease?
imaging - radiographs, CT, MRI CSF tap (cisternal or lumbar)
what is involved in conservative treatment for spinal cord disease?
6 weeks strict rest physiotherapy anti-inflammatory drugs analgesia steroid therapy
what is involved in surgical treatment for spinal cord disease?
hemilaminectomy
ventral slot (upper cord)
dorsal laminectomy
spinal stabilisation/fixation
what is a hemilaminectomy?
removal of compressing/problematic bone
how does upper motor neuron disease affect bladder function?
increased urethral resistance detrusor and urethral sphincter can contract at same time not able to control bladder function urinary retention kidney damage possible difficult to manually express require catheterisation intermittent "squirting" of urine
how does lower motor neuron injury affect bladder function?
flaccid bladder, does not contract spontaneously
continues to fill, resulting in “overflow” leaking of urine
bladder muscle is overstretched
easy to manually express
what are the nursing considerations for patients with spinal cord injury?
holistic care enrichment nutrition turning/physio temperature control padded bedding excretion management grooming hygiene
what is an intracranial disease?
a disease that affects the brain
what is the skull vault?
a closed, inelastic compartment that doesn’t allow any room for inflammation and swelling
what does the skull vault contain?
80% parenchymal tissue
10% blood
10% CSF
what is parenchymal tissue?
brain tissue
how is cerebral blood flow maintained?
autoregulatory mechanisms maintain cerebral blood flow over a wide range of mean arterial pressures (50-150mmHg)
what is intracranial pressure?
pressure exerted between skull and intracranial tissues
normal is 5-10mmHg
what is the effect of intracranial hypertension?
results in reduced cerebral perfusion pressure, reduced blood flow and secondary changes
what triggers cushings reflex?
severe, acute rise in ICP
what is cushings reflex?
a rise in MAP and reflex bradycardia
what does cushings reflex indicate?
it is a sign of potentially life threatening increase in ICP and should be treated immediately
what are the possible causes of intracranial disease?
trauma inflammatory (MUO) infections neoplasia toxins seizures anomalous (hydrocephalous)
what types of neoplasia can can intracranial disease?
meningioma
glioma
choroid plexus tumour
which part of the neurological examination are most likely to pick up on ICP?
mentation (alert, obtunded, stuporous, comatose)
cranial nerve function (menace, PLR, gag, palpebral, vestibuloccular)
what is alert mentation?
normal response to surroundings
what is obtunded mentation?
awake but less responsive, will sleep if left
what is stuporous mentation?
only responds to noxious/painful stimuli
what is comatose mentation?
unconscious, unresponsive to any stimuli
what mentation signs indicate something could be wrong with ICP?
circling head pressing pacing head tilt head turn
what is the menace response?
covering one eye and moving hand towards the face menacingly - animal should blink/flinch
what is the oculocephalic reflex?
physiological nystagmus - eye position correction with movement
what does absence of oculocephalic reflex indicate?
poor prognosis for the animal - severe brainstem damage
what is miosis/miotic pupils?
constricted pupils
what is mydriasis/mydriatic pupils?
dilated pupils
what is anisocoria?
unequal pupil size
which pupil status indicates a very poor prognosis?
mid-size fixed pupils that are unresponsive to light
list some of the clinical signs of intracranial disease.
circling and ataxia
head tilt/turn
nystagmus, blindness
altered mentation/loss of consciousness/coma
seizures
cheyne-stokes respirations
loss of gag reflex and oculocephalic reflex
strabismus and non-responsive pupils
decerebrate/decerebellate posture
what are the 3 domains of the glasgow coma score?
motor activity
brainstem reflexes
level of consciousness
what glasgow coma scale score indicates a grave prognosis?
3-8
what glasgow coma scale score indicates a guarded prognosis?
9-14
what glasgow coma scale score indicates a good prognosis?
15-18
what is the main treatment for raised intracranial pressure?
IV mannitol infusion
why is mannitol used to decrease ICP?
hyperosmolar - reduced cerebral oedema
increases CPP and cerebral blood flow
rapid onset (minutes)
effects for 1.5-6 hours
what should be infused after mannitol treatment?
isotonic fluids - mannitol has a profound diuretic effect
what is the alternative treatment for raised ICP?
hypertonic saline therapy - similar osmolarity to mannitol
in addition to mannitol, what else can be used in treatment of raised ICP?
sedatives/analgesia anaesthesia mechanical ventilation CRI require intense care and monitoring
what is involved in nursing management of raised ICP patients?
recumbency - turning, padding, physiotherapy, monitor/manage excretions
elevate cranial part of body 30-40°
ocular care
mouth checks
nutritional support - in sternal every 4-6 hours if conscious
what is hydrocephalus?
excessive accumulation of CSF within the ventricular system
how can hydrocephalus be caused?
obstruction to CSF outflow
decreased absorption of CSF
increased production of CSF
what are the 2 types of hydrocephalus?
congenital - present at birth
acquired - tumour, inflammation, haemorrhage
what are the clinical signs of hydrocephalus?
behavioural changes slowness in learning loss of coordination visual deficits seizures circling depressed/obtunded mentation enlarged and dome-shaped skull signs can wax and wane
how is hydrocephalus managed medically?
aims to reduce production of CSF - steroids (prednisolone, frusemide, omeprazole)
how is hydrocephalus managed surgically?
aims to divert CSF to another location
ventriculoperitoneal shunt - tubing placed from ventricle to peritoneal cavity
what is the prognosis for hydrocephalus?
dependent on cause and severity of signs - more severe = more guarded
good prognosis for infectious cause
tumour = more guarded
what is MUO?
meningoencephalitis of unknown origin - inflammatory disorder of CNS
what are the 3 types of MUO?
granulomatous ME
necrotising
necrotising leukoencephalitis
why are the 3 types referred to as an umbrella term of MUO?
not possible to determine type in live patient
which dogs are more prone to MUO?
small dogs
females more than males
>6 months of age
what are the neurological signs of MUO?
seizures muscle tremors blindness head tilt altered balance and posture circling
how is MUO diagnosed?
clinical examination
blood tests
MRI - brain
CSF analysis
what is involved in management of MUO?
immunosuppressive drugs - steroids, cyclosporine, azathioprine, cytarabine
antiepileptics
nursing care
what is the prognosis for MUO?
variable
seizures = poorer
better for focal lesions than multifocal
improvement within 3 months = good prognosis
patients can relapse and represent with clinical signs
what considerations need to be taken in regards to nursing considerations of neuro patients?
ambulation status/recumbency type of surgery continence temperament normal routine of patient
what type of bedding should be used for a neuro patients kennel?
thick bedding to prevent sores (duvet/mattress as bottom layer)
layer with incontinence pads
vet bed as top layer to wick away any urine
pad out sides of kennel for extra comfort and injury prevention
which methods are available to help a patient empty their bladder?
manual expression intermittent catheterisation (males only) in-dwelling catheterisation (larger/aggressive/nervous patients; constantly leaking urine)
what is overflow incontinence?
where the patient is unaware their bladder is full - overflows and leaks urine (reflexes have been affected)
how many times should the bladder be emptied per day?
ideally 4x a day
what is the main cause of urine scalding?
overflow incontinence/leaky bladder
if passing an intermittent urinary catheter, how often should this be done?
twice daily - always a risk of causing iatrogenic trauma with each catheter passed
how do we monitor for UTIs in spinal injury patients?
monitor smell, colour and turbidity of urine
guidance must be given to owner at discharge to monitor urine and take a sample to vet for urinalysis if concerned
how can we manage faecal incontinence patients?
check beds regularly
keep patient clean/dry at all times - may require regular bathing
check skin daily for changes/sore spots
apply topicals if necessary (under vet direction)
what is a decubitus ulcer?
an open skin wound caused by continued pressure of skin on a firm surface - eventually causes tissue ischaemia in the skin
where do decubital ulcers most commonly occur?
bony prominences e.g. ileum, ischium, hock, olecranon and feet
how often should patients be turned in order to prevent decubitus ulcers?
every 4 hours as a minimum - more often for more bony breeds
how can you prevent decubital ulcers?
turn every 4 hours with great care
deep padded bedding, checked regularly
keep patients clean and dry
donut bandages on elbows and hocks can help prevent
prop recumbent patients up with pillows for comfort
which products/medications can be used to prevent and treat decubital sores?
clorexyderm for treatment of mild urine scalding
talc to help dry a patient after bathing
cavilon spray as a no sting barrier around anus/perineum (diarrhoea)
flamazine - antibac cream used for surface thickness sores
what can you use to exercise the paretic/paraplegic patient?
sling/rear harness
foot covers
why do we cover the hind paws when walking paretic/plegic patients?
to prevent trauma to the hind toes and claws (will drag along floor)
how can we exercise the tetraparetic/plegic patient?
walk using a secure and supportive chest harness/sling/rear harness
may require a hoist/multiple people
cover all 4 paws
which spinal surgery carries a higher risk of seroma?
hemilaminectomy - more skin movement, separation of layers of tissue and over the midline
how is cold therapy useful post-surgery?
provides analgesia and decreases inflammation
how long should cold therapy be given post-surgery?
15 mins 4x daily for 48-72 hours
how can you prevent patient interference with surgical wounds?
primapore dressing
why might self-mutilation happen in neuro patients?
can occur in deep pain negative animals due to paraesthesia, boredom or stress
how can self mutilation be prevented?
use a buster collar if a patient starts to like/bite at any part of their body
look for any triggers such as a sore
what is physiotherapy useful for post neuro surgery?
can help keep joints and muscles mobile as well as retrain limbs to move correctly as mobility improves
why do physiotherapy?
promote recovery
prevent further complications
how much physiotherapy is involved in recovery from acute spinal cord damage?
aggressive therapy 1-2 weeks after trauma
how much physiotherapy is involved in recovery from chronic spinal cord damage?
low impact, low intensity long-term therapy to preserve neuromuscular function
how can physiotherapy help with degenerative myelopathy?
can lead to longer survival times
what are the benefits of physiotherapy?
pain management improved range of motion reduce muscle contraction and tension stimulate the nVS improve blood perfusion improve cardiorespiratory capacity encourage relearning of motor patterns weight management
how can we make sure patients are safe to undergo physiotherapy?
patients should be clinically stable before commencing therapy - critical surgical and medical needs should have been addressed
how should we handle/move dogs during physiotherapy?
encourage natural movement
short, regular sessions
take it slow
keep spine in line (vital!)
which patient factors will affect rehabilitation therapy program design?
patient size temperament degree of disability location of incision(s) IV/urinary catheterisation bandages and external coaptation comorbidities
which client factors will affect rehabilitation therapy program design?
physical abilities
financial resources
schedule and household restrictions
emotional needs and concern
which facility factors will affect rehabilitation therapy program design?
size and indoor/outdoor exercise space availability of lift equipment appropriate modalities facility hours adequate bedding and housing
which staff factors will affect rehabilitation therapy program design?
availability of sufficient support staff
proper training and experience
physical ability to lift and transport patients
access to specialists
what different components are involved in physiotherapy?
massage
passive range of motion (PROM)
assisted exercises
proprioceptive exercises
neuromuscular electrical stimulation
what are the 4 types of physiotherapy massage?
effleurage
petrissage
percussion
vibration
what is effleurage massage?
gentle contact with palm of hand - stroke towards the heart
can be used all over body
what is petrissage massage?
therapist rolls, squeezes, compresses and kneads the skin and muscles to increase circulation
what is percussion massage?
gentle tapping o the skin with pam or side of hand - increases blood supply and aids relaxation of the muscle
what is vibration massage?
limbs are gently shaken to stimulate the whole limb
good for relaxation at the end of the massage session
what is coupage?
a technique which loosens secretions and assist in airway clearance by coughing
firm cupped hands on chest - caudal to cranial
when might we perform coupage?
important in recumbent patients and those suffering from pulmonary disease/aspiration pneumonia
what is passive range of motion?
joint mobilisation and stretching
external forces applied to the limbs/axial skeleton - flexion/extension (normal ROM) and monitor for pain
how often should PROM be performed?
3-4 times daily for 10 mins
how should PROM be performed?
begin at toes and move up limbs
care with hips and shoulders
consider comorbidities (anything that may affect ROM)
what assisted exercises can be performed as part of physiotherapy?
assisted standing/walking
assisted sit
three-legged standing
weight-shifting
what proprioceptive exercises help with sensation and awareness of limbs?
standing wobble boards uneven surfaces over poles weaving different surfaces
why perform active exercises as part of physiotherapy?
improve strength
promote independence with functional activities (off lead, normal walking etc)
what types of active exercise can be done?
lead exercise - slowly and increasing gradually add in steps/stairs/ramps figure of 8, circles encourage sitting and then standing pole walking, weight shifting move head/neck with treats/food balls hydrotherapy
which patients cannot do pool hydrotherapy?
ventral slot patients due to swimming position
patients in early stages of recovery
what is e-stim?
neuromuscular electrical nerve stimulation applied to skeletal muscle to stimulate contraction
how is NMES delivered? what does it do?
percutaneously
increases tissue perfusion and can help to slow neurogenic muscle atrophy
what are the benefits of e-stim?
increases muscle strength, ROM and muscle tone enhances function pain control (some) oedema reduction reduces muscle spasm
how does e-stim generate effective muscle contractions?
1 electrode placed near motor point of muscle and other placed along the muscle body
check for muscle contraction
how often should e-stim be used?
10-20 mins daily (depends on patient tolerance)
what is the procedure for applying the e-stim?
clip hair clean with spirit apply conducting gel place electrode on top of gel set contraction/rest cycle
