NMES Flashcards
What is the rationale behind NMES?
Machine sends electrical impulses through
electrodes to the body and reaches the underlying nerves or muscle group
Causes the muscle to contract
Used to strengthen weakened muscles
Explain how NMES can be used to strengthen weakened muscles.
1) Patient watches their muscle contract
2) Patient attempts to contract own muscle with the machine
3) Progress by turning down intensity & reducing rest time
4) Patient to maintain contraction during machine off phase
5) Further progression by increasing relaxation time
What are the physiological effects of NMES?
Increase muscle strength.
Promote continence.
Maintain or improve range of movement (ROM).
Increase and improve the blood supply to the muscle in cases of intermittent claudication.
As a warm up prior to exercising.
Help alleviate the changes of muscle tone as appropriate in muscle spasm and spasticity.
Prevent disuse atrophy e.g. rheumatoid arthritis.
What conditions can NMES benefit?
Urinary and rectal incontinence.
Chronic neurological conditions to decrease spasticity, to strengthen. muscle and promote higher levels of activity.
Peripheral nerve lesions, including brachial plexus and Bell’s Palsy.
Muscle atrophy and pain relief
What structures does NMES affect?
Neuromuscular junctions in area
How would you apply NMES?
1) Introduce
2) Explain procedure & benefits for informed consent
3) Identify the area of application and ensure that it is clean.
4) Check for any contraindications.
4) Perform a pin prick (sharp/ blunt) test.
5) Place electrode either over the motor point of the muscle or either end of the muscle belly
6) Attach the leads to the machine.
7) Set the desired frequency, pulse duration and on/off time.
8) Turn up the intensity until a suitable muscle contraction occurs.
9) Start the timer, usual treatment time is 15 minutes.
10) Turn the machine off and remove the electrodes checking the skin for any signs of any adverse reactions.
11) Patient may have to be taught how to do this as NMES treatment is optimal several times a day, depending on the condition
What are the parameters used for muscle strengthening?
Pulse duration - 300μs,
Frequency – 40Hz (pps),
On/ off time – 15/50 seconds,
Treatment for up to 15 minutes x 4 daily
What are the contraindications?
Patient fitted with demand style pacemaker.
During pregnancy.
Patients with undiagnosed pain conditions.
Patients with peripheral vascular disease.
Patients who cannot understand the instructions.
Neoplastic tissue.
Devitalised skin – after deep x-ray therapy.
Do you have a pacemaker or any other heart conditions?
Do you have any pain in the area?
Do you have any skin conditions?
Precautions
Do not drive a vehicle whilst attached to a NMES
Skin irritation may occur – check skin thoroughly
Only use NMES for what you have been prescribed
Do not immerse in water
Do not place the electrodes:
-Over the carotid sinus
-Over larynx or trachea
-Inside the mouth
-On anaesthetised skin
