Russian Flashcards
What are the two broad categories that electrical muscle stimulation (EMS) can be divided into?
- Neuromuscular electrical stimulation (NMES; sometimes called electromyostimulation) used for strengthening.
- Functional electrical stimulation (FES) used for re-education or endurance training of muscles.
What is NMES used for?
strengthening or therapy; it increases muscle strength, however it does not appear to be superior to voluntary training. In rehab, NMES is used for prevention of atrophy in injuries to bones, joints, muscles, ligaments, and tendons. Effectiveness in sports training is debated, but some coaches and athletes use it to supplement training schedules.
What is FES used for?
re-education or endurance training of muscles
Is NMES training effective in a weight loss program?
it uses minimal calorie burning, however it is NOT a weight loss method
The FDA approved neuromuscular stimulator devices as medically necessary for what indications?
- When muscular atrophy is present in the setting of an intact nerve supply to the muscle, including brain, spinal cord and peripheral nerves.
- As a component of post-operative rehabilitation settings. This occurs when muscular atrophy is present before an orthopedic intervention (i.e., repair of anterior cruciate ligament). Or when neuromuscular stimulation may be initiated immediately in the post-op phase as an adjunct to physical therapy.
When is neuromuscular stimulation NOT considered medically necessary?
- Prevention of muscle ATROPHY, i.e., following an orthopedic procedure
- Treatment of PAIN for various musculoskeletal conditions, including, but not limited to patellofemoral syndrome, spinal stenosis, lumbago, muscule strains/sprains
- As a technique to increase GENERAL CIRCULATION.
What is the carrier frequency of Russian stimulation?
2,500 Hz
What is the on/off time of Russian stimulation?
10-milliseconds at 10-millisecond intervals, producing fifty 10-millisecond bursts per second.
Russian stimulation produces time interval interruption which produces ____________ current. This is also known as ________ frequency, ________________.
time modulated, medium, BURST alternating
What is the wave form of Russian stimulation?
biphasic sinusoidal
What is the modulation of Russian stimulation?
continuous pulsatile current with burst modulation
Russian current is simply a variation of _________ current.
alternating
How often are bursts of Russian stimulation delivered?
50 bursts per second
What is the interburst interval of Russian stimulation?
10 msec
What is the burst duration of Russian stimulation?
10 msec
Within each 10 msec burst, there are ____ complete cycles of AC.
25
What waveform is well suited for activating skeletal muscle?
a waveform with a therapeutic, or treatment, frequency of 50 Hz and 500 microseconds cycle duration
Today the burst duration of Russian stimulation described as having ___% duty cycle.
50
True/False: The duty cycle is different than the original duty cycle
true
What is the original protocol for Russian stimulation? What are the generally accepted parameters for strengthening.
50% relative duty cycle, 400 micro seconds.
For strengthening: 75 pps, 10 seconds on: 50 seconds off, 10 min.
What is Kots’s Russian Stimulation Protocol regarding strength increases?
Carrier frequency 2500 Hx sine wave. Burst frequency: 50 bursts per second.
15 seconds on (5 sec ramp & 10 sec at max stim)
50 seconds off
Duty time 23%
15 contractions daily at supramax contraction.
What is today’s typical muscle strengthening protocol for Russian stimulation?
amplitude: tetanic muscle contraction. pulse rate: 50-70pps. pulse duration: 150-200/micro sec. Ramp 1-5 sec based on patient’s tolerance. Duty cycle: 1:5.
Russian stimulation is applied to provide stimulation during the following volitional activities:
- isometric exercises at several points through ROM
- slow isokinetic exercise; e.g., 5-10 degrees/sec
- short arc joint movement when ROM is restricted
A Russian pulse rate less than 10 pps for twitch contraction, which is used for:
edema control & chronic pain
A Russian pulse rate greater than 30 pps for tetanic contraction, which is used for:
spasm reduction & disuse atrophy
When inducing a tetanic Russian stimulation contraction, you must use a ________
surge (ramp)
Russian stimulation intensity is dependent on the patient response. However, it needs to be sufficient in order to _____.
cause muscle contraction
How long does it take for the skin resistance to decrease.
5-10 seconds, after this occurs the intensity may be increased
Pause ____ sec in each area to overcome skin resistance.
5-10
If the patient complains of discomfort check:
- too much current (most probable cause)
- Insufficient moistening of sponge
- Minor small denuded area (scratches, cuts, abrasions)
- The patient’s hypersensitivitiy
- poor electrode conformity or size
As the patient gets stronger, resistance can be applied __________.
during the contraction
What is the length of application of Russian stimulation?
10-30 minutes
What is NMES used for?
Used for muscle reeducation & prevention of disuse atrophy. NMES is of value in maintaining muscle integrity, combating disuse atrophy, and promoting early AROM in postsurgical patients.
These might be patients for whom peripheral nerve innervation is INTACT but normal voluntary contraction is weak or limited from muscle atrophy after prolonged immobilization, after surgery, or as a result of pain. Don’t use if patient is strong enough to do a voluntary muscle contraction.
How does NMES restore muscle function
- Depolarizes a-motor neurons, NMS causes muscles to involuntarily contract
- After several repeated contractions, the CNS receives and processes afferent feedback from the muscle.
- This improves the patient’s proprioceptive and visual sense of the motions.
- The patient begins to relearn the motions.
- As the patient gets stronger, they need to isometrically contract the muscles
Electrical muscle stimulation recruits fibers in the ____ order than a voluntary contraction.
opposite; when a patient is hooked up to an NMES unit and allows the machine to produce a passive contraction, the large nerve fibers fire first, followed by the smaller fibers.
When a patient performs an active voluntary contraction, the ____ fibers fire firest, followed by the ____ ones.
small, larger
While the paitnet is using Russian stimulation & getting stronger ___________ can be applied.
resistance; can be manual or with leg weights
Is NMES used for decreasing muscle spasm
yes
Spasms of skeletal muscles are most common and are often due to:
dehydration and electrolyte abnormalities.
A spasm can result from:
microtrauma, macrotrauma, accumulation of chemical irritants, muscle weakness, and pain
As a spasm puts pressure on sensitive nerve endings, more pain is produced, causing the:
vicious pain-spasm-pain cycle
The goal of treating muscle spasm with Russian stimulation is:
goal is to break the pain-spasm-pain cycle while providing normal ROM to the area of pain
What are the 3 goals of tetanic contraction stimulation
- increase local circulation
- remove metabolic wastes
- mechanically stimulate muscle fibers & induce some muscle spasm fatigue.
What effect does stimulating a muscle fiber at a certain intensity for long durations do?
Render that muscle unable to contract. This allows for a decrease in pain that the patient feels and allows other tissues surrounding the area to recuperate without the muscle spasm hindering healing.
What protocol is used to reduce acute & chronic muscle spasm protocol?
Intensity: strong enough to see a visible contraction of the affected muscle.
Pulses per second: 100-125 pps
Continuous
Pad placement should allow for complete contraction of the affected muscle
An electrode placement using a surrounding technique is usually the most accurate
treatment time: 20 minutes or until spasm is broken
How does NMES decrease edema?
It can produce muscle contraction (twitch contractions) to stimulate lymphatic flow and help remove free protein and edema from the area.
Should the patient contract muscles during NMES to decrease edema?
Yes, the patient should contract during the ON phase of each stimulation to help milk out edema
What is the duty cycle for NMES to decrease edema?
1:1
How does NMES increase ROM
Increasing the ROM in contracted joints is also a possible and documented use of electrical muscle stimulation. Electrically stimulating a muscle pulls the joint through the limited range. The continued contraction of this muscle group over an extended period of time appears to make the contracted joint and muscle tissue modify and lengthen.
What must you do before doing NMES for increasing ROM?
rule out bony impairments that might be impairing ROM before starting.
What is the duty cycle for increasing ROM?
it varies from 1:1 to 2:5
How strong should the intensity be for NMES with a goal of increasing ROM?
the intensity should be strong enough to move the extremity through the anti-gravity ROM. Intensity should be increased throughout the treatment.
How many pulses per second is needed to increase ROM using NMES?
20-30
What mode is used for NMES with a goal of increasing ROM?
interrupted or surge mode
What is the on/off time for NMES with a goal of increasing ROM?
on 15-20 seconds & off 15-20 seconds
What is the treatment time for NMES with a goal of increasing ROM?
90 min daily (3 sessions x 30 min)
For increasing ROM what group of muscles is stimulated the agonist or antagonist muscle that has the contracture?
antagonist
What are the 4 precautions for NMES?
- May cause burns beneath the electrodes (monitor the patient).
- Don’t use on patients who cannot provide feedback
- hypertension or hypotension (monitor frequently), ANS response may affect the BP
- very overweight people may have increased sensitivity to burns (monitor frequently)
What are the contraindications of NMES?
- healing fractures
- areas of active bleeding
- malignancies or phlebitis in treatment area
- superficial metal implants
- pharyngeal or laryngeal muscles
- patients with demand-type pacemaker, myocardial disease
A variation on Russian current is ______ current
“Aussie”
Aussie current is _____Hz ____modulated ___current delivered in __ msec bursts
1000, burst, AC, 4
With Aussie current there is greater ____ production and decreased rate of ____ _____ that have been reported compared to conventional 2500Hz, 10msec burst waveform of Russian current.
torque, muscle fatigue
What are the 3 reasons why one cant get washboard abs using NMES?
- ES does not cause a contraction that is as strong as a voluntary contraction unless it is turned way up.
- The order of m. fiber recruitment is reversed and uncontrolled
- The exercises is not effortless; it is involuntary. ATP is still used as are all other components of contraction
In burst, pulsed current; there are __ phase durations of ___micro sec and __ interphase intervals of ___micro sec, the burst duration is 1.7msec
6, 200, 5, 100
6 phases (3 biphasic pulses) in 1.7 msec equates to a carrier freq of ___Hz
1675
A burst freq of 50 bps, the interburst interval is 18.3 msec, equating to a duty relative cycle of __%
9
