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Fall 2023 Physical Agents > Week 6 E-Stim (NMES, FES, & EMS) > Flashcards

Week 6 E-Stim (NMES, FES, & EMS) Flashcards

1
Q

NMES Definition

A
  • Neuromuscular Electrical Stimulation
  • Activation of skeletal muscle for strengthening, reeducation or edema reduction - Peripheral nerve depolarization to create a muscle contraction
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2
Q

Which depolarizes first Nerves or muscle cells?

A

Nerves have a lower threshold for depolarization and will depolarize before muscle cells

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3
Q

FES Definition

A
  • Functional Electrical Stimulation
  • Activation of skeletal muscle for reeducation or movement training for functional use
  • May be used on innervated or denervated muscle
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4
Q

EMS Definition

A
  • Electrical Muscle Stimulation
  • Implications stimulation of denervated muscle- muscle cells depolarize to create a muscle contraction
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5
Q

What is the primary difference between NMES and EMS

A

The type of tissue stimulated in the main difference

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6
Q

True/ False NMES will not work for LMN

A

True
NMES will not work for LMN you will need to consider EMS
–> NMES and FES are options for UMN

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7
Q

what are the goals of NMES

A
  • Strength and re-education
    1. Prevent or treat muscular atrophy following disuse, immobilization or detraining
    2. increase or maintain ROM
    3. Re-education, retain or facilitate muscle for movement posture
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8
Q

NMES can Increase (blank) very rapidly

A
  • Can increase motor recruitment rapidly
  • Increasing number off motor units recruited
  • Increasing frequency motor units recruited
  • Motor units recruited more synchronously
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9
Q

NMES Evidence supports….

A
  • Supports strengthening weakened muscles
  • increased muscle size
  • Improved motor unit recruitment
  • Similar strength improvements compared to exercise
  • Shown to prevent muscle atrophy***
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10
Q

True/ False the training intensities of ES and exercise have to be similar training intensities for strength gains

A

True

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11
Q

ES results show in early rehab…

A
  • ES results in greater gains in strength than voluntary exercise or no exercise in early rehab when voluntary exercise may be difficult
  • Significant positive relationship between strength of ES and strength gained
    –> Post rehabilitation stages show little to no difference between subjects who use ES and those who do not
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12
Q

NMES for Strengthening and for Orthopedic conditions they are beneficial for early phases of rehab and…..

A
  • Post knee surgery
  • ACL reconstruction
  • TKA
  • Knee meniscal repairs
    Non- Surgical benefits
  • Knee OA
    -Patellofemoral Syndrome
    BENEFICAL FOR ATROPHY ASSOCIATED RA
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13
Q

NMES can help with which kinds of critically ill patients

A
  • COPD
    -Chronic Heart Failure
  • Thoracic cancer
  • After cardiothoracic surgery
    Multiple studies show promise with NMES used for these critical conditions
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14
Q

NMES best evidence supports which kinds of patients?

A

Stroke

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15
Q

What is the goal of NMES for increasing ROM in neurological conditions?

A

Longer treatment time (low load, prolonged application)

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16
Q

What are the 3 theories for NMES for Decreasing Spasticity in Neurological Conditions

A
  1. Stimulate antagonist= reciprocal inhibition
  2. Stimulate agonist= recurrent inhibition (fatigue the muscle or recurrent inhibition)
  3. Habituation= sensory level- continuous with lower amplitude to avoid a muscle contraction
17
Q

What are the precautions for Implanted Sacral Nerve stimulators

A
  • Pregnancy
  • Could become pregnant
  • infections or lesions
  • prolapsed uterus
  • recent pelvic surgery
18
Q

NMES Waveform

A
  • Pulsed Biphasic= adjustable pulse duration and frequency
  • Russian= Medium frequency AC with a carrier frequency of 2500Hz delivered in 50 burst per second
19
Q

NMES Amplitude

A
  • Highest tolerated pulse duration/amplitude
  • Greater than 50% MVC recommended
20
Q

Shorter duration is more comfortable for …… muscles

21
Q

Longer duration is mor comfortable for …..muscles

22
Q

If the pulse duration than a …… amplitude will be required to achieve the same strength contraction

23
Q

Frequency

A
  • Determines muscle response
  • If frequency is to low, separate muscle twitches produce rather than smooth tetanic contraction
  • Range typically 35-50pps up to 80pps for larger muscles
24
Q

NMES time on and off to reduce spasms and increase ROM

A

On:off= 1:1
on and off times each 2-5 seconds

25
Q

NMES time on and off time for strengthening

A

1:5
1:3
on and off time 6-10 seconds
Off tie up to 50 seconds
Ramp up time 1-5 seconds
Ramp down time 1-2 seconds

26
Q

Parameter for NMES strengthening

A

Waveform= Biphasic PC or Burst modulation AC, Russian, Aussie

Pulse frequency= 20-80pps: small muscles 20-30+pps: Larger muscles 50+pps

Pulse Duration= 200-600microseconds (micropenis): typical 125-250 smaller muscles: larger muscles 200-350

Amplitude= as high as a patient can tolerate with a goal of reaching 50% max voluntary contraction

Duty Cycle= 1:3 to 1:50: ramp up 2-5 secs: ramp down 1-2 secs

Duration= 10-20 strong contractions: 1 hr/day- 3-5x/week 4-8 weeks

27
Q

NMES for Muscle Spasm reduction/ Improve tissue extensibility

A

Waveform= Biphasic PC, burst modulation, Russian, Aussie

Pulse Frequency= 35-50pps

Pulse duration= typically 125-200microseconds for smaller muscles: 200-350 microseconds for larger muscles

Amplitude= To visible contraction

Duty cycle= 1:1

Duration= 10-30 minutes
1-4x/day 2-6 weeks

28
Q

FES muscle contraction for functional use

A

Waveform= Biphasic PC, burst modulation AC, Russian, Aussie

Pulse Frequency= 20-60 pps

Pulsed Duration= 200-600 microseconds

Amplitude= to level commensurate with functional activity

Duty Cycle= Depends on function activity

Duration= task specific

29
Q

Limitations of NMES

A
  • Increased fatigability can account for greater muscle soreness, limit in amount of training
  • Increase DOMS
  • Limited number or muscle groups can be trained
  • Only single joint activity
30
Q

NMES Parameters for Subacute and Chronic Edema

A

Waveform= Biphasic PC or burst modulation AC, Russian, or Aussie

Pulse Frequency= 20-80pps

Pulse duration= 100-600 microseconds

Amplitude= mA to tetanic contraction

Duty Cycle= 1:1

Duration 10-20 minutes o rhythmic contractions
1-2x day monitor edema

31
Q

EMS Parameters for Denervated Muscle

A

Waveform= Monophasic/ DC

Pulse duration= 1-450 microseconds

Frequency = 1-500 pps

Amplitude= high enough to obtain contractions but low enough to prevent burns

Ramp up/down= none

Duty cycle= Highly variable; on time 3-10 seconds and off time 30-50 seconds

Treatment duration= 30minutres/ 8 hours per day ; 5-7days a week; 4 days to 4 years

Fall 2023 Physical Agents (7 decks)

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