Electrical Stimulation for Motor Activity
Phase duration for NMES
200-300 usec
FES
Functional Electrical Stimulation
Also called
NMES, EMS, FES
NMES for peripheral circulation
20 to 35 Hz or 3 Hz; amplitude is 10-30% of max. contraction, strong but tolerable; electrodes on motor point; non-fatiguing, 1:6 duty cycle; 10 to 30 min., as frequently as is comfortable to the pt.
NMES for muscle re-education
<40 Hz (30-39 is suggested); intensity to muscle contraction required for the functional activity; electrodes on motor point; for duty cycle adjust ramp and fall times according to the task; short, frequent tx. session; 10-30 min., 2-3 x/day
NMES for endurance
<40 Hz (30-39 is suggested); intensity to muscle contraction; should not be painful; electrode on motor point; variable duty cycle, start with non-fatiguing (1:6 or 1:5), progress to longer on times & shorter off times; start with what pt can tolerate w/o excessive fatigue, increase gradually; 1 to 3 times per day
intact peripheral nervous system
E-stim for the purpose of improving motor performance through the...
Functional Electrical Stimulation
E-stim used to supplement or replace function
EMS
Electrical Muscle Stimulation
NMES
Neuromuscular Electrical Stimulation
Mobility
ROM can be increased by strengthening weak muscles
6 to 10 seconds
What hold time builds optimal tension for muscle strengthening (NMES)?
Peripheral circulation
can be improved with intermittently activating the muscle pump around the circulatory network & to increase metabolic demand
Precautions
decreased sensation; open wounds; extreme edema; heavy scarring/thick adipose tissue; laryngeal and pharyngeal muscle; near carotid sinus; chronic use of corticosteroids; uncomfortable amplitudes
Muscle strengthening cont'd
electrodes on motor point; duty cycle 1:5 minimum; rest cycle should be 5-10 times as long as hold cycle (10 sec on/50 sec off); helps avoid fatigue; tx. duration 8-10 contractions/tx. session; at least 3x/week for 4 weeks
NMES for mobility
intensity to muscle contraction for improved ROM; electrodes on motor point; <40 Hz (30-39 suggested); duty cycle, start with 1:6 on:off time to avoid fatigue, progress to 1:1 with 10-15 sec. of hold time; progress from 15 min. 2x/day to 30 min. 3x/day
Electrical Stimulation
intro of an electrical current across the skin to excite nerve or muscle tissue
Types of units used
large multipurpose units and small portable units
facilitating muscle activity by assisting voluntary contraction
muscle re-education
Indications cont'd
reduce or prevent shld subluxation after stroke; facilitate active contraction after stroke; improve sensation in pts with chronic stroke; improve ROM in pts with chronic stroke; improve function in pts with permanent central neurological deficits (i.e. SCI); improve function in children with CP; improve muscle & respiratory function in pts with chronic COPD; improve bladder control in pts with stressor urge incontinence
Muscle strengthening
resting position, slightly lengthened range; 50 Hz; intensity strong enough to elicit muscle contraction; stimulation should not be painful
Indications
restore force generation; reduce muscle inhibition due to joint pain and effusion; OA & RA; restore motor control and force generation after total joint arthroplasty; maintain muscle health in peripheral nerve injuries; Bell's Palsy
Purpose & effects
to excite muscle tissue; help strengthen weakened muscle; improve recruitment of motor units during function (i.e. reeducation); decrease spasticity; maintain or improve mobility; improve endurance; decrease swelling & promote peripheral circulation through activating a muscle pump
Contraindications
where active motion is contraindicated; pacemaker; over other implanted stimulators; cancer; metal in tx. area; pregnancy; disoriented pts; active bleeding