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