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NEUROMUSCULAR ELECTRICAL STIMULATION

Theories of strength augmentation using NMES . Based on the overload principle.Greater strength will occur when training at higher contraction intensities (forces) than training at lower intensities.Based on the recruitment order.ES results in recruitment of large motor nerves and thus in prefere

MikeCarlo
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NEUROMUSCULAR ELECTRICAL STIMULATION

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    1. NEUROMUSCULAR ELECTRICAL STIMULATION Uses To increase force out put and strengthening. Muscle endurance training. Functional electric stimulation. Management of spasticity. Tissue healing. Pain reduction. Reduction of edema.

    2. Theories of strength augmentation using NMES Based on the overload principle. Greater strength will occur when training at higher contraction intensities (forces) than training at lower intensities. Based on the recruitment order. ES results in recruitment of large motor nerves and thus in preferential stimulation and training of type II muscle fibers, which produce more force than type I, fibers.

    3. Parameters settings for ES for muscle strength Current type / wave form MF Burst AC and symmetrical BPC have demonstrated to be effective in muscle strengthening. MPC has not been shown to promote strengthening in uninjured subjects.

    4. Parameters settings for ES for muscle strength Current amplitude: Current amplitude is increased until the desired physiologic response is achieved. Increasing the amplitude to the highest tolerable level demonstrated a good result in muscle strength. The minimum force required to gain strength is equal to 50% of MVIC. Studies suggested that 10% of MVIC of the UN injured limb can produce strength in injured part.

    5. Parameters settings for ES for muscle strength Frequency To maximize force out put without fatigue, a range of 50 to 80 Pps for BPC. When using MF burst AC, a carrier frequency of 2500 Hz, with a burst frequency of 50 burst per second and 50% duty cycle. Lower duty cycle to 20% is also effective.

    6. Parameters settings for ES for muscle strength Pulse duration A motor level response must be produced to affect strengthening. Pulse duration of PC should be set at a range of 100 to 600 u sec. Longer duration within this range increase the force output as long as it is tolerated by the patient.

    7. Parameters settings for ES for muscle strength On and off time 6 to 10 seconds appear to be most effective to produce MVIC. Longer off time will prevent a decrease in force output over successive contractions in a series. 50 to 60 seconds off is highly recommended.

    8. Parameters settings for ES for muscle strength On and off time The time constrains of the patients may influence the available treatment time and thus the selection of off time. If the force does not decline, maintain the selected off time. The off time is increased if the force is declined to allow enough time for the muscle to rest and recover.

    9. Parameters settings for ES for muscle strength Ramp Should be set according to patient tolerance. Ramp down should be half or equal to ramp up time. Up to 5 seconds is recommended

    10. Parameters settings for ES for muscle strength Electrode configuration Placement of electrodes parallel to the direction of muscle fibers appears to be highly effective. The choice the number of electrodes depends on the size of the muscle. Electrode size should be chosen to maximize muscle coverage. Prevent over flow of the stimulus to the adjacent muscle as much as possible, by selecting the appropriate size of the electrode.

    11. Contra indications cardiac pacemaker, carotid sinuses, venous or arterial thrombosis, thrombophlebitis, indwelling phrenic nerve stimulator, indwelling urinary bladder stimulator, Operating diathermy device.

    12. Precautions Over tissue vulnerable to hemorrhage or hematoma. Over areas of skin irritations, damage or lesions. In thoracic region in skinny patients. Over eyes. Pregnancy. Over cervical area for patients with a history of seizures. Impaired sensations.

    13. Effect of current amplitude on muscle torque

    14. Clinical Applications Put the patient in a comfortable position, according to the nature of his problem to maximize the potential benefits of the treatment. Before placing the electrodes, inspect patient’s skin. Determine the site of the electrodes and the numbers of electrode that you are going to use Select the treatment parameters settings. During treatment, ask the patient regarding his comfort and unpleasant sensation. When the treatment is completed, remove the electrodes and inspect the skin again. Measure the muscle strength. Document the treatment.

    15. Two channels four electrodes configuration

    16. Electrode configuration

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