1 / 16

NeuroMuscular Electrical Stimulation in CNS Dysfunction: Applications and Optimization

Explore the use of NMES for central nervous system dysfunction and hemispherectomy, including goals, benefits, and optimization strategies for effective habilitation. Discover how NMES facilitates sensory/motor integration, muscle strengthening, and reduction of spasticity.

amyl
Download Presentation

NeuroMuscular Electrical Stimulation in CNS Dysfunction: Applications and Optimization

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. NeuroMuscular Electrical Stimulation for facilitation in central nervous system dysfunction Possible applications following hemispherectomy

  2. NMES – HOW? • Surface • Therapeutic • Short to Medium term Training • Implant • Long term Management (FES)

  3. NMES – WHEN? • Acute Habilitation • Sub-acute Habilitation • Long Term

  4. NMES – Why? • Added Sensory Information for Processing • Muscle strengthening • Increased Sensory/Motor Integration • Motivation • Modification of ‘spasticity’/ tone

  5. NMES – Whom? • Orthopedic Dysfunction • Neurologic Dysfunction • Developmental Dysfunction

  6. Treatment Goals Enhanced with NMES • Strengthening Programs • Range of Motion & Contracture Management • Facilitation & Reeducation • Edema Management • Temporary Spasticity & Spasm Management • Functional Electrical Stimulation

  7. Proprioceptive changes in cortical processing of finger flexion/extension FES Assist > Vol FES Evoked > Vol Normal subjects comparing sensory processing between voluntary finger contractions and NMES assisted (NMES Assist) with stimulation without voluntary overlay (NMES evoked). Take home message – voluntary AND NMES activate more brain!

  8. Proprioceptive changesVol + NMES compared to just NMES Super Front Sulcus SMA – Supplimentary Motor Association Cortex Super Front Gyrus From: Modulation of proprioceptive feedback during functional electrical stimulation: an fMRI study, Europ J Neuroscience 2013

  9. Optimizing NMES training • Sensory Level to Motor Level NMES • Based on Awarness and Voluntary Control – Less is Ultimately More • COMBINED with “Meaningful Activity” • Specific for your child • NMES TRIGGERED at appropriate points of the activity – Dynamic Input

  10. Optimizing NMES training • HABILITATION (CREATING a ‘Motor Program’) requires longer Intervention to Attain (based on CP experience) • Creative and Dynamic Applications with Therapist /Parent • MAKE IT FUN!

  11. Cortical profusion of Hemiparetic Patients before and after training with EMG-FES From: The effects of electromyography-controlled functional electrical stimulation on upper extremity function and cortical perfusion in stroke patients: in ClinNeurophysio 2013 Pre-Training After 5 weeks Training

  12. Facilitation in Children

  13. Meaningful activities for children

  14. NMES Why Bother? • Multiple Treatment Outcomes from One Treatment Intervention • Facilitation may enhance muscle strength and increase ROM • Strengthening Increases ROM and Decreases Spasticity

  15. NMES Why Bother? • Multiple Goals to Reduce a Wide Variety of Impairments • It will take great creativity to enhance FUNCTION !

  16. NMES – Why Bother? • NMES – a potentially powerful, multimodal tool for Habilitation B U T it will require a skilled and knowledgeable Therapist and could be optimized by a very involved family (for home follow-up, with or without the NMES)

More Related