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Basic Therapy Principles

Basic Therapy Principles. Sybil Hedrick, OTR/L, CHT, CSCS Amy Rinder , OTR/L, CHT. General Factors Effecting Prehension. Somatosensory feedback Anticipatory Control Pre-shape of hand Velocity of reach Power of grip Gradation based on expected sensory (i.e. slippery)

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Basic Therapy Principles

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  1. Basic Therapy Principles Sybil Hedrick, OTR/L, CHT, CSCS Amy Rinder, OTR/L, CHT

  2. General Factors Effecting Prehension • Somatosensory feedback • Anticipatory Control • Pre-shape of hand • Velocity of reach • Power of grip • Gradation based on expected sensory (i.e. slippery) • Visual information

  3. Electrical Stimulation: Estim • NMES (neuromuscular electric stimulation) • Can augment muscle strengthening in muscles being prepared for transfer • Direct current: used to stimulate denervated muscle • Pulsed alternating current: • TENS • Primarily pain modulation • Biofeedback

  4. Denervated vs. Innervated • Denervated muscles require a pulse duration of 1 millisecond. • Functioning nerves only require 300-400 microseconds to stimulate. • So…denervated muscles require pulse duration of 2-3 x longer to reach threshold • Denervated muscle tissue can only be stimulated by direct current.

  5. DC Estim details… • For denervated muscles • With the “oil can” stimulator can do 2 different methods 1) 2 rubber electrodes that need a coupling agent -negative pole over the muscle desired to be stimulated 2) Pin-point stim with the tip with a sopping wet ground somewhere else on the body. • For hand muscles, i.e. FDM, use pin-point stim • For ECRB, use the 2 electrodes • You can learn the exact motor points, can follow a chart, or just play around during the treatment (because everyone’s body is different).

  6. NMES: general settings • Rate selection…pps • Affects the quality of a muscle contraction and muscle fatigue • Tetany, so gets a smooth muscle contraction and want 25-50pps • Higher rates elicit muscle fatigue (80pps) • We want to find the minimum rate to get a good tetanized contraction…this will help reduce the onset of fatigue • 4-8pps is more for edema reduction • Pulse duration or width • Typically between 200-400microseconds • 100-200 is generally used for small muscle groups • 250-400 for large muscle groups • At the same intensity, increasing pulse width will recruit more motor units, giving a stronger muscle contraction. • Duty cycle • Initially want longer off (rest) times to delay muscle fatigue • Muscle re-education is typically set at 1:3 (10 sec on/30 sec off) • Muscle spasm is usually 1:1 (10 sec on/10 sec off)

  7. Other Modalities • Heat • Decrease pain (Gate theory, increased blood flow, increased tissue extensibility) • Increase ROM • Must be cautious when sensation is impaired to avoid burns • Can increase speed of nerve conduction velocity

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