Principles of application of NMES and FES in neuro rehab (lab 7)

what is NMES

involves the use of a device which transmits an electrical impulse to the skin over muscle groups by way of electrodes

what does NMES do

stimulate the muscle while the individual is in a resting state to prevent or treat atrophy

NMES features

targets motor nerves and muscles, improves muscle strength, placed over muscle belly, used for stroke / TBI / SCI, often paired with functional tasks, focuses on neuroplasticity and muscle activation

what are TENS unit features

targets sensory nerves, relieves pain, placed around or near the site of pain, used for stroke / TBI / SCI for pain management, no movement, focuses on sensory modulation and comfort

how does NMES contraction occur

from a depolarization of motor neurons where large motor units and type II fibers fire first

what are the uses of NMES

re-educate muscles, improve ROM, decrease spasticity, decrease edema, manage disuse atrophy

what is FES

the use of the electrical impulses to activate specific muscles and motor nerves. These impulses make muscles contract to perform a functional task.

FES must be paired with

a functional movement

what is Excite2

FES station with pre-programmed activities / sequencing and multiple channels

what is FES good for post-stroke

to help with foot drop and promote recovery of muscle activation

where can FES be placed for foot drop

anterior tib or peroneal nerve

what are direct benefits of NMES/FES

hypertrophy of MM, improved strength, motor control improvements, circulation, spasticity reduction

what are indirect benefits of NMES/FES

increase bone density, heart and blood vessel function, overall body composition, pressure regulation, augmented aerobic exercise benefits

what are NMES/FES precautions / contraindications

pregnancy, cancer, pacemaker, broken skin, blood clot or fracture, sensitive skin, exposed metal, undiagnosed / uncontrolled CVD, uncontrolled AD (autonomic dysreflexia), uncontrolled epilepsy

how do you reduce the risk of e-stim

make sure there is strong conductivity and low resistance by prepping the skin, using appropriate size electrodes, replacing electrodes frequently, avoiding bony prominences, and adjusting parameters before increasing amplitudes

what is the frequency of FES

20-50 hertz

what is the pulse width of FES

200-400 us

what is the amplitude of FES

2-120 mA

how much space do you need between estim pads

1 inch

where do you put pad placement for plantar flexion

on the gastroc

how can FES help with shoulder

can help prevent subluxation

what do you need to document about FES

area of body, patient positioning / functional task, parameters used, electrode placement, treatment duration, response to treatment