PHYSMOD_ ELECTRICAL CURRENTS FOR MM CONTRACTION

DOT

________

• means Intact peripheral nerves, including the motor unit and neuromuscular junction

  ▪ Usually manifests as disuse atrophy

  • E.g. post-operative weakness, orthopedic

    conditions, CNS affectation, etc.

Innervated Muscles

DOT

______

• happens due to peripheral nerve injury

  • manifests as denervation atrophy

Denervated Muscles

DOT

______

• Use of ES to produce muscle contractions in innervated muscles

________

• Aka Orthotic Substitution

• Type of NMES that specifically enhances the control of movement and posture

  • NMES integrated to functional activities

• Neuromuscular Electrical Stimulation

• Functional Electrical Stimulation (FES)

Muscle Contraction

Volitional

• Due to command from ______ neurons

• Recruits ____ to ____ motor units

• Activates first type ___ muscle fibers

• _____ recruitment of motor units

• ____ onset of muscle fatigue

• Due to command from upper motor neurons

• Recruits smaller to larger motor units

• Activates first type I muscle fibers

• Asynchronous recruitment of motor units

• Slow onset of muscle fatigue

Muscle Contraction

Electrically-induced

• Due to applied electricity stimuli

• Recruits larger to smaller motor units

• Activates first type II muscle fibers

• Synchronous recruitment of motor units

• Rapid onset of muscle fatigue

baliktad lang ng volitional

Therapeutic Effects

• INC Muscle Strength

  • ______Principle

    • ↑ current, ↑ frequency, ↓ pulse duration ,

      INC externally-applied resistance

  • ______ Theory

    • Targets type II muscle fibers which are reduced

      after surgery, immobilization or any pathology

• INC Muscle Strength

  • Overload Principle

    • ↑ current, ↑ frequency, ↓ pulse duration ,

      INC externally-applied resistance

  • Specificity Theory

    • Targets type II muscle fibers which are reduced

      after surgery, immobilization or any pathology

Therapeutic Effects

• INC Muscle _____

  • Increased muscle size ↑ muscle mass usually takes several weeks to occur

• Improved motor unit _______

  • Occur more rapidly

  • Synchronized recruitment of more motor units

• INC Muscle Strength

  • Increased muscle size ↑ muscle mass usually takes several weeks to occur

• Improved motor unit recruitment

  • Occur more rapidly

  • Synchronized recruitment of more motor units

Therapeutic Effects

• Promotes Muscle _______

  • Improvement of motor control

  • Stimulates brain plasticity

• Promotes Muscle Re-education

  • Improvement of motor control

  • Stimulates brain plasticity

Therapeutic Effects

• Prevents _____ Atrophy

  • Provides externally-induced muscle contraction to prevent muscle wasting

  • With adequate muscle strength, it serves as a biofeedback to promote muscle contraction

• Prevents Disuse Atrophy

  • Provides externally-induced muscle
    contraction to prevent muscle wasting

  • With adequate muscle strength, it serves as a
    biofeedback to promote muscle contraction

Therapeutic Effects

• Reduces Muscle ______

  • Over both agonist

    • Fatigue the muscle , Relaxation

• Reduces Muscle Spasm

  • Over both agonist

    • Fatigue the muscle , Relaxation

Therapeutic Effects

• Reduces Muscle Spasticity

  • Over the antagonist 

    • _____ inhibition of agonist muscle

  • Over both agonist and antagonist muscle

    • _____ stimulation of agonist then followed by antagonist

• Reduces Edema

  • Through the ________ effect

• Reduces Muscle Spasticity

  • Over the antagonist 

    • Reciprocal inhibition of agonist muscle

  • Over both agonist and antagonist muscle

    • Sequential stimulation of agonist then followed by antagonist

• Reduces Edema

  • Through the muscle pumping effect

Functional Electrical Stimulation (FES)

• During gait training

  • Over tibialis anterior during initial contact

  • Over gastrocnemius during push-off

• For idiopathic scoliosis

  • Over lateral flexors on convex side 

• During gripping activity

  • Over wrist extensors

• For shoulder subluxation 

  • Over supraspinatus and posterior deltoids

• During cycling 

  • LE: Over quadriceps femoris and hamstrings

  • UE: Over biceps brachii and triceps brachii
    

Parameters Waveforms:

• ________

  • Commonly uses square, balanced, symmetrical,

    biphasic PC; some use asymmetrical biphasic PC

• _________

  • Uses medium frequency AC with a frequency of 2500

    Hz delivered in 50 bursts per second

• _________

  • Alternating medium-frequency currents, which are

    slightly out of phase and amplitude-modulated at low

    frequency

• Biphasic Pulsed current

• Russian current

• Interferential current

Electrode placement 

• Active electrode over the motor point and dispersive electrode about __ inch away on the same muscle following the orientation of the muscle fiber (preferred) [ ____ if on same muscle; ___ if on other area]

  • Face and smaller muscles of the hand: motorpoint stimulation using probe/motor pen

• Motor point between 2 electrodes (_____)

• 4 electrodes over targeted muscle (_____)

• Wider spacing —> _____ stimulation 

• 2 inch away

• bipolar → same ; monopolar → other area

• bipolar

• quadripolar

• Wider spacing —> deeper stimulation

PARAMETERS FOR STRENGTHENING

• ______ Principle & _______ Recruitment

• Pulse Duration →

• Amplitude →

• Ramp Up/Down →

• Frequency →

• Treatment Duration →

• On time: Off Time →

• Ratio →

• Overload Principle & Selected Recruitment

  • 150-200 μsec (smaller muscles) & 200-350 μsec (larger muscles)

  • ≥50% MVIC; max tolerated muscle contraction

  • At least 2s

  • 20 pps (smaller mms) ,30 pps (larger mms), 35-50 pps (smooth tetanic) ,50-80 pps (greater strengthening)

  • 10-20min (10-20 reps)

  • 1:5 initially , 1:3 , 1:1

  • 10 sec on: 50 sec off

PARAMETERS FOR MUSCLE ENDURANCE

• __ contraction time & _ rest intervals

• Pulse Duration →

• Amplitude →

• Ramp Up/Down →

• Frequency →

• Treatment Duration →

• On time: Off Time →

• Ratio →

• ↑ contraction time & ↓ rest intervals

• 150-200 μsec (smaller muscles) & 200-350 μsec (larger muscles)

• 25-50% MVIC

• At least 2s

• 30-50 pps

• More repetitions

• 1:1

• NA

PARAMETERS FOR SPASTICITY Motor Level

• Pulse Duration →

• Amplitude →

• Ramp Up/Down →

• Frequency →

• Treatment Duration →

• On time: Off Time →

• Ratio →

• 150-200 μsec (smaller muscles) &

• 200-350 μsec (larger muscles)

• At motor threshold; to visible contraction

• 0.5-3 sec

• 35-50 pps

• 10-60 min

• 1:1, 3:4

PARAMETERS FOR SPASTICITY Sensory Level

• Pulse Duration →

• Amplitude →

• Ramp Up/Down →

• Frequency →

• Treatment Duration →

• On time: Off Time →

• Ratio →

• 20-100 μsec

• Below motor threshold

• NA

• 80-100 pps

• 10-60 min

• NA

PARAMETERS FOR MUSCLE SPASM MOTOR Level

• Pulse Duration →

• Amplitude →

• Ramp Up/Down →

• Frequency →

• Treatment Duration →

• On time: Off Time →

• Ratio →

• 150-200 μsec (smaller muscles) &

• 200-350 μsec (larger muscles)

• At motor threshold; to visible contraction

• At least 1 sec

• 35-50 pps

• 10-30 min

• 1:1

• (2-5 sec on; 2-5 sec off)

PARAMETERS FOR EDEMA REDUCTION MOTOR Level

• Pulse Duration →

• Amplitude →

• Ramp Up/Down →

• Frequency →

• Treatment Duration →

• On time: Off Time →

• Ratio →

• 150-200 μsec (smaller muscles) &

• 200-350 μsec (larger muscles)

• At motor threshold; to

• visible contraction

• At least 1 sec

• 35-50 pps

• 30 min

• 1:1 (2-5 sec on; 2-5 sec off)

Duty Cycle Formula

Duty Cycle = [ON ÷ (ON + OFF)] x 100

PARAMETERS: STIMULATION MODES

• _____________

  • Channels 1&2 produces ON and OFF times together

  • Stimulate muscles during on time and off time actively; two channels acting on the same time

    • Eg. Quadriceps and TAs

    • Ask the Pt. to extend the knee and bring the toes upwards once you feel the electric sensation

SYNCHRONOUS (CO-CONTRACTION)

PARAMETERS: STIMULATION MODES

• ____________

  • While channel 1 is ON, channel 2 is OFF

  • Application on antagonistic or agonistic muscles; may be done separately if aim is a more focused contraction

    • Eg. During ON time, ask the Pt. to extend the knee. At OFF time, ask the Pt. to relax the limb

RECIPROCAL

Progressive Training Methods

• ________

  • Muscle contraction solely relies on electricity

• ________

  • Contraction produced by both the electrical stimulator and the patient

• ________

  • Electricity only serves as feedback for contraction

• NMES

• NMES plus volition

• NMES as biofeedback for motion

NMES/FES DOCU

NMES/FES using To <affected muscle> x <pulse frequency> x <pulse duration> x <duty cycle or On & Off time> x <treatment duration> to<rationale>.

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