Exam/Skills Check 2 — PARAMETERS

What are the 4 treatment goals for NMES?

1. Muscle strengthening

2. Muscle re-education

3. Muscle spam reduction

4. Edema reduction using muscle pump

What are the pulse frequencies you would use for each of the treatment goals for NMES?

1. Muscle strengthening = 35-80 pps

2. Muscle re-education = 35-50 pps

3. Muscle spam reduction = 35-50 pps

4. Edema reduction using muscle pump = 35-50 pps

What are the pulse durations you would use for each of the treatment goals for NMES?

Muscle strengthening, Muscle re-education, Muscle spam reduction, & Edema reduction using muscle pump = 125-200 µs for small muscles; 200-350 µs for large muscles

What are the amplitudes you would use for each of the treatment goals for NMES?

1. Muscle strengthening = to greater than 10% of maximum voluntary isometric contraction (MVIC) in injured muscle; greater than 50% in uninjured muscle

2. Muscle re-education = sufficient for functional activity

3. Muscle spam reduction = to visible contraction

4. Edema reduction using muscle pump = to visible contraction

What are the on:off times you would use for each of the treatment goals for NMES?

1. Muscle strengthening = 6-10 sec on, 50-120 sec off (may reduce off time w/ repeated treatments)

2. Muscle re-education = depends on functional activity

3. Muscle spam reduction = 2-5 sec on, 2-5 sec off

4. Edema reduction using muscle pump = 2-5 sec on, 2-5 sec off

What are the ramp times you would use for each of the treatment goals of NMES?

1. Muscle strengthening = at least 2 sec

2. Muscle re-education = at least 2 sec (no ramp time for gait training)

3. Muscle spam reduction = at least 1 sec (4-8 sec if contracting antagonist to spastic muscle)

4. Edema reduction using muscle pump = at least 1 sec

What are the treatment times you would use for each of the treatment goals of NMES?

1. Muscle strengthening = 10-20 repetitions (10-20 min)

2. Muscle re-education = depends on functional activity

3. Muscle spam reduction = 10-30 min

4. Edema reduction using muscle pump = 30 min

How many times per day would NMES be done for each of the treatment goals?

1. Muscle strengthening = every 2-3 hrs when awake

2. Muscle re-education = N/A

3. Muscle spam reduction = every 2-3 hrs until spasm relieved

4. Edema reduction using muscle pump = 2x/day

What are the parameters for NMES for muscle strengthening?

1. Pulse frequency = 35-80 pps

2. Pulse duration = 125-200 µs for smaller muscles; 200-350 µs for larger muscles

3. Amplitude = greater than 10% of maximum voluntary isometric contraction (MVIC) in injured muscle; greater than 50% in uninjured muscle

4. On:Off Time = 6-10 sec on, 50-120 sec off (off time may be reduced w/ repeated treatments)

5. Ramp time = at least 2 seconds

6. Treatment time = 10-20 reps (10-20 min)

7. Times per day = every 2-3 hrs when awake

What are the parameters for NMES for muscle re-education?

1. Pulse frequency = 35-50 pps

2. Pulse duration = 125-200 µs for smaller muscles; 200-350 µs for larger muscles

3. Amplitude = sufficient for functional activity

4. On:Off Time = dependent on functional activity

5. Ramp time = at least 2 seconds (no ramp time for gait training)

6. Treatment time = depends on functional activity

7. Times per day = N/A

What are the parameters for NMES for muscle spasm reduction?

1. Pulse frequency = 35-50 pps

2. Pulse duration = 125-200 µs for smaller muscles; 200-350 µs for larger muscles

3. Amplitude = to visible contraction

4. On:Off Time = 2-5 sec on, 2-5 sec off

5. Ramp time = at least 1 second (4-8 sec if contracting antagonist to a spastic muscle)

6. Treatment time = 10-30 min

7. Times per day = every 2-3 hrs until spasm relieved

What are the parameters for NMES for edema reduction using muscle pump?

1. Pulse frequency = 35-50 pps

2. Pulse duration = 125-200 µs for smaller muscles; 200-350 µs for larger muscles

3. Amplitude = to visible contraction

4. On:Off Time = 2-5 sec on, 2-5 sec off

5. Ramp time = at least 1 sec

6. Treatment time = 30 min

7. Times per day = 2x/day

If the goal is sensory analgesia (gating at the spinal cord), what specific e-stim modality would be done?

Conventional (high-rate) TENS

If the goal is endogenous opiate liberation (endorphin release), what specific e-stim modality would be done?

Acupuncture-like TENS (low-rate)

If the goal is endogenous opiate liberation (endorphin release) & rapid pain relieg, what specific e-stim modality would be done?

Intense TENS

What pulse frequencies would you use for Conventional TENS, Acupuncture-like TENS, and Intense TENS?

1. Conventional = 100-150 pps

2. Acupuncture-like = 2-10 pps

3. Intense = 150+ pps or 80-130 Hz

What pulse durations would you use for Conventional TENS, Accupuncture-like TENS, and Intense TENS?

1. Conventional = 50-80 µs

2. Acupuncture-like = 150-300 µs

3. Intense = greater than 150 µs

What amplitudes would you use for Conventional, Accupuncture-like, and Intense TENS?

1. Conventional = able to produce a strong tingling sensation W/O muscle contraction

2. Acupuncture-like = to visible contraction

3. Intense = able to produce a strong sensation (to tolerance) & non-rhythmic muscle contraction

What treatment times would you use for Conventional, Accupuncture-like, and Intense TENS?

1. Conventional = up to an hour, but can be worn up to 24 hrs as needed

2. Acupuncture-like = 20-30 min (45+ will result in muscle soreness)

3. Intense = 5-10 min

What parameters would you use for Conventional TENS?

1. Pulse frequency = 100-150 pps

2. Pulse duration = 50-80 µs

3. Amplitude = able to produce a strong tingling sensation W/O muscle contraction

4. Treatment time = up to an 1 hr, but can be worn up to 24 hrs as needed

What parameters would you use for Acupuncture-like TENS?

1. Pulse frequency = 2-10 pps

2. Pulse duration = 150-300 µs

3. Amplitude = to visible contraction

4. Treatment time = 20-30 min (longer can cause muscle soreness)

What parameters would you use for Intense TENS?

1. Pulse frequency = 150+ pps or 80-130 Hz

2. Pulse duration = greater than 150 µs

3. Amplitude = able to produce a strong sensation (to tolerance) & non-rhythmic muscle contraction

4. Treatment time = 5-10 min

What pulse frequencies would you use for IFC/Pre-Mod?

1. IFC = fixed carrier frequency (most use 2000-5000 Hz); greater than 4000 Hz for better sensory stimulation

2. Pre-mod = fixed carrier frequency

What pulse durations would you use for IFC/Pre-Mod?

IFC & Pre-mod = changes inversely w/ carrier frequency

What amplitudes would you use for IFC/Pre-Mod?

IFC & Pre-mod = able to produce a strong tingling or vibration sensation

What treatment times would you use for IFC/Pre-Mod?

IFC & Pre-Mod = 20-30 min

What parameters would you use for IFC?

1. Pulse frequency = fixed carrier (most use 2000-5000 Hz); greater than 4000 for better sensory stimulation

2. Pulse duration = changes inversely w/ carrier frequency

3. Amplitude = able to produce a strong tingling or vibration sensation

4. Treatment time = 20-30 min

What parameters would you use for Premod?

1. Pulse frequency = fixed carrier frequency

2. Pulse duration = Changes inversely w/ carrier frequency

3. Amplitude = able to produce a strong tingling or vibration sensation

4. Treatment time = 20-30 min