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Neuromuscular Electrical Stimulation (NMES)
The use of electrical currents to produce muscle contraction in innervated muscles
Does NMES require an intact and functioning nervous system?
Yes it does to work properly
What is NMES used for?
Muscle strengthening
Muscle education and reeducation
Edema
Slow Twitch Type 1
Innervated by small nerve fibers
Activated first in physiological contractions
Produce lower-force contractions
Fatigue and atrophy resistant (for endurance)
Fast Twitch Type 2
Innervated by larger diameter nerve fibers
Activated first when muscle is stimulated electrically
Produce strongest contractions
Fatigue rapidly and atrophy rapidly with disuse (for explosive power)
Overload principle
A principle of strengthening muscle that states the greater the load placed on a muscle and the higher the force contraction it produces, the more strength that muscle will gain
Specificity Theory
Muscle contractions specifically strengthen the muscle fibers that contract
What is the best way to increase strength through electrical currents?
Higher force contractions should be used
What is the best way to increase endurance through electrical currents?
Lower-force contractions should be used
Orthopedic conditions treated by ES
ACL reconstruction
TKA
Nonsurgical management of other orthopedic conditions
Neurological conditions treated with ES
Occurs via direct muscle strengthening or inc excitability of the motor neuron produced by motor level ES
SCI - counteracts muscle atrophy and improves circulation
Stroke - improves voluntary recruitment of motor units, proves gait, reduce agonist/antagonist co-contraction
MS
CP
TBI
Functional electrical stimulation (FES)
Application of an electrical current to produce muscle contraction during a functional activity
Ex. stimulation of the anterior tibialis to cause DF during swing phase of gait
Contraindications for ES for Muscle Contraction
Pacemaker or unstable arrhythmias
Over the carotid sinus
Venous or arterial thrombosis or thrombophlebitis
Pelvis abdomen, trunk or low back during pregnancy
Precautions for Electrical Stimulation for Muscle Contraction
Cardiac disease
Impaired sensation or mentation
Malignant tumors
Skin irritation or open wounds
Parameters for ES for Muscle Contraction
Waveform
Electrode placement
Pulse duration
Pulse frequency
On:off ratio
Ramp up/down
Amplitude
Duration of treatment (10-20 min)
What is the MOST appropriate position for a patient using NMES?
A position that allows the pt to contract their muscle in the direction of the contraction being created by the NMES
How should the electrodes be placed when using NMES
Parallel to the muscle fibers with one on the motor point
As the pulse duration (width) is shortened, how will the amplitude need to be adjusted to achieve the same strength of contraction?
The amplitude will need to be raised
What is MVIC?
maximum voluntary isometric contraction
What MVIC should be used when using ESTIM on a muscle without injury?
50%
What MVIC should be used when using ESTIM on muscles after post-op?
10%
What is the ratio used for beginning muscle contraction ESTIM?
1:5 with 6-10 seconds on and 50-120 seconds
What is the ratio for muscle contraction ESTIM to relieve muscle spasms (or to make them relax)?
1:1
How long does the pulse width need to be to stimulate a contraction in denervated muscle?
10 ms or longer