NMES

Neuromuscular Estim (NMES) use

strengthening of muscle, improved recruitment of motor units

Functional Estim (FES) use

substitution for orthotics, functional improvements in ADL work activities

Electrical muscle stimulation (EMS) use

contraction of denervated muscle

Indications of NMES

muscle re-ed, prevention of muscle atrophy, improvement ROM, muscle strengthening, reduction muscle spasms, edema reduction, improvement bf, functional stim

4 major clinical application of estim for motor effect

muscle re-ed, muscle strengthening, muscle pump contraction, retardation of atrophy

Subsensory intensity

Barely tingling (5-10 mA)

Sensory intensity

Perceptible tingling (10-20 mA)

Motor intensity

Muscle contraction (20-60 mA)

Noxious intensity

uncomfortable/intolerable (over 80 mA)

Frequency

the number of pulses per second

Range of frequency for NMES

0-70 Hz

The higher frequency of stimulus leads to

sustained tetany

What frequeny is considered low

1-10 Hz

What frequency is considered medium

20-50 Hz

What frequency is considered high

over 60 Hz

Frequency good for small muscle groups

20-30 Hz

Frequency good for large muscle groups

35-50 Hz

What pulse duration will stimulate motor nerves?

150-350 microseconds

What do longer pulse durations do

create stronger contractions

What do smaller pulse durations do?

smaller pulses feel more comfortable for smaller muscles

Ramp up/down

gradual increase or decrease in force

Longer ramp makes

NMES more comfortabale

What type of stim uses no ramp

FES with gait

When would you use a longer ramp time

with apprehensive patients and spasticity

Duty cycle

percentage of on time, measured in seconds

Strength duration curve

shows relationship between intensity and pulse duration to reach depolatization

What fibers require the least amount of stimulation

Abeta

Rheobase

minimal current intensity needed with long duration

Chronaxie

duration needed at twice rheobase intensity

How is electrical muscle contraction different from voluntary muscle contraction?

Electrical recruits muscle fiber types simultaneously which creates greater muscle fatigue

Fibers in order of most myelinated to least

Aalpha (gto and muscle spindle), Abeta, A delta, C fibers

What fiber correlates to tingling feeling?

Abeta

What fiber correlates with visible contraction

a motor

What fiber correlates with sharp pain

Adelta

What fiber correlates with dull, aching pain

C fibers

Biostimulation

low amplitude DC can guide cell growth, healing, and protein synthesis

Absolute contraindications

cardiac devices, pregnancy, cancer, hemorrhagic conditions, infection, DVT, skin compromise

Relative contraindications

impaired circulation, sensation, over scar tissue, history of cancer

4 main clinical applications of NMES

muscle pump, atrophy, muscle strengthening, muscle re-ed

Deep oscillation therapy

uses biphasic AC current to create electrostatic field between two electrodes

Bone growth stimulation

electrical currents to stimulate bone healing in cases of delayed union or nonunion

Noninvasive Stimulation

electrodes or coils on skin over desired areas

Invasive stimulation

implanted devices usually DC, often used for spinal current

What is FES

multi-channel electrical stimulation to activate muscles in coordinated patterns for functional tasks

What is FES used for

foot drop, aids in standing/transfers/ambulation, upper extremity function in paralysis

What methods use monophasic waveform polarity?

HVPC, CDC, microcurrent

What methods use biphasic waveform polarity

TENS, russian, H-wave

High volt current

twin-peak pulse waveform with long interpulse intervals, most commonly used for muscle contraction

Russian current

medium frequency, pulse duration and frequency increase together

Electrode placement

negative electrode over motor point of muscle, positive placed more proximally on same muscle

Types of diathermy

shortwave diathermy, microwave diathermy

Shortwave diathermy

uses high frequency electromagnetic waves to heat deep tissues

Microwave diathermy

uses microwave frequencies to heat more superficial tissues

What kind of heat transfer does shortwave diathermy do?

conversion heat transfer

Thermal effects of diathermy

increased tissue temp, blood flow, filtration/diffusion, metabolic rates, decreased joint stiffness, muscle relaxation

Non thermal effects of diathermy

soft tissue injury, wound healing, repolarize damaged cells

Indications of diathermy

post-acute MSK injuries, increased blood flow, metabolism, vasodilation, joint contracture, increased circulation

Contraindications of diathermy

acute traumatic MSK injuries, areas with ischemia, pregnancy, fluid filled areas, infection, cancer, eyes, epiphyseal plates

Precautions for diathermy

areas of acute inflammation, metal implants, areas of reduced sensitivity, pelvic area during menstruation

Laser therapy

focused light to stimulate cellular processes, reduce inflammation, and promote tissue repair

Uses of laser therapy

promote tissue healing and regeneration, reduce inflammation, stimulate cellular repair

Photobiomodulation

this is the principle by which light interacts with tissues, different wavelengths of laser light penetrate tissue to different depths, stimulating cells through absoprtion of photons

Three properties of laser

coherence, monochromaticity, collimation

Coherence

all photons of light emitted from individual gas molecules are the same wavelength

Monochromaticity

specificity of light in a single defined wavelength

Collimation

minimal divergence of photons

Types of lasers

high or low power

High power laser effect

thermal response, medical use

Low power energy use

no thermal response, healing of wounds, control acute or chronic inflammation, pain control

What is gridding technique used for

laser

Indications for low level laser

wound healing, pain reduction, increasing strength of scar tissue, bone healing

Contraindications of low level laser

cancer, eyes, hyperthyroidism, pregnancy, testicle area

Precautions for low level laser

photosensitizing medications, severe blood loss