Unit 3 DP 2

What does NMES stand for and what is its function?

Neuromuscular Electrical Stimulation; stimulates muscles via intact motor nerves to produce contraction.

What does FES stand for?

Functional Electrical Stimulation.

How is FES used in rehabilitation?

It is the use of NMES during functional movement or task performance.

List three indications for NMES use in neurological patients.

Strengthening weak muscles, increasing range of motion, decreasing spasticity.

What is one use of NMES related to bladder control?

To reduce urinary incontinence (requires specialized training).

What type of nerve integrity does NMES require?

Intact motor nerves.

What does MMT stand for and how is it utilized in NMES?

Manual Muscle Testing; used to identify target muscles for stimulation.

How can limited range of motion affect function in patients?

It may limit function; NMES can assist to improve it.

What should be monitored with patients who have decreased sensation during NMES?

They require more frequent monitoring.

Why is pain an important consideration during NMES treatment?

It is essential to evaluate the benefit versus discomfort.

According to the notes, how can spasticity be affected by NMES?

Spasticity may increase or decrease depending on the technique used.

What demographic might require extra precaution and supervision during NMES?

Patients with cognitive status concerns.

What is often needed if a patient cannot self-administer NMES?

Caregiver assistance.

How should NMES be coordinated?

It should be coordinated with other concurrent therapies.

What is the goal of using NMES for muscle strengthening?

To improve strength in patients with stroke, CP, SCI, and MS.

What percentage of Max Voluntary Contraction is needed for strong contractions in NMES?

At least 50%.

What type of current is recommended for NMES muscle strengthening?

Biphasic or burst-modulated current (Russian/Aussie).

What is the typical pulse duration for NMES muscle strengthening?

200–800 µs.

What is the recommended frequency range for NMES muscle strengthening?

30–100 Hz.

What is the typical ramp up time in NMES for muscle strengthening?

1–5 seconds.

What is the typical ramp down time in NMES for muscle strengthening?

1–2 seconds.

What is a common duty cycle ratio used in NMES for muscle strengthening?

1:3 to 1:5 (10s on / 30–50s off).

How long should NMES treatment typically last for muscle strengthening?

10–20 contractions or up to 1 hour/day, 3–5 times per week.

What is the purpose of NMES for increasing range of motion?

To increase joint mobility by stimulating the antagonist of the tight muscle.

Give an example of how NMES can be used to increase ROM.

Stimulate wrist extensors to stretch wrist flexors.

What is the typical pulse duration for NMES to increase range of motion?

200–300 µs.

What frequency is typical for NMES in increasing range of motion?

12–33 Hz.

What should the amplitude be for NMES to increase range of motion?

3+/5 contraction.

What is the recommended ramp up time for comfort in NMES for increasing ROM?

3 seconds.

What is the duty cycle for NMES when increasing range of motion?

1:1 (10s on / 10s off).

What is the typical duration of NMES for increasing range of motion?

15 minutes to 6 hours/day, for 2–6 weeks or more.

What is a tip for using NMES to increase range of motion?

Apply low load, prolonged stretch.

What type of frequency and amplitude should be used to reduce fatigue during NMES for increasing range of motion?

Low frequency and low amplitude.

What are the two main techniques for NMES to decrease spasticity?

Antagonist stimulation and direct stimulation.

What does antagonist stimulation do in NMES for spasticity?

Activates the opposite muscle to inhibit the spastic one.

What does direct stimulation in NMES for spasticity do?

Applied to the spastic muscle for fatigue and Renshaw cell inhibition.

What is the pulse duration range for NMES to decrease spasticity?

250–500 µs.

What is the frequency range for NMES to reduce spasticity?

20–100 Hz (up to 100 Hz for fatigue).

What is the minimum amplitude needed for NMES to decrease spasticity?

≥3-/5 contraction.

What is the typical ramp time for NMES when decreasing spasticity?

0.5 to 3 seconds.

What is the duty cycle for NMES when decreasing spasticity?

1:1 to 10:7.

What is the duration range for NMES treatment to decrease spasticity?

10–60 minutes/day (up to 8 hours in some studies).

What is the purpose of Functional Electrical Stimulation (FES)?

To integrate electrical stimulation into functional movements to promote independence and neuroplasticity.

Provide an example of common uses for FES.

Shoulder subluxation, hand and upper-extremity function, foot drop and gait training.

What is the goal of FES for shoulder subluxation?

Elevate humeral head into glenoid fossa without abduction.

Which muscles are typically targeted for FES treatment of shoulder subluxation?

Posterior deltoid and supraspinatus.

What is the pulse duration for FES treatment of shoulder subluxation?

200–350 µs.

What frequency is used for FES treatment of shoulder subluxation?

10–60 Hz.

What is the recommended ramp up/down time for FES of shoulder subluxation?

3 seconds.

What is the suggested initial duty cycle for FES in shoulder subluxation?

Begin with 1:5 or 1:3 and progress to 1:1.

What is the treatment duration for FES of shoulder subluxation?

20 minutes to 6 hours/day, 5–7 days/week, for 4–8 weeks.

What is the goal of FES for hand and upper extremity function?

To improve grasp, release, and fine motor tasks.

What conditions may require FES for hand and upper extremity function?

Stroke, TBI, CP, SCI.

What is the pulse duration for FES treatment for hand and upper extremity function?

200–350 µs.

What is the typical frequency for FES in improving hand function?

30–50 Hz.

What is the amplitude requirement for FES to achieve functional movement in the hand?

Enough to achieve functional movement.

What should be the ramp time for FES to improve hand function?

Very short.

How should the duty cycle be timed in FES for hand function?

Timed with the task (manual trigger used).

What is the treatment duration for FES focused on hand and upper extremity function?

30–45 minutes, 1–2 times/day, 3–6 times/week for 6–16 weeks.

What is the goal of FES for foot drop and gait training?

To stimulate dorsiflexors during the swing phase to clear the foot.

What devices are often used for FES related to gait?

Cuff systems with heel pressure sensors (e.g., WalkAide).

What pulse duration is recommended for FES treatment of foot drop?

200–350 µs.

What is the typical frequency for FES to manage foot drop?

30–40 Hz.

What is the minimum amplitude required for FES to treat foot drop?

3-/5 contraction.

What is the ramp time for FES related to foot drop and gait?

0–1 seconds.

What should the duty cycle of FES be for foot drop treatment?

Synchronized with the gait cycle.

What determines the duration of FES treatment for foot drop?

Based on fatigue and task tolerance.

What should be explained to patients before NMES treatment?

The purpose, procedure, and sensations they may experience.

Why is it important to emphasize the need for strong contraction before NMES treatment?

It is crucial for effectiveness.

How can familiarity be achieved before NMES techniques, especially in children?

Provide a familiarization session or distract with games/videos.

What should be checked before starting NMES treatment?

Skin integrity and sensation.

What should be monitored during NMES treatment?

Contraction strength and comfort.

What adjustment may be necessary during NMES treatment?

Adjust amplitude as needed.

What should be done if a patient has cognitive deficits during treatment?

Add supervision and check skin mid-session.

What should clinicians inspect after NMES treatment?

Inspect skin for irritation or burns.

What is a normal skin condition post-NMES treatment?

Mild redness that fades within 24 hours.