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NMES Indications
Strength/capacity building
NM re-education
Spasticity reduction
Volitional vs NMES Contraction
Volitional: Asynchronous firing that recruits Type I first.
NMES: Synchronous firing that recruits Type II first.
NMES Expiration Date
NMES + ExRx is better only in the early stages of rehab (FOR STRENGTH GAINS).
Tetanic motor stimulation must use an _____
On/off cycle
For NMES strengthening, you must allow at least a ___-second contraction tmie
5
Bipolar electrode placement → NMES strengthening
Proximal and distal ends of muscle belly
Russian Stimulation
Polyphasic pulsed current used for strengthening.
Russian Stim parameters
Intensity: Maximally Tolerated Contraction
Phase Duration: 200 microseconds/2500 Hz carrier frequency
Frequency: 50 Hz
On/off: 10/50
Strengthening, re-education, FES, and edema management all take advantage of _____ stimulation
motor
Iontophoresis
Use of a low-amplitude DC to drive ionized drugs transdermally. The medication must match the polarity of the electrode in order to be repelled into the tissue.
Electroporation
DC-induced increased porosity of the epidermis
Iontophoresis Depth
3-20 mm; influenced by impedance
Iontophoresis Current Density
Cathode: <0.5 mA/cm²
Anode: <1.0 mA/cm²
Current Dosage equation
mA x minutes
Iontophoresis Home-device Use
Very low current applied over 4-12 hours.
BFRT
Technique that partially restricts arterial and venous flow to create local muscular hypoxia while completing low-load resistance training.
Gold Standard for monitoring limb occlusion pressure
Doppler
BFRT Contraindications
VTE (Venous thromboembolism)
Clot risk
Vascular issues
HTN (Stage 3+)
BFR % of limb occlusion pressure: UE vs LE
UE: 30-50% LOP
LE: 60-80% LOP
BFR Protocol
20-30% 1RM
4 sets, 30 reps then 3×15
30 second rest between sets, cuff remains inflated
Deflate cuff between exercises (Max cuff time: 20 min)
High-load training is _____ than BFRT for strengthening and _____ for hypertrophy
better; equal