Unit 3 DP 2

Key Definitions

NMES (Neuromuscular Electrical Stimulation):

Stimulates muscles via intact motor nerves to produce contraction.

FES (Functional Electrical Stimulation):

The use of NMES during functional movement or task performance (e.g., walking, grasping a cup).

Indications for Use in Neurological Patients

Used to:

Strengthen weak or atrophied muscles

Increase range of motion

Decrease spasticity

Improve functional mobility and participation

Reduce urinary incontinence (requires specialized training)

Special Considerations

Consideration Clinical Rationale

Muscle Innervation NMES requires intact motor nerves

Strength Testing Use MMT to identify target muscles

Range of Motion Limited ROM may limit function; NMES can assist

Sensation Decreased sensation requires more frequent monitoring

Pain Evaluate benefit vs. discomfort

Spasticity May increase or decrease depending on technique

Cognitive Status Extra precaution and supervision

Caregiver Assistance Needed if patient cannot self-administer

Concurrent Therapies Coordinate with other interventions

💪 NMES for Muscle Strengthening

Goal: Improve strength in patients with stroke, CP, SCI, and MS.

Key Points:

Strong contractions are needed (≥50% of Max Voluntary Contraction).

Use biphasic or burst-modulated current (Russian/Aussie).

Typical Parameters:

Pulse duration: 200–800 µs

Frequency: 30–100 Hz

Ramp up: 1–5 sec

Ramp down: 1–2 sec

Duty cycle: 1:3–1:5 (10s on / 30–50s off)

Treatment: 10–20 contractions or up to 1 hr/day, 3–5x per week

🦾 NMES for Increasing Range of Motion (ROM)

Purpose: Increase joint mobility by stimulating the antagonist of the tight muscle.

Example: Stimulate wrist extensors to stretch wrist flexors.

Typical Parameters:

Pulse duration: 200–300 µs

Frequency: 12–33 Hz

Amplitude: 3+/5 contraction

Ramp up: 3 sec (for comfort)

Duty cycle: 1:1 (10s on / 10s off)

Duration: 15 min – 6 hrs/day, 2–6 weeks or more

Tips:

Apply low load, prolonged stretch.

Use low frequency/amplitude to reduce fatigue.

🧘 NMES for Decreasing Spasticity

Two Main Techniques:

Antagonist Stimulation (Reciprocal Inhibition) – Activates opposite muscle to inhibit the spastic one.

Direct Stimulation – Applied to spastic muscle for fatigue and Renshaw cell inhibition.

Typical Parameters:

Pulse duration: 250–500 µs

Frequency: 20–100 Hz (up to 100 Hz for fatigue)

Amplitude: ≥3-/5 contraction

Ramp: 0.5–3 sec

Duty cycle: 1:1 to 10:7

Duration: 10–60 min/day (up to 8 hrs in some studies)

🤲 Functional Electrical Stimulation (FES)

Purpose: Integrates electrical stimulation into functional movements to promote independence and neuroplasticity.

Common Uses:

Shoulder subluxation

Hand and upper-extremity function

Foot drop and gait training

Cycling programs (upper/lower extremity)

FES for Shoulder Subluxation

Goal: Elevate humeral head into glenoid fossa without abduction.

Placement: Posterior deltoid + supraspinatus.

Parameters:

Pulse duration: 200–350 µs

Frequency: 10–60 Hz

Ramp up/down: 3 sec

Duty cycle: Begin with 1:5 or 1:3 → progress to 1:1

Treatment: 20 min – 6 hrs/day, 5–7 days/week, 4–8 weeks

FES for Hand and Upper Extremity Function

Purpose: Improve grasp, release, and fine motor tasks (e.g., eating, drinking).

Conditions: Stroke, TBI, CP, SCI.

Parameters:

Pulse duration: 200–350 µs

Frequency: 30–50 Hz

Amplitude: Enough to achieve functional movement

Ramp: Very short

Duty cycle: Timed with task (manual trigger used)

Duration: 30–45 min, 1–2x/day, 3–6x/week for 6–16 weeks

FES for Foot Drop and Gait

Goal: Stimulate dorsiflexors during the swing phase to clear the foot.

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

Parameters:

Pulse duration: 200–350 µs

Frequency: 30–40 Hz

Amplitude: 3-/5 contraction

Ramp up/down: 0–1 sec

Duty cycle: Synchronized with gait cycle

Duration: Based on fatigue and task tolerance

🧩 Application and Monitoring

Before Treatment:

Explain purpose, procedure, and sensations.

Emphasize need for strong contraction.

Provide familiarization session if necessary.

For children → distract with games or videos.

Check skin integrity and sensation.

During Treatment:

Monitor contraction strength and comfort.

Adjust amplitude as needed.

If cognitive deficits → add supervision and check skin mid-session.

After Treatment:

Inspect skin for irritation or burns.

Mild redness is normal and fades within 24 hours.