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Neuromuscular Electrical
Stim
motor level stim to produce tetanic contractions for the mgmt of selected impairments and functional limitations. ES of innervated or partially innervated skeletal muscle. Will still get a sensory response-using a higher frequency to achieve tetanic contraction TERM 2
Factors that determine pattern/force of
NMES
DEFINITION 2 stim amp/duration, stim frequency, electrode size/placement, subject tolerace, on/off time, instructions and encouragment TERM 3
Amplitude's effect on Contraction Force
DEFINITION 3 as you increase the amplitude at a set duration, force production will go up until a point is reached where increasing amplitude will no longer result in an increase in force production TERM 4
Axon Recruitment
DEFINITION 4 achieved by increases in amplitude and duration and result in an increase in contraction forceorder tends to be opposite that of voluntary activationFast Fatigueable(FF)-FR-Slowfast twitch are larger than slow twitchlargest and most superficial fibers/units will get recruited first TERM 5
Fused Tetanic contraction
DEFINITION 5 strong contraction, >20 ppsunder 20 is not functional
Frequency's Effect on Contraction Force
higher frequency increases force production due to rate coding.force produced will level out at about 50 pps, so if you are at 50 pps and still aren't getting desired results, increase amplitud. TERM 7
Rate Coding
DEFINITION 7 controlled by frequency of stimulationtells the motor units to contract fasterresults in an increase in Force Production TERM 8
On time/Off time effect on Contraction Force
DEFINITION 8 there is less muscle fatigue if you decrease the frequency with a higher amplitude.if more rest is allowed the muscle is more able to contract at a higher force10/50 is best then 10/30, then 10/10 shows most marked fatigue TERM 9
Electrode Placement (NMES)
DEFINITION 9 want to pass the most current through the most amount of muscle. size should be as large as possible to decrease discomfort -large relative to location=less current density and less likely to reach noxious levelwant to stimulate the nerve to activate the m-place one electrode over the motor point TERM 10
Motor Point
DEFINITION 10 point where least amount of current is required to activate the muscle, it is the most excitable point
Mechanism of Strength Gains (NMES)
increases the synthesis of contractile protein (actin/myosin)increases number of cross bridges formed in fibers w/ voluntary contraction leads to more gainshypertrophy occursimproved voluntary control, cns develops better ability to recruit/rate code TERM 17
Isometric for NMES
DEFINITION 17 shortening contractions may produce muscle cramping and pain, isometric contractions avoid crampingit is limited, but more comfortable TERM 18
Waveform for NMES
DEFINITION 18 no best waveformbased on personal preference-what is most comfortable/allows higher current? which evokes biggest contraction? TERM 19
Benefits of NMES
DEFINITION 19 higher strengthening than voluntaryimproved voluntary strength of contractionimproved gaitreduced length of rehabtypically used for everyday muscles-larger TERM 20
NMES indications
DEFINITION 20 only 1 or 2 muscle groups are weakvolitional contraction is not sufficient for ther ex programwhen nmes returns patient to functional level faster-jumpstarts training
NMES contraindications
ant neck/cervical area, thorax, intercostal region,abd/lumbar region of pregnant womentrauma, burn, acutely inflammed areaneoplasmskin with decreased sensationthick adiposescarringsevere edemasuperficial conductive metal implants TERM 22
NMES contraindications/precautions
DEFINITION 22 implanted electronic deviceno transcranialno over art/venous thrombusif active m. contraction is contraindicatedheart disorderscommunication dysfunctionepilepsy TERM 23
NMES adverse rxns
DEFINITION 23 fainting, nausea,skin burns, irritationautonomic dysreflexia TERM 24
Autonomic Dysreflexia
DEFINITION 24 sudden, life threatening increase in BP in SCI pts T6 or abovesweating, facial redness, headache, goosebumpssit or stand pt up, must lower BP immediately
