Electro Lab

Front 1

NMES

Purpose

Back 1

• Strength
• Endurance
• Assist with Motor Learning
• Promote ROM

Must have: Intact PNS

Front 2

NMES


Dose Response

Back 2

• Patients: 50-65% MVIC
• Preferred: 80-100% MVIC
• Want 10-15 Isometric contractions

Front 3

NMES

Parameters

Back 3

• Waveform: Subjective
• Pulse Duration: 200-600μs
o 400μs considered standard
• Frequency: Beginning of FFR plateau: ~40-60 pps
o ↑ frequency = More comfort for patient = Quicker fatigue
• ON Time: 10-15 seconds
• OFF Time: 45-120 seconds
• Ramp On: 1- 3 seconds
• Electrodes:
o Bipolar arrangement at proximal & distal ends of muscle
o Motor Point of Muscle

Front 4

NMES

Patients

Back 4

• Disuse atrophies patients
• CNS disruption

Front 5

NMES

Contraindications/Precautions

Back 5

Contraindications/Precautions
• Uncontrolled hypo/hypertension
• ↑adipose = ↑ intensity
• Severe osteoporosis
• Impaired sensation
• In thoracic region
o Cardiac muscle or pacemaker
• Region of phrenic nerve or urinary bladder stimulators
• Over carotid sinus
o May interfere with BP or cardiac contractility
o Areas of Peripheral Vascular Disease
 Fear of releasing emboli
 Neoplasm or infection
 Pregnancy
 Near Diathermy
 Broken skin
 Patients unable to provide clear feedback or understand why NMEW is being applied

Front 6

FES

Purpose
 

Back 6

• Primary Goals
o Maintain posture
o Produce purposeful movement
o Sustained or repetitive
o Orthotic substitute
• Secondary Effects
o Improved motor control
o Diminished muscle spasticity
o Maintain ROM
o Muscle strengthening
o Preservation of muscle bulk


Must have: Intact lower motor neuron

Front 7

FES

Patient Problems

Back 7

• Foot Drop
• Standing & Walking
• Shoulder Subluxations
• Cardiovascular Training
• Maintain ROM
• Scoliosis management
• SCI- Gluteal pressure relief
• Muscle Pump
• Cardiac assist
• Bowl & Bladder Incontinence
• Bowl & Bladder Voiding

Front 8

FES

Parameters

Back 8

• Pulse Duration: 200-400μs
• Frequency: 20-40 pps
• ON/OFF Time: Continuous
• Ramp On: None
• Duration: Dependent upon activity
• Electrode:
o Bipolar arrangement at proximal & distal end of muscle
o Over motor point

Front 9

FES

Contraindications & Precautions

Back 9

• Weakness—Must be a 3/5 MMT, can do it against gravity (Fair+)
• PVD—venous thrombosis or thrombophelbitis, avoid PE
• Not able to provide clear feedback regarding stim levels
• Decreased or absent sensation, skin integrity at risk
• Thoracic region should be avoided, pacemaker or not
• Over carotid sinus
• Uncontrolled hyper/hypotension
• Pregnant femalesOver trunk
• Excessive adipose tissue
• Cautious of autonomic dysreflexia in SCI patients

Front 10

Ionto: Pain

Back 10

Lidocaine (+)

Anode (+)

Rarely used alone

Front 11

Ionto: Calcium Deposits

Back 11

Acetic Acid (-)

Cathode (-)

Calcific tendonitis, myositis ossificans

Front 12

Ionto: Inflammation

Back 12

Dexamethazone (-)

Cathode (-)

Plantar fasciitis, lateral epicondylitis, rotator cuff tendonitis,
infrapatellar tendonitis

Front 13

Ionto

Parameters

Back 13

• Waveform: Direct current
• Duration: Long time
• Current: 5 mA or less
• Dose: 40-80 mA*min
o Best closer to 80
• Peak Amplitude:
o Cathode: 0.5 mA/cm2 x cm2
o Anode: 1.0 mA/cm2 x cm2

Front 14

Ionto

Contraindications & Precautions

Back 14

• Broken, damaged skin
• Reduced sensation- precaution
• Pacemaker, bladder stimulators, phrenic nerve stimulators
• No cell phones
• Pregnant
• Scar- Impeded, no pores

Front 15

Biofeedback

Indications:

Back 15

o Patients with ↑ spasticity or ↓ activation
o Need to know muscle is alive
o Improve motor control

Front 16

Biofeedback

Electrodes:

Back 16

o Should be parallel to muscle fiber
o Avoid motor point
o Narrow = EMG less, less MU
o Wide = EMG more, More MU
o Better w/little contraction
o Negative: More cross talk

Front 17

Biofeedback

Parameters:

Back 17

o Above tone: Signals if person goes above a goal point
o Below tone: Signals if person goes below goal point
o Max Display: Max number the patient has reached when contracting

Front 18

Biofeedback

Info to Know

Back 18

o Differential Amplification = (Ground – 1st electrode) – (Ground – 2nd electrode)
o ↑ EMG indicates: More MU activated OR MU activated faster
o Resting Potential should be <5 mV
 If not could be problem with the lead, connectors or an old electrode.

Front 19

Conventional TENS – Sensory Level

Back 19

• Indications: short term pain relief, acute pain
• Parameters
o Frequency: 50-100 pps
o Pulse Duration: 2-50 μs
o On/Off Time: Continuous
o Duration: 20 minutes

Front 20

Strong Low Rate Motor TENS

Back 20

• Indications: Chronic pain, Long duration
• Parameters
o Frequency: 2 -4 pps
o Pulse Duration: > 150 μs
o On/Off Time: Continuous
o Duration: 45 + minutes

Front 21

High Frequency Motor TENS

Back 21

• Indications: Chronic pain, Long duration
• Parameters
o Frequency: 50-100 pps
 Tetanic contraction
o Pulse duration: >150 μs
o On/Off Time: 1:1
o Duration:

Front 22

Seek & Destroy

Back 22

• Indications: Trigger Points
• Parameters
o Frequency:
 Seek: 120 Hz
 Destroy: 2 Hz
o Pulse Duration: >150μs (200μs-800μs)
o Duration: 30-60 seconds for 5-8 minutes

Front 23

Noxious Level TENS

Back 23

• Indications: Non-contractile tissue, Hours of relief
• Parameters
o Frequency:
 Low: 1-5 pps
 High: 50-100 pps
o On/Off Time: 12s/8s
o Duration: 10-15 minutes
o Pulse Duration: 400 μs
o Ramp On: 2 seconds

Front 24

Interelectrode Analgesia

Back 24

• Indications: Immediate pain relief during painful treatment
• Parameters
o Frequency: 100 + pps
o Pulse Duration: 50 + μs
o On/Off Time: Continuous
o Duration: As indicated

Front 25

TENS

Precautions, Contraindications, & Adverse Effects

Back 25

• When pain is providing a useful function
• Over carotid sinus
• Pacemakers
• Over abdomen of pregnant woman
• Noxious-be cautious of thermal burns- small electrodes