Fundamentals Of Electrical Stimulation
1/11/2021Fundamentals ofElectrical StimulationSteve Page, OTR/L, PhD, MS, ePRehabStevePRehab1Lesson Objectives123List relevant estimparameters thatcan be modifiedby therapistsDifferentiatebetween differenttypes of electricalstimulationIdentify purposesof different estimtypes2Amplitude (Intensity) How “big” (intense) the stimulation is compared to baseline Measured in amperes (milliamps) or volts (millivolts) With increasing amplitude, more, deeper, and smaller fibers arereached stronger contractionCurrentPositiveTime31
1/11/2021Increasing the amplitude will: Increase the depth ofpenetration Amplitude should be adjustedto produce the desiredphysiologic response Physiologic response is thekey, do not focus on thenumber of milliamps.4Amplitude and Pulse Duration Amplitude– How much?Pulse Duration Pulse Duration– The length of timethat the specifiedamplitude is flowingduring a given pulse,usually stated inmilliseconds (msec) ormicroseconds ( sec).– It can be also calledpulse width.400 sec50 secNarrowWide5FrequencyHertz Pulses per second (pps)– The number of pulsesoccurring in 1 second Cycles per second (cps)– the number of time ACswitches direction in 1second Both used to describe thefrequency of pulsedcurrent1 HZ4 HZ1 sec1 sec4 HZ62
1/11/2021Ramp-Time Indicates how long it will take to get to presetamplitude. Individual pulses gradually increase/decrease inintensityRampupRampdownDuty cycle – on/off time or stimulation versus rest time7How Do I Know Where the “Best” Motor Point is Located?8 Black electrode –cathode/negative leadSmoke overfire?Notnecessarily!– placed over the area thatyou want to activate usingthe stimulator. Red electrode –anode/positive lead– placed over the area ofthe nerve supplying thespecific muscle93
1/11/2021Shoulder Flexion and Abduction10Types of Stimulation11TENS/Sensory Stimulation(sub-threshold) Low voltage, “subthreshold” stimulation Delivers electricity across the intactsurface of the skin to activateunderlying nerves Applications:– Pain - acute, chronic, non-malignant– Sensory restitution124
1/11/2021NMES (neuromuscular electrical stimulation)Causes repeated limb use but does not require active participation by the patient!Goals: Decrease spasticityMuscle strengtheningReduce edemaMuscle reeducationPrevent atrophyPreserve/increase range of motion13EMG-Triggered NMESNeuromove 4500 www.zynex.comHow does it work? Set stim intensity and EMGthresholdElectrodes sense tracecontraction/muscularattemptDevice rewards patient withstimulation ONLY whenpatient hits thresholdGoal:- Increase AROM in peoplew. trace/minimal movement 4740https://www.saebo.com14Cyclic e-stim during functionalmovements and task specific activitiesFacilitation for functional ls: Improve hand function and voluntarymovement Facilitate neuromuscular reeducation Regulate muscle tone (decrease spasticity) Prevent atrophy- muscle strengthening Initiate and regain voluntary motor functions(muscle reeducation)155
1/11/2021E-stim Can (and should) Be Graded:Begin repetitive practice paradigmsGet a few degrees of AROMEMG-based estim/functional estimGet trace movementCyclic estim16Billing/DocumentationExamplesSee Files Located in ThisLesson17Chattanooga Continuum Empi “2 channel stimulator to provide electricalstimulation treatments in pain management(TENS) and neuromuscular stimulation(EMS/NMES)” 399.00 2600-kit186
1/11/202119ElectricalStimulation Unitsand EquipmentAvailable Elsewhereon This LessonArticleDevicesTrigger switchesContraindications20Unitsfrom DJO217
/nmes.html 150 each 55 each22SaeboStimOne 119https://www.saebo.com/shop/saebostim-one/23248
1/11/2021There is Level 1a evidence that neuromuscularelectrical stimulation in combination withgait/balance training improves gait/balancewhen compared to stimulation or trainingalone.There is Level 1a and Level 2 evidence thatfunctional electrical stimulation duringconventional rehabilitation improves gait,balance, and independence when compared torehabilitation alone2526LE-stim AFOsBioness L300WalkAide279
1/11/202128transcranial Direct Current Stimulation(tDCS)Constant, low currentdelivered to brainthrough electrodesplaced on scalpNon-invasive brainstimulationInexpensive,portable, safe29Functional Brain Stimulation tDCS overlaid onto taskoriented therapy CPT codes: ADL training (97530) Neuromuscular Re-ed(97112) Gait training (97116)3010
1/11/2021Device 1-2mA for 20 minutes Dose: 40 mA/min Chattanooga Ionto – 300.00– Others Small, portable, automaticramp up and shut off Alerts (e.g., sponges notsufficiently soaked, not securedtightly enough to head)31Take Home Messages & “Nuggets” Adjust amplitude and other parametersdepending on patient specs & response Incorporate different types of estim with/withoutpractice depending on patient specs Estim can also be used for stretching, maintainingmuscle bulk, maintaining joint ROM, edema32Thank-you!Spage@Neurorecovery.net3311
Chattanooga Continuum Empi 2 channel stimulator to provide electrical stimulation treatments in pain management (TENS) and neuromuscular stimulation . There is Level 1a evidence that neuromuscular electrical stimulation in combination with gait/balance training improves gait/balance when compared to stimulation or training
transcutaneous neuromuscular electrical stimulation (NMES), is based on improving the function of in-nervated but paretic/paralytic muscles by electrical stimulation of corresponding intact peripheral nerves. Low-level stimulation provides sensory feedback, whereas increased current intensity or pulse duration
Electrical foot stimulation (see Figure 1) was produced by surface electrodes placed on the sole of the foot over the plantar muscle group. Electrical stimulation was delivered by the Focus Neuromuscular Stimulation System (Empi, Inc., St. Paul, MN). The crucial stimulus parameters were biphasic symmetric square wave at 50 pulses per second,
Neuromuscular Electrical Stimulation (NMES) vs. Functional Electrical Stimulation (FES) NMES: uses a device to send electrical impulses to nerves.This input causes muscles to contract. The electrical stimulation can increase strength and
Upper limb electrical stimulation exercises. P Taylor, G Mann, C Johnson, L Malone In this article we wish to document some of the electrical stimulation techniques we use for the upper limb, primarily with hemiplegics, in the Salisbury FES clinic. There is a
Adverse effects associated with implantation and stimulation were primarily hoarseness, cough, dyspnea, pain, paresthesia, nausea and headache, with hoarseness and dyspnea more likely to occur on high stimulation than low stimulation. Englot et al. (2016) examined rates and predictors of seizure freedom with VNS. The investigators examined 5554 .
Neuromuscular Electrical Stimulation (NMES) To investigate the ability of muscle contractile activity to dictate donor cell behavior in vivo, NMES was performed using a Neuromuscular Stimulator (Empi 300 PV, St Paul, USA) and modified surface electrodes, as previously described [17]. Prior to stimulation, the anterior lower limb was shaved.
Electrical Infrastructure includes an electrical installation, electrical equipment, electrical line or associated equipment for an electrical line. 1.9 Electrical installation As per the Electrical Safety Act 2002 (s15) (a) An electrical installation is a group of items of electrical equipment that—
FSA ELA Reading Practice Test Questions Now answer Numbers 1 through 6. Base your answers on the passages “from The Metamorphoses” and “from Romeo and Juliet.” 1. Fill in a circle before two phrases Ovid uses in Passage 1 to show that Pyramus and Thisbe experience a shared love. “A A thing which they could not forbid, B they were both inflamed, with minds equally captivated. C There .
