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Functional Electrical Stimulation

Shoulder Subluxation

Description

Functional electrical stimulation encompasses a wide


range of stimulator units and techniques for disuse
atrophy, impaired ROM, muscle spasm, muscle reeducation and spasticity management
FES is also called neuromuscular stimulation (NMES) and
functional neuromuscular stimulation
FES can be an alternative or supplement to the use of
orthotic devices
Use alternating current (AC at 80 100 Hz full titanic
contraction) to stimulate an innervated muscle
AC (biphasic) most common ; INNERVATED MUSCLE
o
Asymmetric biphasic Faradic current (most
preferred; most comfortable to px)
o
Symmetric biphasic Sinusoidal current
o
Short duration interrupted current Faradic type

Goals

Muscle re-education
Disuse atrophy
Increase ROM (increase strength)
o
Can give weights

Spasticity Mx

o
o

Scoliosis

Duty cycle

The current ON time vs OFF time, in seconds expressed in


ratio
The ratio should INCREASE as muscle atrophy or
weakness increases to prevent fatigue during tx
Pulse duration and Pulse interval ratio:
ON:OFF ratio
ON time/ON+OFF time
Causes
No atrophy
Moderate atrophy
Severe atrophy

Idiopathic scoliosis
Electrode placement: midaxillary line or the convexity of
curve

Dorsiflexion Assist in Gait Training

FES electrodes may be applied on:


Agonist other muscle: upon stimulation reciprocal
inhibition
Antagonist spastic muscle: stimulate until muscle
fatigues relax
Ex: Biceps is spastic; Triceps is the agonist
Which application of FES is more effective?
AGONIST
According to Siegelman, reciprocal inhibition
Think of it like this:
o
In FATIGUE THEORY: target muscle (the one that will
be stimulated) is the SPASTIC MUSCLE (Agonist)
o
In RECIPROCAL INHIBITION: target muscle (the one
that will be stimulated) is the muscle OPPOSITE to
the SPASTIC MUSCLE (the one that will be relax)

Patient with CVA may initially exhibit weakness or flaccid


paralysis of the muscles supporting the glenohumeral
joint, especially the supraspinatus and posterior deltoid
Electrical stimulation characteristics of FES
o
a. Wave form: asymmetrical biphasic square
o
b. Modulation: interrupted
Procedure
o
a. Electrode placement: bipolar. Electrodes on
supraspinatus and posterior deltoid
o
b. treatment parameters

Amplitude: tetanic muscle contraction to


patients tolerance

Pulse rate 12-25 pps

Duration of treatment: 15-30 minutes. Three


times daily up to 6-7 hours. On/off ratio: 1:3 (2
sec : 6 sec) progressing to 12:1 (24 sec : 2
sec)

Duty Cycle
1:1 or 1:2 (best minimal
atrophy, answer) weakness
1:3 or 1:4 (best answer)
1:5 or 1:10 (best answer)

Patient with hemiplegia sometimes exhibit paralyzed


dorsiflexor and evertor muscle
FES controls foot drop, and facilitates dorsiflexors and
evertors during swing phase
Electrical stimulation characteristics
o
Wave form: asymmetric biphasic square
o
Pulse duration: 20-250/ microsec
o
Modulation: interrupted by foot switch
Procedure
o
Electrode placement: Bipolar. Peroneal (fibular)
nerve near head of fibula or anterior tibialis muscle
o
Treatment parameters

Amplitude: tetanic muscle contraction


sufficient to decrease plantarflexion

Pulse rate: 30-300 pps

Treatment mode: heel switch contains


pressure-sensitive contact which stops
stimulation during stance phase and
activates timulation during swing phase.
Hand switch also allows therapist to control
stimulation during gait

Other Gait-Assisted Protocol Considerations

Placement of electrodes in appropriate muscles to


control muscles during push-off (plantar flexors, late
swing phase (hamstrings), quadriceps and/or gluteals
(stance phase)
Electrical stimulation characteristics: similar to
dorsiflexion protocol
Method of application: similar to dorsiflexion protocol
except for electrode placement