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Advanced Principles of Electrical Stimulation and Muscle Rehabilitation in Therapy

This comprehensive guide covers essential therapy principles utilizing electrical stimulation for muscle rehabilitation. It discusses key factors affecting motor control, including somatosensory feedback, anticipatory control, and effective grasp techniques. Different modalities of electrical stimulation are explored, such as NMES and TENS, with emphasis on settings for denervated versus innervated muscles. The guide also highlights the importance of pulse duration, frequency, and duty cycles in achieving optimal muscle contraction and reducing fatigue. Further, thermal modalities are reviewed for pain reduction and enhanced range of motion.

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Advanced Principles of Electrical Stimulation and Muscle Rehabilitation in Therapy

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  1. Basic Therapy Principles Sybil Hedrick, OTR/L, CHT, CSCS Amy Rinder, OTR/L, CHT

  2. General Factors Effecting Prehension • Somatosensory feedback • Anticipatory Control • Pre-shape of hand • Velocity of reach • Power of grip • Gradation based on expected sensory (i.e. slippery) • Visual information

  3. Electrical Stimulation: Estim • NMES (neuromuscular electric stimulation) • Can augment muscle strengthening in muscles being prepared for transfer • Direct current: used to stimulate denervated muscle • Pulsed alternating current: • TENS • Primarily pain modulation • Biofeedback

  4. Denervated vs. Innervated • Denervated muscles require a pulse duration of 1 millisecond. • Functioning nerves only require 300-400 microseconds to stimulate. • So…denervated muscles require pulse duration of 2-3 x longer to reach threshold • Denervated muscle tissue can only be stimulated by direct current.

  5. DC Estim details… • For denervated muscles • With the “oil can” stimulator can do 2 different methods 1) 2 rubber electrodes that need a coupling agent -negative pole over the muscle desired to be stimulated 2) Pin-point stim with the tip with a sopping wet ground somewhere else on the body. • For hand muscles, i.e. FDM, use pin-point stim • For ECRB, use the 2 electrodes • You can learn the exact motor points, can follow a chart, or just play around during the treatment (because everyone’s body is different).

  6. NMES: general settings • Rate selection…pps • Affects the quality of a muscle contraction and muscle fatigue • Tetany, so gets a smooth muscle contraction and want 25-50pps • Higher rates elicit muscle fatigue (80pps) • We want to find the minimum rate to get a good tetanized contraction…this will help reduce the onset of fatigue • 4-8pps is more for edema reduction • Pulse duration or width • Typically between 200-400microseconds • 100-200 is generally used for small muscle groups • 250-400 for large muscle groups • At the same intensity, increasing pulse width will recruit more motor units, giving a stronger muscle contraction. • Duty cycle • Initially want longer off (rest) times to delay muscle fatigue • Muscle re-education is typically set at 1:3 (10 sec on/30 sec off) • Muscle spasm is usually 1:1 (10 sec on/10 sec off)

  7. Other Modalities • Heat • Decrease pain (Gate theory, increased blood flow, increased tissue extensibility) • Increase ROM • Must be cautious when sensation is impaired to avoid burns • Can increase speed of nerve conduction velocity

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