Electrical stimulation to Increase Functional Activity by a76m823ik

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									Electrical stimulation to Increase
       Functional Activity

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             Introduction
1.Pioneering work : Duchenne, more than a
  century ago
2.NMES¡÷ intact PNS¡÷ M.C.
              Introduction
3.interfere with NMES
  1peripheral neuropathies(DM)
  2partial innervation(root or peripheral
     nerve entrapment)
  3muscle pathology(myopathies,
     dystrophies)
            Treatment Goals
1.improve force or maintain muscle mass
2.maintain or gain ROM
3.reeducate and facilitate voluntary motor
  control
4.temporarily reduce the effects of spasticity
5.provide an orthotic support
6.reduce edema formation
 Preserving and Increasing ROM
1.significant exception :
 ¢w older patient
  ¢w joint replacement
 Preserving and Increasing ROM
2.indication :
  1only intrinsic soft-tissue shortening, not to
    bone obstruction of the joint
    ¢w connective tissue surrounding the joint
     ¢w muscle acting across the joint on the
        shortened side
 Preserving and Increasing ROM
3.evaluation :
  1end-feel
  2X-Ray¡÷ rule out bone obstruction
  32 week daily treatment¡÷ some
    improvement
 Preserving and Increasing ROM
4.intervention :
  1combining with other technique
     (cast, position)
  2within limited arcs of range
 Preserving and Increasing ROM
5.Rational :
  1automated and repetitive nature of
    contraction¡÷ compliance¡ô
    ¡÷ gentle stretch
  2encourage facilitation and force
      improvement
  3pain management¡÷ relax
 Preserving and Increasing ROM
6.Technique :
 130 minutes
 2100 repetition
 3available range
 Preserving and Increasing ROM
4level low enough to avoid a jamming effect
 at the end of available range
5prevent painful, swelling, effusion of joint
6daily, home program
  Inadequate Voluntary Control
1.Problem :
  1peripheral inhibition of the CNS (shorter)
    ¢w pain at knee may inhibit Quadriceps
         ¡÷ trauma, surgery
           ¡÷ recruit motor unit pool¡õ
       ¡÷ strengthening
  Inadequate Voluntary Control
2decreased decending activation from AMN
 onto LMN (prolonged)
   ¢w follow a stroke
    ¡÷ peripheral sensory drive¡÷ excitability¡ô
 ¡÷ reeducate and facilitate motor
           recruitment on a voluntary basis
      ¡÷ target : one or two key muscle
        ¡÷ dysfunction¡õ
      NMES and Reeducation
1.For peripheral inhibition in the presence of
    orthopedic pathology
   ¢w weakness, disuse, pain¡÷ trauma or
      surgery to a joint
  ¢w inhibition onto the motoneuron pools
      through peripheral sensory drive
      NMES and Reeducation
2.NMES¡÷ motoneuron recrutment in initial
           stage
      ¡÷ motoneuron excitability¡ô
        ¡÷ voluntary muscle force¡ô
       NMES and Reeducation
3.induced muscle strength ¢w
   1initial +3, but +1 to part of older patient
   2different with power strengthening
     enhance program
      NMES and Reeducation
4.application :
  1useful immediately after trauma or
    surgery
  2used at the patient’s bedside
  3coupled with isometric contraction
5.patient¡÷ normal strength level
           ¡÷ power strength enhance program
       NMES and Facilitation
1.For CNS dysfunction (in complete stage)
2.result of increased voluntary recruitment of
  motor units
3.stimulation accelerated the recovery process
  but could not alter the ultimate level of
  recovery
       NMES and Facilitation
4.combination of NEMS with voluntary
  activity appeared to provide the most
  effective increase
5.special program¢w
  1avoid chronic shoulder subluxation
  2decrease hemi-inattention
  3SCI¢w be awareness of muscle and
           partially innervated
      NMES and Facilitation
6.indication¢w CVA. SCI. CP. TBT
7.goal :
  1enhance the motor control
    (ROM, force, function)
                Spasticity
1.antagonist muscle stimulation¢w reciprocal
  inhibition
                 Spasticity
2.spastic muscle stimulation¢w
  1antidromic activation of the alpha
    motoneuron axon
    (a)¡÷ spinal level reflex
         ¡÷ longer lasting modulation of the
               spastic tone
     (b)¡÷ excite a pool of Renshaw cells
           ¡÷ inhibit the alpha motoneuron
                Spasticity
   2fatigue of the myoneural junction
3.antagonist and spastic muscle program
4.generalized Hyperreflexia
  ¢w sensory habituation and intense point
     stimulation
   Permanent Loss of Voluntary
         Motor Control
1.as a substitute for conventional orthoses
2.is true functional electrical stimulation(FES)
   Permanent Loss of Voluntary
         Motor Control
3.enhance hand function
    ¢w C5, C6-wrist extension for hand open and
       release
  ¢w may tendon transfer, joint arthrodesis,
       electrode implantation
   ¢w CVA, TBI, CP, SCI
   Permanent Loss of Voluntary
         Motor Control
4.for shoulder subluxation Reduction
  ¢w Es of posterior deltoid and supraspinatus
5.for standing and walking with SCI
   1standing, stepping¢w available
   2walking¢w difficulty
   3multiple channel
   Permanent Loss of Voluntary
         Motor Control
4problem¢w
 (a)multiple muscle control
 (b)spasticity
 (c)control sequences, sensors
 (d)adequate training, fatigue
 (e)velocities
 (f)flexibility             (g)safety
   Permanent Loss of Voluntary
         Motor Control
6.FES exercise in paralysis
   ¢w disuse atrophy¡õ
  ¢w outcome¢w 1strength¡ô
                 2endurance¡ô
                 3aerobic capacity¡ô
                 4bone mineral density¡ô
   Permanent Loss of Voluntary
         Motor Control
5pressure sore ¡õ
6healing¡ô
7urodynamics¡ô
 8self-esteem¡ô
¢w static, dynamic training

								
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