Clare Goodman, Physiotherapist Julia Schmidt, Occupational Therapist. With thanks to the team of Master Trainers:

Transcription

1 Clare Goodman, Physiotherapist Julia Schmidt, Occupational Therapist With thanks to the team of Master Trainers: Natasha Lannin, Ruth Barker, Simone Dorsch, Annie McCluskey, John Cannell

2 Goal orientated / purpose Training vs treatment (FES vs ES) Set up of program How to implement?

3 Example Electrodes Strengthen & lengthen thumb abductors Prevent shoulder subluxation Strengthen wrist extension with goal

4 ES EMS NMES TENS TES FES EMG trig FES EMG controlled FES Outcome triggered FES Accelerometer triggered FES / ES Iterative Learning Control FES Any type of electrical stimulation Electrical muscle stimulation to excite denervated muscle directly Neuromuscular electrical stimulation used to stimulate a peripheral nerve and to cause either a sensory, motor or noxious response Transcutaneous electrical nerve stimulation used as an analgesic without causing muscle contraction Therapeutic electrical stimulation causing a muscle contraction which aims to improve impairments after stimulation Functional electrical stimulation causing a muscle contraction to assist performance of function during stimulation EMG triggered FES or Electromyography triggered FES describes ES that is initiated voluntarily by EMG from target muscle. EMG controlled FES describes ES that is initiated maintained and terminated by the person using the EMG signal of the target muscle. Outcome-triggered FES describes ES that is initiated voluntarily by reaching a pre-set distance Accelerometer-triggered FES / ES describes ES that is initiated voluntarily by the reaching a preset position or automatically with a change of position Iterative Learning Control FES describes ES that is applied in response to kinematic and force data from a previous attempt

5 Use of ES Range / options What would you choose? When? Why? Who? When? Indications / not Contraindications Precautions Types of applications TES FES Types of ES machines Mode Cyclic Triggered Single v multi Synch v alternating Stimulus parameters Range / options What would you choose? When? Why? Waveform Pulse width /duration Frequency Ramp up /down On/off time Threshold-EMG-Stim Intensity

6 Training protocol Range / options What would you choose? When? Why? Set-up Muscles to stimulate Skin preparation Electrode placement Type, size & shape of electrode Instructions for use Repetitions per session Sessions / day / week Duration of training program Other

7 Address impairments Protocol Prevent shoulder subluxation Strengthen wrist extension Prevent or reduce hand oedema Strengthen Dorsiflexion Lengthen thumb abductors Goal ES or FES or trig-es Frequency Pulse width Mode Ramp times On / off times Muscle/s to stimulate Electrode placement Instructions for use Repetitions Length of session Duration of Rx / training Other

8 References American Occupational Therapy Association. (2008). Physical agent modalities: A position paper. American Journal of Occupational Therapy, 62(6), American Physical Therapy Association (1990). Electrotherapeutic terminology in physical therapy. Alexandria, VA, American Physical Therapy Association. Bracciano, A. G. (2008). Physical agent modalities: Theory and application for the occupational therapist (2nd ed.). Thorofare, NJ: Slack. Bracciano, A.G., & Mu, K. (2009). Physical agent modalities: Developing a framework for clinical application in occupational therapy practice. OT Practice, 14(11), CE-1-CE-8. NSW Government. (1991). Public health act Retrieved from ctrophysical_treatment NSW Government (2002). Public health (general) regulation Retrieved from Peek, C.J., (2003) A primer of biofeedback Instrumentation in biofeedback: A practitioner s guide. In: M.S. Schwartz & F. Andrasik (Eds) USA: The Guilford Press. Robinson, A.J., Snyder-Mackler, L. (1995). Clinical electrophysiology: Electrotherapy and electrophysiologic testing (2 nd ed.). Baltimore: Williams & Wilkins. ter Haar, G. (2008). Electrophysical and thermal principles in electrotherapy: Evidence-based practice (12 th ed). In: T. Watson (Ed.). China: Churchill Livingstone Elsevier.