“Full-movement neuromuscular electrical stimulation improves plantar flexor spasticity and ankle active dorsiflexion in stroke patients: a randomized controlled study”
This was an interesting article. It examined the use of electrical stimulation as a treatment for spasticity in the ankle plantar muscles, specifically the tibias posterior, gastrocnemius, and soleus. Electrodes were placed over the extensor digitorum longus muscles and the extensor hallicus muscles of post stroke patients with plantar flexor spasticity. Various intensities were tested. The article explains that spasticity in the ankle plantar flexors can lead to an equinovarus or strephenopodia deformity. The article also recognizes the common use of botulinum injections which
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The control group received only standard physical therapy treatments (stretching and strengthening exercises). There were three experimental groups. One group received estim to the intensity of stimulating only sensory nerves. The next group received estim with an intensity that minimally stimulated motor neurons. The final group received “full movement neuromuscular electric stimulation,” which was an estim intensity to the maximum tolerated intensity to receive maximum muscle movement. All three experimental groups also received standard PT interventions (stretching and strengthening exercises). At the start of the four week trial there were no measured differences between the groups. After the four week, all four groups had decreased spasticity, however only the FMNES group retained a significant after a two week fallow up and there were no significant differences among the other three groups. Also only the FMNES group retained increased dorsiflexion strength after the two week follow up (which was significantly greater than the control). An LSD post-hoc test revealed that all four groups had an equal significant reductions in “timed up and go” walking time at the two week follow
Next with a stimulation duration of 50us, the stimulus amplitude should be set to the maximal tolerable stimulus intensity. With stimulus frequency of 2Hz, observe and record the leg movement, increase it by 5Hz but should not exceed 50Hz. With the electrodes connected to the analogy output channel and ground of the DAQ board. With the corresponding LabVIEW program, the frequency and amplitude (voltage) of the stimulation supplied to the leg can be controlled. With this the “sweet spot” of the lowest amplitude and best frequency to cause evoked movement can be found and recorded. Now the stimulation frequency should be set to 10Hz and the duration of stimulation pulse to 5ms or less. The range if leg movement changes can be observed as amplitude changes. Electrical stimulation in increments of 0.01V should be delivered and the minimal voltage required to generate muscle twitch should be recorded. The pulse duration should then be increased by durations of 10ms and the minimum voltage should be recorded this should be repeated for a variety of pulse
Mechanical purpose: At this phase power and balance are needed to make the free throw a success.While the player is getting into the position they are mentally preparing for the throw. For this the player has placed their feet shoulder length apart with their right foot a little bit in front of the left on the line. Doing this should have the arch of the right foot aligned with the toe of the left foot. This will allow the player better balance while flexing at the knees and chest to be a center of gravity to have a greater support and is called the “staggered stance”.
David et al. (2004) did a study using “intramuscular neuromuscular electric stimulation (NMES)” for supraspinatus, posterior deltoid, middle deltoid, and trapezius for 6 hours/day for 6 weeks and using a cuff-type sling in the control group for 6 weeks. They found pain reduction in the higher proportion of the participants in NMES group at the end of the treatment (65.6%:24.1%) and it persisted up to 6months.
Within the past few years, however, scientists have made many new advancements. The United States Food and Drug Administration has approved 2 electronic systems that regulate muscles by sending electrical signals through implanted wires, called functional electrical stimulation (FES). Some proteins have been found to promote nerve growth and restore limb function and sensation when administered directly
This therapy may be used for a variety of pain and disability states especially involving the hands and feet.
The background of Proprioceptive Neuromuscular Facilitation (PNF) is traced back to the late 1940s/early 1950s with Herman Kabat (MD), Margaret Knott (PT), and Dorothy Voss (PT) being the developers of this method. PNF was developed to treat neurological dysfunctions (such as multiple sclerosis and cerebral palsy) . “This was an attempt to gain better control in a population of neurologically impaired instead of just offering the standard treatment at the time which was range of motion exercising and gate belt training”(Knott and Voss, 1968). Even though PNF was developed for neurological dysfunctions overtime it also became principle used in others areas of life such as with athletes and personal/physical trainers. The common misconception with
Muscle strength and neuromuscular control is compromised. This could develop into long-term muscle weakness and motor planning dysfunction. Transcutaneous electrical nerve stimulation (TENS) could be utilized to help control pain and improve muscle weakness related to arthrogenic muscle inhibition. Evidence shows that TENS is effective in improving maximal voluntary torque and electromyographic signals of muscles (Konishi, McNair, & Rice, 2017). Mr. Versace may benefit from TENS on quadriceps femoris muscle to minimize muscle strength deterioration
Patients will report to physical therapists with a multitude of impairments throughout the progression of the disease. The most prominent impairments will present during cerebellar testing. Patients will show signs of dysmetria, dysphasia, dysdiadochokinesia, and ataxia primarily as a result of the atrophy and damage to the cerebellum. Instability and lack of postural control will be demonstrated during the Romberg's test. Additionally, cranial nerve testing will have positive results for many cranial nerve palsies such as CN III, V, VII, IX, and XII. Patients show weakness in their trunk and extremities during the manual muscle testing. Vestibular testing will result in abnormal VOR, saccades, smooth pursuits and nystagmus. As a result of these impairments, patients experience functional limitations. Primarily, these patients are considered to be “high fall risks,” which ultimately decreases their independence due to weakness, instability and decreased postural control. These patients will feel uncomfortable in many situations and be unable to function independently in the community. This creates an increased risk for further injury. Due to the dysmetria and weakness, patients will also experience difficulty with their daily living skills, such as maintaining proper hygiene; They will have trouble bathing themselves and brushing their teeth without assistive equipment. PT interventions can help minimize and control these limitations. The implementation of balance training and assistive devices will be imperative interventions for an individual to modify and adapt to their gait
Electrical Muscle Stimulation is an exceptional method of helping the body boost and work with its natural healing process. This is often accomplished by sending a very tiny electrical current into the affected injury or problem area. The EMS therapy utilizes this current in an effort to help reduce swelling and release trigger points that will have the muscle seized up. It accomplishes this by assisting the body with releasing natural pain reliever usually referred to as endorphins.
Future work in this area will focus on the use of EEG with exoskeleton assistance to maximize cortical activity during gait rehabilitation. The next step for the exoskeleton is use over extended periods of time, outside of the clinical environment, to determine if maintained muscle activity and improved kinematics translate to effects in normal walking.
There were several different interventions performed aimed at increasing range of motion, balance/proprioception, and to increase strength of the right lower extremity. Following the initial examination and evaluation a brief therapeutic exercise period ensued. The gastrocnemius and soleus were both stretched against a wall each for two sets of 60 seconds to help increase dorsiflexion range of motion (Radford, Burns, Buchbinder, Landford, Cook, 2006). Active range of motion for dorsiflexion, plantarflexion, inversion and eversion was performed on a wobble board while seated for 20 repetitions in each directions to increase range of motion, but more importantly to improve proprioception (Bernier and Perrin, 1998). Plantar flexion strength was addressed by utilizing green thera-tubing around the forefoot with the patient holding the other end of the tube. This was performed for one set of 20 repetitions. Body weight squats using a railing for support were chosen as they are a closed kinetic chain exercise that challenges the gluteus muscle group as well as hamstrings while also causing dorsiflexion of the ankles (Gryzlo SM, Patek RM, Pink M, Perry J, 1994). Closed chain exercises were started initiated at the first visit as they cause an increase in joint compressive forces which can lead to increased stability, increased muscle activation, and decreased joint shearing forces (Harter, 1996). Supine bridges on a 55 cm theraball were performed for 20 repetitions to address the
Functional electrical stimulation (FES) is when electrical current is used to elicit a response from an excitable nerve in order to regain motion and function. It is used with those who have upper motor neuron damage such as spinal cord injuries (SCI), strokes, multiple sclerosis, cerebral palsy, and traumatic brain injuries. Consequently it cannot be used with lower motor neuron injuries as the peripheral nerves are not excitable. FES units are designed to improve tissue health and increase voluntary function which often produce results that can be carried over when the devices are not applied. FES units can be worn throughout the day or are used in conjunction with therapy in cases of FES bikes. Motor use and sensation in many
Plantar fasciitis pain is a commonly occurring foot complaint. Stretching is frequently utilized as a treatment, yet an assessment focusing only on its effectiveness has not been published. This study aimed to assess the effectiveness of stretching on pain in people with plantar fasciitis. Method: Patients (n=36) diagnosed as having plantar fasciitis were included in our study at our out-patient department and they were advised to stretch the calf muscle for at least 5 minutes over a given wooden ridge. Their pain before and after calf stretching exercises was recorded on pain visual analog scale and analyzed. Results: According to visual analog scale (VAS) which ranges from zero ( NO PAIN ) to 100 (WORST POSSIBLE PAIN), the average
Interferential current (IFC) electrical stimulation is vastly used in the physical therapy and athletic training settings to control pain. This can be done via the gate control theory or opiate release mechanism and on the sensory or motor level depending on the parameters set. IFC is commonly thought of when trying to reduce acute pain in athletes, but there have also been studies using this modality for chronic pain in individuals. As an athletic trainer, it is important to determine whether IFC can effectively control or limit chronic pain in order to decide how to implement successful treatment to athletes who have chronic orthopedic conditions such as persistent low back, or knee pain.
Plantar fasciitis is a common condition that causes foot pain. It is inflammation of the band of tough fibrous tissue on the bottom of the foot that runs from the heel bone (calcaneus) to the ball of the foot.