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    SD Curve and Es Lab

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    2022dse.velvet

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    © All Rights Reserved
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    SD Curve and Es Lab

    Uploaded by

    2022dse.velvet
    8 views28 pages

    Original Title

    SD CURVE AND ES LAB

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    © All Rights Reserved
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    8 views28 pages

    SD Curve and Es Lab

    Uploaded by

    2022dse.velvet

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 28

    Strength-Duration curve (SD

    curve)
    Interrupted Direct Current (IDC)
    Stanley John Winser
    EPT 2
    SD curve
    • Type of current used: rectangular, monophasic pulse, with frequency
    of 1 or 2 Hz.
    • Duration: ranges between 10 microseconds to 300 milliseconds
    • Pulse width: More than double the pulse duration (700ms)
    • The intensity that elicits a minimal perceivable contraction is recorded
    • A graph is then plotted for the threshold intensity and pulse duration
    • SD curve needs to be done after the completion of Wallarian
    degeneration (≈2 weeks post injury)
    Contraindications
    • Active TB or cancer
    • Cardiac pacemaker
    • Metal implant
    • Unreliable patients
    • DVT or thrombophlebitis (may dislodge clot - embolus)
    • Skin lesions (burn)
    • Infections (spread via blood stream)
    SD curve preparation
    • Provide clear instructions to the patient
    • Check for contra-indications
    • Check for skin sensation
    • Prepare the part of skin with soap or wet towel to reduce skin
    resistance
    • Have the equipment's needed for the testing handy
    • Check machine
    SD curve
    • Setting pulse duration and pulse interval

    Pulse duration Pulse interval Current


    1 300ms 700ms Record
    2 50ms 700ms Record
    3 10ms 700ms Record
    4 5ms 700ms Record
    5 1ms 700ms Record
    6 0.1ms 700ms Record
    SD curve
    • Rheobase: defined as the minimum intensity (V or mA) required to
    produce a threshold motor response to an infinite pulse duration
    • Chronaxie: defined as the pulse duration necessary to obtain a
    threshold response using pulse of twice of rheobasic intensity.
    Normal values of Rheobase and Chronaxie
    Outcome Rheobase Chronaxie
    measure Innervated Denervated Innervated denervated
    Threshold 2-18mA Higher <1ms >10ms
    current
    Threshold 3-40V Higher <0.1ms >10ms
    voltage
    Outcomes of SD curve

    Source: Electrical stimulation of Denervated Muscle. In


    Electrotherapy Explained Principles and Practice. Edition 4;
    Pg:148
    Management of denervated muscle with IDC
    • Indications and benefits
    • Slow down muscle atrophy
    • Maintain muscle extensibility
    • Maintain circulation
    • Reduce edema
    • Maintain nutrition to the muscle
    • Re-educate muscle during recovery
    Contra-indications and dangers
    • Active TB or cancer
    • Cardiac pacemaker
    • Metal implant
    • Unreliable patients
    • DVT or thrombophlebitis (may dislodge clot - embolus)
    • Skin lesions (burn)
    • Infections (spread via blood stream)
    Parameters for muscle stimulation
    • Pulse duration will be the Chronaxie
    • Pulse interval will be 4-5 times the pulse duration to avoid muscle
    fatigue
    • Waveform: saw tooth or triangular [Rectangular may be painful]
    • Intensity: adjust to an intensity that will elicit a moderate visible
    contraction that is not too painful
    • Treatment time: use several short bursts of stimulation
    Parameters for muscle stimulation
    • Frequency - 1pps to 35 pulses per second
    • 1-2 times per day, 3 sets of 5 to 20 contractions
    • ~ 5 sec rest between contractions, ~ 2 minutes rest between sets
    • Determine chronaxie and gradually increase pulse
    • Duration and/or intensity to obtain moderately strong contraction
    Motor points of the upper and lower limb
    Case study (SD Curve)
    • Name : Mrs. ZZ Sex : F Age : 15
    • Diagnosis : Fracture and posterior dislocation (R) elbow – likely
    damage to the radial nerve
    • Physiotherapy : Perform SDC to assess denervation
    • Assessment : Medical history
    - Falling on outstretched hand 6 wks ago
    - ? Radial nerve injury

    Signs and symptoms


    - Difficulty lifting (R) wrist and fingers actively
    - Weakness in (R) wrist extensors (all Grade 0/5)
    Case study (IDC)
    Name : Mrs. YY Sex : F Age : 45
    Diagnosis : Dislocation (R) fibula with likely
    damage to the common peroneal nerve
    Physiotherapy : Stimulation for denervated muscle
    Assessment : Medical history -
    -Falling from height 6 wks ago

    Signs & Symptoms -


    -Complained of difficulty in walking, right foot slaps the ground
    -After 6 weeks, start active mobilisation - found weakness in (R) ankle dorsiflexion and
    eversion (all grade 1)
    Electrical stimulation for other neurological
    conditions
    • NMES for:
    • Bells palsy
    • Shoulder subluxation
    • Spasticity
    • Foot drop
    • Muscle re-education in stroke
    Contraindications for FES
    • Cardiac disease
    • Cardiac pacemaker
    • Deep brain stimulation
    • Impaired sensation
    • Cancer
    • Acute skin irritation or open wound
    • Pregnancy
    Preparation and set-up
    Device monitor

    Up and down arrow for increase and decrease intensity

    Turn-on
    Turn-off Cable socket
    Select from menu
    Hit the prog key for selecting parameters
    NMES for Bell’s ES for stroke ES for spasticity NMES for Foot NMES for muscle
    palsy (Targan (shoulder Agonist stimulation drop re-education in
    protocol) subluxation) Type: Alternating Electrode stroke
    Electrode Electrode Intensity: Strong placement: Electrode
    placement: placement: Frequency: 20 Hz Anterior placement:
    Styloid process Supraspinatus and Pulse duration: compartment of Proximal and distal
    and 3 branches of posterior Deltoid. 0.5ms leg and foot to the muscle belly.
    facial nerve. Type: Alternating On/off time: 2.5 sec switch Pulse duration:
    Type: Monophasic Intensity: High to Duration: 20 Type: Alternating 300ŭS
    Pulse duration: 86 produce shoulder minutes × 5 days Pulse duration: Freq: 20 Hz
    ŭS realignment /week × 5 weeks 0.3 mS Intensity: Minimal
    Frequency: 1.4 Hz Frequency: 12 to 25 Antagonist Frequency: <50 required for full
    On and off time: Hz stimulation Hz ROM
    6:6 Pulse duration: 100 Same parameters as Intensity: Low Ramp up: 1.4s
    Intensity: Sub- ŭS above. On and off time: Ramp down: 1.5 s
    motor On/off: 1:3 to 1:12 Avoid overflow of 1:2 Dosage: 30 minutes
    Dosage: 30 Duration: 30 current. Dosage: 30 × 1/day × 3 days.
    minutes × 2 minutes/ day and Reciprocal minutes × 2
    weeks. increase upto 8 stimulation weeks. [Powell et al 1999]
    hours/ day if Intensity should
    needed × 6 weeks produce only
    minimal contraction
    Case study: Bells palsy
    • Name : KK Sex : M Age : 26
    • Diagnosis : (R) Bell’s Palsy
    • Physiotherapy : Electrophysical Therapy
    • Assessment : Medical history -
    - Sudden onset of facial asymmetry 30 days ago

    Signs and symptoms -


    - Facial asymmetry
    - Presenting problems: inability to raise (R) eyebrow and tendency to drool
    EMG Biofeedback
    For personal use only
    Clinical Applications in PT
    • To facilitate muscle contraction:
    ➢ Muscle re-education e.g. selective vastus medialis oblique training for knee
    conditions
    ➢ Fecal/ urinary incontinence e.g. training of the pelvic floor muscles
    ➢ Balance/ postural control: e.g. trunk muscle
    ➢ Respiratory control: EMG activity of the 3rd intercostal muscle
    • To reduce muscle activities:
    ➢ Muscle relaxation e.g. stress management, tension headache, anxiety,
    asthma
    ➢ Neurological conditions e.g. reduction in spasticity for patients with stroke
    ➢ Pain reduction e.g. neck and shoulder pain due to overuse

    All rights reserved


    Contraindications & Precautions for EMG

    For personal use only


    Biofeedback
    • General
    • If the patient is prohibited from moving the joint or isometric contractions, then EMG BFB
    should not be used,
    • Unhealed tendon grafts,
    • Avulsed tendon,
    • A third-degree tear of muscle fibers,
    • Unstable fracture,
    • Injury to joint structure, ligaments, capsule, or articulating
    surface.
    • Specific contraindications for pelvic floor training
    • Acute inflammatory conditions
    • Pregnancy
    • Bladder or vaginal infection (for incontinence training)
    • Rectal or pelvis surgery (for incontinence training)
    Watch out for rash or skin allergic reaction to the electrode adhesive
    All rights reserved
    For personal use only
    Case study: EMG Biofeedback
    Name : BB Sex : M Age : 32
    Diagnosis : Fracture femur with likely inury to the femoral nerve
    Physiotherapy : Electrophysical Therapy
    Assessment : Medical history -
    - RTA with fracture of L femur
    - Immobilised in long leg POP for 8 weeks
    -(L) in left quadriceps

    Signs & Symptoms -


    -(L) knee extension weakness
    -(L) ROM full
    -(L) Quadriceps grade 4

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    •Thank you!

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