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NeuroMuscular Electrical Stimulation for facilitation in central nervous system dysfunction

NeuroMuscular Electrical Stimulation for facilitation in central nervous system dysfunction. Possible applications following hemispherectomy. NMES – HOW?. Surface Therapeutic Short to Medium term Training Implant Long term Management (FES). NMES – WHEN?. Acute H abilitation

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NeuroMuscular Electrical Stimulation for facilitation in central nervous system dysfunction

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  1. NeuroMuscular Electrical Stimulation for facilitation in central nervous system dysfunction Possible applications following hemispherectomy

  2. NMES – HOW? • Surface • Therapeutic • Short to Medium term Training • Implant • Long term Management (FES)

  3. NMES – WHEN? • Acute Habilitation • Sub-acute Habilitation • Long Term

  4. NMES – Why? • Added Sensory Information for Processing • Muscle strengthening • Increased Sensory/Motor Integration • Motivation • Modification of ‘spasticity’/ tone

  5. NMES – Whom? • Orthopedic Dysfunction • Neurologic Dysfunction • Developmental Dysfunction

  6. Treatment Goals Enhanced with NMES • Strengthening Programs • Range of Motion & Contracture Management • Facilitation & Reeducation • Edema Management • Temporary Spasticity & Spasm Management • Functional Electrical Stimulation

  7. Proprioceptive changes in cortical processing of finger flexion/extension FES Assist > Vol FES Evoked > Vol Normal subjects comparing sensory processing between voluntary finger contractions and NMES assisted (NMES Assist) with stimulation without voluntary overlay (NMES evoked). Take home message – voluntary AND NMES activate more brain!

  8. Proprioceptive changesVol + NMES compared to just NMES Super Front Sulcus SMA – Supplimentary Motor Association Cortex Super Front Gyrus From: Modulation of proprioceptive feedback during functional electrical stimulation: an fMRI study, Europ J Neuroscience 2013

  9. Optimizing NMES training • Sensory Level to Motor Level NMES • Based on Awarness and Voluntary Control – Less is Ultimately More • COMBINED with “Meaningful Activity” • Specific for your child • NMES TRIGGERED at appropriate points of the activity – Dynamic Input

  10. Optimizing NMES training • HABILITATION (CREATING a ‘Motor Program’) requires longer Intervention to Attain (based on CP experience) • Creative and Dynamic Applications with Therapist /Parent • MAKE IT FUN!

  11. Cortical profusion of Hemiparetic Patients before and after training with EMG-FES From: The effects of electromyography-controlled functional electrical stimulation on upper extremity function and cortical perfusion in stroke patients: in ClinNeurophysio 2013 Pre-Training After 5 weeks Training

  12. Facilitation in Children

  13. Meaningful activities for children

  14. NMES Why Bother? • Multiple Treatment Outcomes from One Treatment Intervention • Facilitation may enhance muscle strength and increase ROM • Strengthening Increases ROM and Decreases Spasticity

  15. NMES Why Bother? • Multiple Goals to Reduce a Wide Variety of Impairments • It will take great creativity to enhance FUNCTION !

  16. NMES – Why Bother? • NMES – a potentially powerful, multimodal tool for Habilitation B U T it will require a skilled and knowledgeable Therapist and could be optimized by a very involved family (for home follow-up, with or without the NMES)

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