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Thread: Ask a PT

  1. #21
    What is it that you are trying to stim? And what is the goal of the stimulation?
    I feel a little unsure about just giving settings... I'd feel much more comfortable if I could see the unit and placement of the electrodes... Feel free to email me pictures or video!

    For strengthening, which is a common use of estim, here is how I would set up a unit on muscles that you can turn on but maybe can't move the joint through it's full range:
    phase = 300usec and frequency = 35pps then turn the amplitude up slowly until the muscle contracts stronger than you can do on your own. This is meant for you to work WITH it.
    I would ramp up for 2 seconds, on time of 4-5 seconds, ramp down for 2 seconds, then off for 20-25 seconds. This is a 1:5 onff setting for rest in between reps. And since it is strengthening, you do want to fatigue the muscle. If you notice the contraction isn't as strong after a few reps, you are done for the day. If you can make it to 20 reps, congrats! But I wouldn't do more than 20. Just like weight lifting, take a day off in between to let the muscle recover and strengthen.

    Hope that helps. PLEASE ask for any clarification!!

  2. #22
    Junior Member meusaf's Avatar
    Join Date
    May 2011
    Winston-Salem by way of Houston
    I have a ProMed PM-500 EMS. Im trying to wake up my nerves and maybe some tone in my legs, and Im not sure where to place the electrodes i just use a chart i got from the net.

  3. #23
    Okay - the research says that using stim to "wake up" nerves, you want to set it up at a sensory level. This means that you don't want to turn it up strong enough to make the muscle contract. Also, if you have sensation, keep it comfortable. Don't turn it up to a level that is uncomfortable.
    So frequency around 75pps and duration around 150usec. Turn up the amplitude, but stop if you notice muscle twitching.
    You can have it on a continuous setting, and just leave it on for an hour. Put the electrodes on the muscle you want to wake up. Space them a couple of inches apart. With estim, one electrode is on, one is the ground. So they have to both be on the same muscle.
    Does that help?

  4. #24
    Hi Scitotalfitness, thanks so much for all the advice. I have an L1 and L5 injury and am 14 months post. I've worked hard and can now get around on canes or with hiking poles. I don't use a wheelchair any longer. My limbs are strong but my balance is the bugger. I don't have a lot of feeling in my feet or ankles and I suspect that I need walking aids more for balance than support. Is there anything I can do to encourage better balance?

  5. #25
    One thing that is important I should have mentioned when writing about electrical stimulation - the parameters I gave are for injuries above L1, and only for injuries of the spinal cord. The parameters are for upper motor neuron injuries - not peripheral nerve injuries (which cauda equina injuries fall under) So if you have a lumbar level SCI, estim is not in your treatment plan.

    Now, onto balance training. Doing balance activities would help (always do in a secure setting so you can catch yourself or someone else can help):
    - practice just standing without using your arms
    - once that is easy, close your eyes. See if you sway
    - keep your eyes, stand with your feet as close together as you can get
    - try walking the line
    - if this gets easy, try a softer surface

    The bigger issue is the lack of sensation going back to your brain to tell your muscles to adjust for balance. That you can't train, you need to compensate for it. Have you ever tried walking with braces? Some AFOs may help. I know people don't like them, but they could make it safer to walk without the canes and can be hidden under clothes. If you get articulating ankle joints, you are not preventing motor recovery. Those are the 2 biggest reasons I hear from people who would benefit from braces but don't wear them.

    Good luck!

  6. #26
    Thanks so much for the suggestions! I had AFOs but worked my way out of them since I no longer have the drop foot. I can pick up and place the feet just fine....after many many hours of practice. It's general balance that's the problem. I will start practicing the same way I did with walking. Somehow, I thought the balance might just 'come back', but no luck, so far. Again, many thanks for the advice!

  7. #27
    Definitely work on your balance - you can train your strength, but if you don't have that sensation traveling back up to the brain to tell your muscles to automatically adjust, you're going to have trouble. So train this the same way you train strength.

    On a side note about AFOs and other braces for everyone out there using them:
    the rigid kind, usually plastic, are made to compensate for decreased strength, like drop foot. Since these are the cheapest, it's often what insurance covers. However, there are AFOs with ankle joints that allow your footplate to move, and this can be on plastic or metal braces. There are usually springs in the joints, and these allow for a couple of things - one is to assist muscles that are turning on but aren't strong enough for safe walking. They can be used by people who have so much spasticity turn on with walking, that walking is too difficult or unsafe by limiting the ability for the joint to reach that point that the spasms turn on. And they can be used by people who don't have sensation coming from their ankle - particularly proprioception that lets you know what your foot is doing without looking at it. Usually the metal ones work best for this, and I know they are not fashionable. But they add input to the brain, and can make walking safer and less effortful. The ankle joints on the braces are called DAAJ (double ankle adjustable joint)
    There are braces that go over the knee and that go over the hip. If anyone is interested in knowing more, I can go into those as well.

  8. #28
    Just a simple question: to bulk up muscles is doing a few reps with heavy weight better, or a lot of reps with less weight?

  9. #29
    Simple answer is fewer reps with heavier weight will help you bulk your muscle.
    Also, increase your protein intake to help the muscles build, give the muscles adequate rest between sessions, and stay hydrated.
    Then my word of caution is to make sure you continue to work the muscles in a balanced fashion since imbalances lead to injury. And to stretch after every session.

  10. #30
    Thank you.

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