中山医学大学物理治疗学系.pdf

Electrical stimulation to Increase Functional Activity 中山醫學大學物理治療學系 林志峰講師 Introduction 1.Pioneering work : Duchenne, more than a century ago 2.NMES→intact PNS→M.C. Introduction 3.interfere with NMES 1peripheral neuropathies(DM) 2partial innervation(root or peripheral nerve entrapment) 3muscle pathology(myopathies, dystrophies) Treatment Goals 1.improve force or maintain muscle mass 2.maintain or gain ROM 3.reeducate and facilitate voluntary motor control 4.temporarily reduce the effects of spasticity 5.provide an orthotic support 6.reduce edema formation Preserving and Increasing ROM 1.significant exception : ─older patient ─joint replacement Preserving and Increasing ROM 2.indication : 1only intrinsic soft-tissue shortening, not to bone obstruction of the joint ─connective tissue surrounding the joint ─muscle acting across the joint on the shortened side Preserving and Increasing ROM 3.evaluation : 1end-feel 2X-Ray→rule out bone obstruction 32 week daily treatment→some improvement Preserving and Increasing ROM 4.intervention : 1combining with other technique (cast, position) 2within limited arcs of range Preserving and Increasing ROM 5.Rational : 1automated and repetitive nature of contraction→compliance ↑ →gentle stretch 2encourage facilitation and force improvement 3pain management→relax Preserving and Increasing ROM 6.Technique : 130 minutes 2100 repetition 3available range Preserving and Increasing ROM 4level low enough to avoid a jamming effect at the end of available range 5prevent painful, swelling, effusion of joint 6daily, home program Inadequate Voluntary Control 1.Problem : 1peripheral inhibition of t