How we use the Stimulette Edition 5 with denervated muscle

Every Body Better

USING THE STIMULETTE EDITION 5 Operation with Denervated muscle

DENERVATION EFFECTS ON MUSCLE AND WHY THIS MATTERS Important to avoid severe muscle degeneration and increased rsik of decubitus ulcers

Permanent denervation of the limbs muscles due to a Lower Motor Neuron lesion may take place when trauma to spinal cord, roots and peripheral nerves occurs. Examples are spinal cord lesion with concomitant root damage, brachial plexus palsy and sciatic nerve injury.

Extensive research shows that muscle structure can be preserved or restored with electrical stimulation with long term health benefits at 6 months

Denervated muscle undergoes structural changes over time without treatment BRUCE M. CARLSON THE BIOLOGY OF LONG-TERM DENERVATED SKELETAL MUSCLE EUR J TRANS MYOL - BASIC APPL MYOL 2014; 24 (1): 5-11

at 3 years - loss of muscle fibre structure collagen & fat increasing

at 30 years

Detrimental effects on skin, circulation and bone health

Four Programmes for Denervation within the Edition 5 "Modern" waveforms based on recent research

"DEN120" The modern form of stimulating denervated muscles is usually with broad, biphasic, rectangular impulse sequences with a frequency of approx. 2 Hz. This type of electrotherapy should be continued until regaining volitional activity. In the event of re-innervation being unlikely, the main objective is to increase blood circulation and improve trophism.

"DEN40" This is a biphasic rectangular impulse train with a frequency of approximately 20 Hz. This strengthens by producing a tetanic contraction. Denervated clients may not initially respond to this pulse train.

"Traditional" waveforms useful in particular situations

"E100"

"E200"

Exponential current consists of 100 ms wide triangular impulses which stimulate the muscle to individual twitches with a frequency of approx. 1 Hz. I favour the biphasic form of impulse.

Due to the triangular impulse shape, the denervated muscle is stimulated selectively while neighbouring innervated muscles are not contracted due to the accommodation ability of innervated muscles.

Treatment generally starts with the shorter impulses of E100 (100 ms). If no response try E200.

For pronounced denervation, the impulse duration must be increased due to the increased need for stimulus of the muscles and the associated prolongation of chronaxy.

Impulse widths from 100 ms to 200 ms are normally sufficient.

Essence of the Protocol FIRST STAGE GOAL

SECOND STAGE GOAL

Improve the "excitability" of the muscles

Strengthen and develop the muscle

WHY? Denervation affects the nerves and structure of the muscle so over time the muscle loses it's ability to contract

HOW? Particular types of FES encourage the nerves and muscle structure to "normalise"

DEN120 BIPHASIC PROGRAMME

WHY? Improved muscle bulk and tissue quality reducing risk of complications improved appearance

HOW? Changing the type of FES to encourage a strong, sustained contraction of the muscle

DEN40 BIPHASIC PROGRAMME

Den120 and Den40?

DEN120 PROGRAMME

IDEALLY WE USE BOTH WITH MORE DEN120 INITIALLY AND OVER TIME INCREASING THE USE OF DEN40

Technically the electrical stimulation has a similar pattern with both programmes but they are designed to have a different effect on tissue.

Initially, DEN120 is most important to re-establish the structure of the muscle.

As the months go by we need to increase the amount of time spent on DEN40 to strengthen what has been gained

DEN40 PROGRAMME

"Exponential" Programmes The Exponential Waveforms supported by the Edition 5 are "E100" and "E200" They represent a more traditional approach to stimulate denervated muscle using a long, triangular shaped waveform

E100 PROGRAMME

Can be used when denervated muscles are close to innervated muscles and there is a likelihood of overactivation of these The E100 waveform produces 100ms impulses and would typically be used initially (equivalent to the DEN120) The E200 waveform produces longer waveforms and can be used when the degree of denervation is more severe

E200 PROGRAMME

These waveforms rely on the muscle fibre structure still being largely intact and capable of excitability

ELECTRODE PLACEMENT POSITION AND SIZE ISSUES Important to cover as much of the muscle as possible without the electrodes touching or overlapping.

Use the largest electrodes that are consistent with this.

After use rinse the sponges and allow to dry. Wash every few days in warm soapy water or cool machine wash

Showing correct electrode placement on the lower leg with wet Sponge and Rubber electrode combination. Note different configuration on each leg

Thigh Placement

Important to cover as much of the muscle as possible without the electrodes touching or overlapping. Use the largest electrodes that are consistent with this. Keep the electrodes wet and in firm contact with the tissue

One electrode placed on pretibial muscles and the second on top of the foot to initiate a twitch contraction in the whole of the lower leg and intrinsic foot muscles

Both electrodes placed on quadriceps muscles to initiate a twitch contraction

One electrode placed on gastrocnemius and the other under the foot. Ensure there is good contact with the undersurface of the foot

Showing correct electrode placement on the abdomen with wet Sponge and Rubber electrode combination. Note different configuration on each leg

Denervated Flank Muscles

Important to cover as much of the muscle as possible without the electrodes touching or overlapping. Use the largest electrodes that are consistent with this.

Keep the electrodes wet and in firm contact with the tissue

Shoulders can be problematic to position the electrodes and hold them securely.

It can be done with a broad elastic wrap placed under one arm pit and across the chest and back to cover the anterior and posterior deltoids.

A better solution is to use an elasticated wrap as shown here - tucking the electrodes in place

Important to cover as much of the muscle as possible without the electrodes touching or overlapping. Use the largest electrodes that are consistent with this.

Keep the electrodes wet and in firm contact with the tissue

WHAT'S THE DOSE? HOW OFTEN? HOW INTENSE?

DOSE?

HOW OFTEN AND HOW INTENSE It is difficult to be precise about this because not every combination of frequency and intensity has been researched.

That being the case we tend to stick with what has been researched and then vary the advice based on the user's response

SAMPLE STIMULATION PLAN & PROTOCOL Make the muscle more responsive with "Twitch" stimulation

IF USER INITIALLY RESPONDS TO DEN120 BUT NOT TO DEN40 Use DEN120 for 20-30 minutes at intensity of 10% or more (if tolerated) over the threshold at which you see the muscle start to contract Test for DEN40 response at 6 week intervals

Make the muscle larger and stronger with "Tetanic" stimulation

USER NOW RESPONDS TO BOTH DEN 40 AND DEN12O

Divide the session into two halves with 15 minutes of Den120 followed by 15 minutes of Den40 If you notice the muscle stop contracting pause for a minute or two and restart.

At least 5 days per week per muscle group (Ideally)

Keep going or reduce to preserve what has been gained

NOTES

After one year, review results and either continue by increasing the proportion of the session devoted to Den40 - or reduce the frequency of sessions to 3 times per week to maintain what has been gained

3 days per week per muscle group or more as desired

Please Remember IT WORKS

IT'S PERSONAL

COMMITMENT

ASK

This process will work if you use it. But it's a marathon not a sprint.

It's more difficult to see progress from day to day so take some measurements and review at around 6 month intervals

It's not possible to research every combination and possibility for how the equipment is used and how this should vary from person to person.

From experience we can say that you shouldn't worry too much about "doing it right"

The most important factor, especially in the early days of application is just to use the system 5 or even 6 days per week.

But beware of making it an endurance game. If you have multiple areas to stimulate try working on only one or two areas for a while

Ask for help when you need it or you have questions.

Generally the product is very simple to use, however a lot of research has gone on to get things to this state. If you want more information on the research just ask

OPERATING THE EDITION 5?

IT'S VERY EASY REQUEST THE "SETUP DOCUMENT", OPERATING INSTRUCTIONS OR FACE TO FACE TRAINING

Contact Us MAILING ADDRESS

Unit 18, Block 6 Trading Estate Third Road Blantyre South Lanarkshire G72 0UP PHONE NUMBER 0141 628 8222 EMAIL ADDRESS info@anatomicalconcepts.com