When can ES be used?
- - prevent disuse atrophy from immobilisation or inactivity
- - maintain or improve range of motion
- - facilitate voluntary motor control
- - decrease oedema (mm pump action)
- - decrease spasticity (recipricol inhibition)
- - act as a substitue for missing motor skill alloing for performance of functional activities
- - prevent shoulder sublux
- - reduce pain (by improve the resting position of joints and spasticiy)
What are the contraindications/ precautions of ES?
- - pregnancy
- - pacemaker
- - decrease circulation
- - decrease sensation
- - decrease communication
- - broken skin
- - skin infection in the treatment area
- - uncontrolled epilepsy
- -SCI above T6 (due to autonomic dysreflexia)
- - malignant tumour
How do you do skin prep for ES?
- - wash area with soap and warm water (or alcohol wipes)
- - leave skin damp
- - after removing electrodes at end of session, check skin for any damages and apply moistureizer
- - assess sensation
Electrode placement for ES?
- - put at motor point of mm- area of least resistance to stimulate the mm
- - you may have to adjust the position of the electrodes several times to obtain the mm response you are aiming for
- - use largest electrodes
- MAKE SURE MACHINE IS OFF BEFORE U HOOK IT UP TO PT
When do you use the tilt table?
- - if someone has been unconcious or hasnt been up for a long period of time
- - someone who has hemiplegia
- - if someone is anxious/ frightened of getting up
- - if someone has perceptual problems
- - pt has decreased communication abilities
What are the benefits of using a tilt table?
- - improving/ stimulating vertical sense
- - providing a sense of weight bearing through both heels with hips and knee extended
- - facilitation of "sit to stand" in the early stages of rehab
- - where difficulties arise from pain/ weakness
- - increasing level of arousal/ conciousness
- - accommodating vesibular problems
- - stretching tendo-achilles/ hamstrings contractures
- - gradual accommodation to upright position for pts who are to stand/ mobilise after a period of bed rest and who are not allowed to sit up eg, some spinal fractures or fusions, post-hip dislocation or unstable THR (total hip replacement)
- - facilitating postural extensor mm
- - standing obese pts
What are the disadvantages of tilt table?
- - postural hypotension
- - assive, not active
- - fear
- - not "normal" functional activity of sit to stand
What do you need monitor when putting a pt on a tilt table?
- - monitor BP
- - have someone with you- if help is needed
- - make sure pts feet are on the floor
- - make sure pt is nice and aligned
- - towel under strap for comfort
- - strap chest, knee and pelvis
- - if worried about sublux put pts arm in a slign
- - be warry of pt neck and the feeling of falling when they are upright
- - generally leave shoes on unless you want to improve proprioception take them off
- - generally used early with therapy
- - pt will fatigue quickly
- - treatment etc is pt dependent
Perform the process of the tilt table
- - cover tilt table with sheet, place pillow at head of table
- - all four wheels must be locked before pt is moved on to table. Place wheels parallel to length of table
- - transfer pt onto bed lying supine with assistance of TA and/ or wards person
- - secure footplate in place
- - lower strap- place over knees
- - put towel under knees
- - midstrap- positioned over pevlis
- - upper strap- aced over chest, under arms
WHat must you do before u tilt the pt
- - explain what is happening and why to the pt
- - note BP, pulse rate and colour as appropriate
- - encourage pt to keep eyes open
- - tilt table slowly upwards with frequent pauses to allow pt time to accommodate
- - first treatmetn should NOT go higher than 60 degrees
- - one person must stand in front of tilt table so that pt can be assessed at all times
- - proceed with rehab activities as appropriate
When must you bring the pt back to a horizontal position and seek medical advice?
- - SOB
- - sustained increase HR > 10-15beats/ min
- - dizzy
- - LOC
- - cyanosis
- - chest pain
- - clamminess/ cold sweats
- - signif > BP if base SBP > 150 of 20 or 10 for 100-150
- - if SBP falls below 90mmHg
What must you do when using tilt table?
- record pt HR and BP as u move pt up
Would you use ES if sensation is impaired?
What warning would you give before giving ES?
- when recieving ES, you should feel a tingling sensation and then a mm contraction whcih will hold for several seconds and then relax for several seconds and then relax for several seconds. If you feel anything other than this or any pain you must alert the therapist immediately: otherwise you are at risk of skin and other tissue damage under the eletrodes. If in dount alert the therpaist. I fyou become uncomfy, alert a therapist. Do you understnad what i have said, do you have any qu, are you happy to proceed?
- Note a little reddening under the electrodes are removed is normal and it should fade away within 20 mins. If redness is still visible the next day then do not use ES until the skin has returned to normal. it is likely the pt is having a reaction to adhesive rather than electrode
To prevent sublux where should you place the electrodes?
- - suprasinatus fossa
- - proximal 2/3 of deltoid
SEE pg 48 for more info on preventing sublux
What can ES be applied for?
- - to prevent shoulder sublux
- - application to manage oedema
- - application for mm activation
Setting for ES to prevent shoulder sublux
settings for ES for management for oedema
- - been shown to be effective with the reduction of arm oedema and hand than elevation. but swelling does return after 24hrs
- - you may choose to stim hand- lumbricals and interossei to asist with the mm pump action. place electrodes in palm of hand and below palmar crease and in the middle of dorsum of hand-you want IP extend and MCPs flex
If you are using a neuro tract for ES what must you do?
- - change the stimulation from synchronous to alternating channels
- - reduce the off phase (as the on phase of one channel created the off pahse for the other)
- - set the intensity for each channel individually when commencing stimulation
See notes pg 50 for all the different types of ES placeemnt for stimulation of mm