14.2.5 Stimulation energy
In NMES, the stimulation energy is directly responsible for spatial recruitment: the higher the stimulation
energy, the higher the percentage of motor units recruited and the greater the impact of the progress.
The general rule is to always try to increase the energy to the maximum level tolerated by the patient.
The therapist plays a fundamental role by encouraging and reassuring the patient, who can then
tolerate levels of energy that produce powerful contractions. The levels of energy reached must increase
throughout the session, and also from session to session, because the patients quickly get used to the
technique.
When the patient has diculty in reaching satisfactory levels of stimulation energy, it can be useful to
ask the patient to add voluntary co-contractions, which improves mediocre spatial recruitment and also
makes the stimulation more comfortable.
The levels of energy can then be gradually increased over time.
For this, the mi-ACTION is a useful tool, because it requires the patient to contract his/her muscle
voluntarily to initiate and/or accompany the electrically induced contraction depending on the given set-
point.
14.3 Rehabilitation of the peroneus muscles following an ankle sprain
The purpose of the peroneus muscles is to maintain the stability of the talocrural joint and prevent the
ankle from rotating inwards.
Following a sprain, due to the functional disability, reflex inhibition phenomena and immobilisation, these
muscles can undergo partial disuse atrophy, a loss of proprioceptive reflexes and a considerable loss of
strength.
Rehabilitation following such an accident must therefore focus essentially on the peroneus muscles in
order to prevent recurrences.
To fulfil their function optimally, the peroneus muscles must eectively put up resistance to brief and
powerful stresses. They must therefore be capable of responding with a powerful, short contraction at
that very moment when the stress being applied to the foot risks making the ankle tilt inwards.
There are therefore two main aspects of the rehabilitation of these muscles:
1. The proprioceptive reflex:
Allows the peroneus muscles to sense the lower limb position relative to neighbouring parts and to
contract at the right moment with an appropriate strength eort.
This aspect of rehabilitation consists of properly performing exercises on classic “balance boards”, such as
Freeman boards, a sucient number of times (number of sessions).
To Next Page
Loading...
