Molly Ayala
Electrical muscle stimulation (EMS) is a treatment method that involves the application of an electrical current across the surface of the skin to stimulate muscle contractions. The MedPro electrical stimulator is a device used for this purpose. To adjust the device, the user must first ensure they are seated comfortably, with the skin properly cleaned and dried before the application of self-adhesive electrodes. The amplitude, or intensity, of the device can then be adjusted to achieve the desired level of stimulation, with a higher amplitude resulting in a stronger contraction. The pulse duration and pulse amplitude can also be adjusted, with shorter pulse durations requiring a greater pulse amplitude for innervated muscles. It is important to increase the intensity of the stimulation gradually to ensure patient comfort and avoid pain or discomfort.
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What You'll Learn
- Amplitude/intensity: Increase for stronger contractions, but balance with pulse width for comfort
- Pulse duration: For innervated muscles, shorter pulse duration, higher amplitude; denervated muscles require longer duration
- Electrode placement: Position adhesive or rubber electrodes near target muscles
- Patient comfort: Ensure patient is seated comfortably with relaxed muscles
- Safety: Check equipment regularly, especially after long periods of non-use
Amplitude/intensity: Increase for stronger contractions, but balance with pulse width for comfort
Amplitude, also referred to as intensity, is the strength of the stimulation delivered, measured in milliamps (mA). The amplitude needs to be high enough to evoke the desired effect while remaining comfortable for the patient. This parameter is always adjustable in EMS devices and often appears like a volume switch.
The amplitude should be increased to achieve the best possible contraction within tolerable levels. If a muscle contraction cannot be generated, the frequency and pulse width can be manipulated to adjust the sensory response. It is important to remember that this may be a new sensation for the patient, and they may perceive it as pain when it is just different.
Balancing the amplitude and the pulse width can help optimise both the muscle contraction produced and the comfort for the patient. A wider pulse duration may mean that the amplitude can be reduced, offering more comfort. A short pulse width can be more comfortable for some patients, but a longer pulse width may recruit more motor neurons and thus improve the muscle contraction produced.
It is important for the patient and therapist to understand what level of muscle contraction is desired during each session so the intensity can be varied accordingly. The therapist should start conservatively, as you can always increase stimulation parameters to effect a better contraction next time. However, if you start too high, you may lose compliance.
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Pulse duration: For innervated muscles, shorter pulse duration, higher amplitude; denervated muscles require longer duration
When using electrical stimulation to stimulate muscle contractions, it is important to adjust the parameters according to the type of muscle being targeted. For innervated muscles, a shorter pulse duration and higher amplitude are required. This means that the pulse width is shorter, and the intensity of the stimulation is higher.
To achieve optimal results and comfort for the patient, the amplitude and pulse width must be balanced. While a wider pulse duration may allow for a reduction in amplitude, thus increasing patient comfort, a short pulse width can be more comfortable for some patients. However, a longer pulse width may recruit more motor neurons, improving the muscle contraction produced.
Innervated muscles require a higher amplitude due to their ability to accommodate a stronger stimulation. The amplitude, or intensity, of the stimulation is measured in milliamps (mA) and is always adjustable in EMS devices, often appearing as a volume switch. As the muscle gets stronger, the amplitude may need to be adjusted to achieve the same response.
For denervated muscles, a longer pulse duration and higher amplitude are necessary. This is because denervated muscles have higher chronaxie values, requiring a longer rise time and longer pulse duration to stimulate the muscle fibers effectively. In clinical practice, denervated muscles are stimulated using slow-rising triangular pulses, which prevent overstimulation of the surrounding innervated muscles and the stimulation of sensory fibers.
It is important to gradually increase the intensity of the stimulation to the maximum tolerable extent by the patient. This is to avoid discomfort and negative side effects, such as burns, which may occur with long-term electrical stimulation.
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Electrode placement: Position adhesive or rubber electrodes near target muscles
When using an electrical stimulator, it is important to position the adhesive or rubber electrodes near the target muscles. This is known as electrode placement.
Electrical stimulation involves the application of an electrical current across the surface of the skin to generate a muscle contraction. The electrodes are placed directly on the skin, in close proximity to the muscles that need to be stimulated. This causes an electrical current to travel into the tissues, resulting in muscle contraction.
The size of the electrodes depends on the muscle group being targeted. For larger muscle groups, it is recommended to use larger electrodes, as they can cover a broader area effectively. These larger electrodes are typically single-snap or double-snap electrodes, measuring 5 x 10 inches. They are ideal for covering large areas and providing a broader diffusion of the current.
On the other hand, for smaller muscle groups or areas requiring high accuracy, smaller electrodes are more suitable. These electrodes, measuring 5 x 5 inches, offer precise stimulation. An example of their use is in targeting the quadriceps, where small electrodes are placed on the vastus medialis and vastus lateralis.
It is important to note that the electrodes should not be placed on the head, neck, or face. Additionally, the comfort and tolerance level of the patient should be considered when adjusting the amplitude or intensity of the stimulation.
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Patient comfort: Ensure patient is seated comfortably with relaxed muscles
To ensure patient comfort, the patient should be seated comfortably in a way that allows their muscles to relax. This is necessary for easier muscle stimulation. The patient's skin should be inspected to ensure there are no abrasions or injuries. The skin should then be cleaned with a cloth and water or alcohol-based wipes, and properly dried.
The patient's comfort is paramount and the intensity of the stimulation should be increased gradually and only to the maximum level that the patient can tolerate. The amplitude, or intensity, of the stimulation should be high enough to evoke the desired effect while remaining comfortable. As the muscle gets stronger, less amplitude may be required to achieve the same response. Balancing the amplitude and the pulse width can help to optimise both the muscle contraction produced and the comfort for the patient.
The electrodes should be placed away from the joints and properly attached to the skin to avoid pain and discomfort. The size of the electrode depends on the size of the muscle or muscle group being stimulated. The cathode can be placed on the motor point of the target muscle and the anode proximally on a nearby muscle supplied by the same nerve. This placement is called monopolar electrode placement and is used when targeting small muscles. Bipolar electrode placement involves placing both electrodes on the muscle belly or one at the proximal end and another on the distal end of the muscle.
It is important to remember that the patient may perceive the sensation as pain when it is just different. A good way to educate the patient is to place the stimulation on yourself or their parent/guardian to show them it is okay.
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Safety: Check equipment regularly, especially after long periods of non-use
Safety is paramount when using electrical stimulators, and regular equipment checks are essential, especially after extended periods of non-use. Here are some detailed guidelines to ensure the safe operation of electrical stimulators:
Annual Equipment Checks: It is recommended, and in some places mandated, that all equipment intended for use on people be inspected at least annually. These inspections should be conducted by qualified biomedical technicians. They will evaluate the integrity of the electrical circuitry, including the insulation of electrical cords and circuit grounding. This ensures that the equipment is safe for use and that the electrical output is accurate.
More Frequent Inspections: In certain cases, more frequent equipment checks may be necessary. For example, if a device has been unused for 3-6 months, it is advisable to test it on yourself before using it on patients. Electrical components can accumulate dust during periods of non-use, affecting conduction and insulation. This can result in irregular current flow, which may be unsafe for patients.
Checking the Power Supply: Before using an electrical stimulator, ensure the power supply cord is securely connected and functioning properly. Check for a green light on the power supply cord when it is plugged into an outlet. If the green light is absent, try repositioning the cord or using another outlet. Also, ensure the power supply cord is compatible with the electrical outlet, and obtain an adapter if necessary.
Battery Considerations: Keep in mind that battery-operated devices may discharge even when not in use, so always check the battery level before use. If the battery is completely discharged, recharge the device and turn the therapy back on. If you have an implant, be aware that some implants enter a discharge state as the battery nears depletion, rendering therapy unavailable until recharged.
By following these guidelines and conducting thorough equipment checks, you can help ensure the safe and effective use of electrical stimulators, especially those that have been dormant for extended periods.
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Frequently asked questions
Amplitude refers to the strength of the stimulation delivered, measured in milliamps (mA). To adjust the amplitude, locate the control that looks like a volume switch and turn it up or down. The amplitude should be high enough to evoke the desired effect while remaining comfortable.
Start with a conservative amplitude and increase the stimulation gradually until you reach the maximum tolerable extent. Balance the amplitude with the pulse width to optimise muscle contraction and comfort.
The pulse width refers to the duration of the electrical pulses delivered by the stimulator. To adjust the pulse width, locate the relevant control on your MedPro device and adjust it according to the desired setting.
Check that the device is powered on and the battery is charged. Ensure that the electrodes are properly attached to your skin and positioned away from the joints. If the stimulator is working correctly, you should feel the electrical impulses, which may feel like a strong sensation but should not be painful.
