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what device we can use to excite a muscle with no functioning nerve?

i need to excite a muscle that have no intact nerve

nuha

3 months ago

Back to General Electrotherapy

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Prof Tim Watson
Prof Tim Watson

Not sure what else I can usefully add. There remains considerable controversy re the stimulation of dennervated muscle as a means to enhance recovery. Historically, certainly was a routine treatment as a mean to maintaining muscle function and excitability whilst waiting for the nerve to 'regrow'. Controversy raised in the early 1990's on the basis that the stimulation may serve to slow down the nerve regrowth and ?promote collateral sprouting (as Dr Hoens notes) - both potentially detrimental. Certainly less widely employed in modern practice. Recent paper (Pinheiro-Dardis and Russo (2017). "Electrical Stimulation Based on Chronaxie Increases Fibrosis and Modulates TWEAK/Fn14, TGF-beta/Myostatin, and MMP Pathways in Denervated Muscles." Am J Phys Med Rehabil 96(4): 260-267) demonstrates detrimental effects - though in a rat model. There are numerous others like this. Advice offered by Dr Hoens is sound

Prof Alison Hoens
Prof Alison Hoens

In addition to the comments of my colleagues, I would like to add: (1) consider discussing with the neurologist the probable extent of nerve damage - neuropraxia, axonotomesis or neurotomesis. This will indicate the expected degree of recovery; (2) consider performing a strength-duration test and intermittently repeating it to determine whether recovery is occurring; (3) consider whether the benefits exceed the burden (patient time, effort and cost as well as consideration of potential theoretical alteration of collateral sprouting in recovery); (4) consider the muscle function and whether it is advisable for the specific muscle group(s) to be recruited simultaneously e.g. facial nerve palsy is generally not recommended for electrical stimulation; (5) If, after considering the above, the patient is fully informed and decides to proceed, work with a local dealer to trial a unit that has the capacity for pulse durations exceeding the conventional 250-400 microsec required for innervated muscle to one with pulse durations approaching 1 millisecond. You may wish to review this article for potential parameters: https://link.springer.com/article/10.1186/s12984-015-0046-0

luisef258
luisef258

Hi, Nuha Any regular electrotherapy equipment serves if it can provided a direct current - glavanic - or alternating current of low or medium frequency. Taking a look at this article may help "Muscle motor point identification is essential for optimizing neuromuscular electrical stimulation use" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3938308/ However crucial is to first establish a purpose for the intervention. As Cliff says "These changes will result in the muscle not functioning as well even when the nerve supply has been regained". So knowing if the nerve is expected to regenerate seems to me that it is important in order to make dicisions about currente type and protocol.

Last updated 3 months ago

Cliff Eaton
Cliff Eaton

Dear Nuha Products like the Chattanooga PHYSIO NMES device (I am sure there will be others) have a programme called Denervation or similar. They use Direst current to activate the muscles cells directly when motor nerves are not patent. This is an important adjunct to rehabilitation especially if nerve supply is expected to recover. Without stimulus the muscles will not only atrophy but produce sclerotic changes and fatty deposits. These changes will result in the muscle not functioning as well even when the nerve supply has been regained Cliff

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