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Electrostimulation denervated muscle

What is the type of current that is recommended to stimulate a denervated muscle? What are the parameters that this current must have? Thanks for your reply

myriam maya

2 years ago

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Dr Ethne Nussbaum
Dr Ethne Nussbaum

Hi Myriam, I have conducted traditional strength duration curve testing on many patients with peripheral nerve damage. Most times the referral came from a physician who wanted to know whether conventional NMES could be applied at home to aid recovery. A muscle response to a 1 ms square wave pulse indicates the presence of some intact motor units. If there are very few such innervated fibres, the muscle response will be very small and will not move the limb through range. To stimulate muscle fibres directly and, at the same time, to prevent a response from nearby normally innervated muscles, I suggest using a triangular pulse shape (i.e. an exponentially rising pulse), at least 300 msec duration (if no response to 300 ms then try 400-600 msec duration). Support the muscle in its mid range - a stretch on the muscle will make it harder to activate. Realize that you are going to see no more than a twitch response. I agree 20x3 contractions. Recommend once daily. Only evidence is from the Alberta group using animals for most their work. Conventional portable muscle stimulators usually deliver 300 microsec pulses. Big difference to what I am suggesting. There used to be devices made in the U.S.A. that provided long duration, exponential pulses. Good luck with your patient.

Last updated 2 years ago

Prof Gad Alon
Prof Gad Alon

In general, to electrically activate denervated muscles you need much more powerful pulses and to get an adequate stimulator, you will have to go to Austria or Germany, the only countries that approved it for clinical use (to the best of my limited knowledge.

Here is one Abstract. Read the article (which include many reference) Kern, H. Hofer, C. Loefler, S. et al. Atrophy, ultra-structural disorders, severe atrophy and degeneration of denervated human muscle in SCI and Aging. Implications for their recovery by Functional Electrical Stimulation, updated 2017. Neurol Res 2017;39: 660-666. OBJECTIVES: Long-term lower motor neuron denervation of skeletal muscle is known to result in degeneration of muscle with replacement by adipose and fibrotic tissues. However, long-term survival of a subset of skeletal myofibers also occurs. METHODS: We performed transverse and longitudinal studies of patients with spinal cord injury (SCI), patients specifically complete Conus and Cauda Equina Syndrome and also of active and sedentary seniors which included analyses of muscle biopsies from the quadriceps m. RESULTS: Surprisingly, we discovered that human denervated myofibers survive years of denervation after full and irreversible disconnection from their motor neurons. We found that atrophic myofibers could be rescued by home-based Functional Electrical Stimulation (h-bFES), using purpose developed stimulators and electrodes. Although denervated myofibers quickly lose the ability to sustain high-frequency contractions, they respond to very long impulses that are able to allow for re-emergence of tetanic contractions. A description of the early muscle changes in humans are hampered by a paucity of patients suffering complete Conus and Cauda Equina Syndrome, but the cohort enrolled in the EU RISE Project has shown that even five years after SCI, severe atrophic myofibers with a peculiar cluster reorganization of myonuclei are present in human muscles and respond to h-bFES. CONCLUSIONS: Human myofibers survive permanent denervation longer than generally accepted and they respond to h-bFES beyond the stage of simple atrophy. Furthermore, long-term denervation/reinnervation events occur in elderly people and are part of the mechanisms responsible for muscle aging and again h-bFES was beneficial in delaying aging decay.

Dr Maryam Almandil
Dr Maryam Almandil

It advisable that you calculate the chronaxie of the nerve and apply current of equal or greater value.
The waveform can vary from asymmetric biphasic to interrupted square DC or even exponential DC. Pulse duration of less than 1 millisecond can be used in the first 2 weeks and replaced with longer pulse durations (more than 10 msec) or you could also use sine wave (less than 10 Hz). Use the most active point in the muscle to apply your stimulation, allow up to 20 contractions x3 and repeat treatment 2-3 times a day. Adjust the rest period to 1:4 or 1:5 to avoid fatigue.

These are protocols that we have used and found helpful

Hope this is useful.

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