Laurie's Blogs.

Hello Laurie,

 I was reading through your slides on modalities, specifically the NMES portion and I wanted to ask your opinions on the parameters you use. I noticed you prefer 5 HZ for disuse atrophy. Is this what you use on most of your patients with success? What pulse duration do you recommend? I am finding, especially with my conservative CCL and geriatric patients that they are not tolerating NMES as well as I would like so I am trying to play around with it at different settings. I actually find that they tolerate the ramp the least. 

 I have read about and heard of so many different recommendations and I know it will vary somewhat with each patient, but I wanted to have a good jumping off point.  I just wanted to get your opinion and see if you have any recommendations. I am mobile and I see a lot of conservative CCL and Geriatric patients and I feel this modality is a good addition to my at-home rehab plans and acupuncture.

For a conservative CCL do you tend to just target the quads and glutes? Or do you work on the hamstrings too? We learned about the alternating setting for quads and hamstrings, but I don't find this to be tolerated well, but again I am working on trying different settings.

Thanks for any info!! I really appreciate it!

E.W.

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Hi E.W.!

Sorry for my slow reply!  I've been super busy it seems!  

Okay... so I ALWAYS default to 5Hz.  Years ago when I started using it at this frequency (because a fellow physio was using it in this manner), I found that the animals tolerated it much better.

In regards to phase duration - you can think of that as 'bang for your buck'... in other words if you set up 5Hz, you will get 5 pulses per second.  Now a shorter phase duration makes for a shorter 'pulse' and a higher phase duration makes for a 'fatter' pulse.  And in clinical terms, the shorter the phase duration, the more comfortable it is, the higher the phase duration, you get more 'bang for your buck' and it's less comfortable and a stronger sensation.  So it's great to start with the lower phase duration (for comfort), but if you don't get a nice contraction, then it is one of the parameter (instead of intensity) that you can use to get a better / stronger contraction.

For Conservative (or any) cruciate rehab... I would primarily target the quads.  It's pretty difficult (when they are on and the dog is upright) to get alternating use and/or active use at the same time.  So I pick one muscle to work on at a time usually.  So quads is my first pic (based on the literature that says it atrophies most).  If I felt coordinated enough, I could do quads and glutes.  And if, further down the rehab path, I noted that the hamstrings seem like limp noodles, then I could use it on them.  All while doing a 3-leg stand I should add.  If it's conservative management, you should be able to start off in standing.  If this is a fresh post-op, you could do quads, hams, Cranial Tib (esp for TPLOs and TTAs) with the dog lying... and really if they are lying down, and since you cannot get the dog to do a 'voluntary contraction' in that position... you can select continuous or alternating, whichever is easiest.

I hope this helps!  Thanks for asking!

Cheers,

Laurie