Global Economics Paper No: 164
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Le téléchargement nécessite un accès à la bibliothèque YouScribe Tout savoir sur nos offres
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Le téléchargement nécessite un accès à la bibliothèque YouScribe Tout savoir sur nos offres
- fiche de synthèse - matière potentielle : measure of conditions
- leçon - matière potentielle : gap
- cours - matière potentielle : by 4 ppt
- cours - matière potentielle : fees
- cours - matière potentielle : by 18 -20 ppt
- cours - matière potentielle : while girls
- annual gdp growth rates by 0.2ppt on average
- overall quality of the students
- secondary schooling 33 33 34 31 47 41 34 40 47 63 univers
- female education
- gender gap
- countries
- girls
- economic growth
Robert M. Rowell, DC, MS
Russian Current
Robert M. Rowell, DC, MS
Muscle Reeducation
Termused is NeuroMusclular Electrical Stimulation (NMES) – Goal is to cause stimulation of alpha motor neuron causing a strong muscle contraction PrimaryIndications: – Retrain lost muscle function from inhibition following injury or surgery Turn muscle back on – Decrease muscle atrophy from periods of immobilization
Physiologic vs electrical contractions Electricalmuscle contraction – Order of recruitment Largerdiameter, fast twitch fibers are recruited first as they have a lower capacitance – Slow twitch are recruited if the stimulation is increased ync ronyo rng Synchronousfiring depending on the frequency Contractioncontinues until the stimulation is off – Inhibition GTOis activated but inhibition is overcome by direct stimulation – Fatigue Musclefatigues rapidly from the fast twitch fiber recruitment and from synchronous firing of motor units
Electrical Muscle Stimulation
Reading assignment
Chapter17 Russian Current Therapy
Physiologic vs electrical contractions Physiologicalcontractions – Order of recruitment Slowtwitch are contracted first – Fast twitch are contracted only when needed extra force n hr nf firin Asynchronousfiring to produce a continuous contraction – Reduces fatigue of any one motor unit – Inhibition Withstrong contractions the GTO will cause inhibition – Fatigue Minimalfatigue because of the order of recruitment and asynchrony of firing motor units
Types of NMES Stimulators
MCcalled Russian Stimulation
Russianscientist (Kots) in
Makesuse of duty cycles (on/off cycles) to cause muscle contraction for muscle strengthening
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Robert M. Rowell, DC, MS
Russian Stimulation
Indications – Muscle reeducation – Retard atrophy M ltr n th nin – Decrease muscle spasm through fatigue Canbe uncomfortable
Treatment Frequency
>50 Hz in a “contract/relax” mode verylow pulse rate or beat frequency – 10 seconds on / 50 seconds off
10 sec
Electrode Placement
ALWAYSalong fibers of same muscle or muscle group 2electrodes = single muscle eec roes – “simultaneous cocontract” same muscle/muscle group bilateral treatment – “alternate” or “reciprocate” agonist/antagonist muscle or muscle group
Electrical Muscle Stimulation
Russian Stim Carrierfrequency (medium) = 2500 Hz “burst”frequency = 50 Hz Result= maximally summated muscle
Applicationparameters – 10s on / 50s off = “rehab” effects retard atrophy, retrain muscle, etc – 10s on / 10s off = spasm or edema spasm:to “overstimulate” muscle
Russian Parameters – Phase duration = High 200to 300 micro seconds – Pulse rate = usually 50 HZ Tocause tetanus contraction should be over 35 Moredoesn’t cause stronger contraction and promotes a gue – Amplitude Shouldbe a strong tolerable contraction that is usually beyond patient comfort PtMay contract muscle on top of stimulation or in off periods – Duty cycle 1:5in initial treatments to prevent fatigue Ontime includes ramp time so may need a longer time if using a long ramp
NMES for Force Capacity Enhancement
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Robert M. Rowell, DC, MS
NMES for Muscle Reeducation
TABLE 174 (continued) CONTRAINDICATIONS TO RUSSIAN CURRENT THERAPY
CONTRAINDICATIONS
Over metal implants
With epileptic patients
v rh m rrhi r
Over a malignant area
Over damaged skin
RATIONALE Risk of causing unnecessary pain due to electrical currentinduced overheating of implants. Risk of causing an epileptic episode (Scherder et al., 1999). Ri kf nhn lin increased blood flow in the treated area. Risk of increasing and spreading the tumor due to increased blood flow in the treated area. Risk of causing unnecessary and severe pain.
Electrical Muscle Stimulation
TABLE 174 CONTRAINDICATIONS TO RUSSIAN CURRENT THERAPY
CONTRAINDICATIONS Over the anterior cervical area
Over the thoracic region
Over the cranial area With patients wearing rateresponsive pacemakers or implanted cardioverter defibrillators (ICDs)
RATIONALE Risk of stimulating key organs, such as the vagus nerve, phrenic nerve, and carotid sinuses, resulting in adverse effects such as hypotensive reaction and laryngeal spasm. Risk of affecting normal heart function. to a respiratory failure in one cardiac patient. Risk of affecting normal brain function. Risk of electronic interference with units (Crevenna et al., 2003, 2004—for more details, see Chapter 14).Important note: NMES may be used with these patients onlyif the ICU unit isturned OFFduring therapy.
TABLE 175 RISKS, PRECAUTIONS, AND RECOMMENDATIONS FOR RUSSIAN CURRENT THERAPY RISKS RATIONALE Prolonged use of electrode, electroconductiveRisk of causing contact dermatitis related to gel, and adhesive tape over the same skinthe materials with which the electrode, gel, or areas adhesivetape are made (for details, see Chapter 14). Usage near functioning shortwave diathermyRisk of causing electronic interference. A (SWD) devicepatient reporting a sudden and variable surge functioning in the neighborhood may be indicative of such electronic interference. PRECAUTIONS RATIONALE With confused and unreliable patientsMay result in unreliable information, which may have a negative impact on treatment effectiveness. Home NMES therapyInstruct patients to keep the portable NMES unit out of the reach of children at all times.
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