IDH Rotation—12/03/21

Electrical Modalities
Transcutaneous Electrical Nerve Stimulator
NMES—device used to send electrical impulses —is a method of pain relief using mild electric
to nerves to produce muscle contraction currents
General Contraindications: Indications: for acute and chronic pain
o Dermatological conditions management
o Allergies
o Pacemaker
o Directly over open wounds
o Eyes or other sensitive tissues
Tilt Table
o Over the carotid sinus
A padded table that rotates on its transverse
axis used to bring a patient to an erect position
General Precautions:
o Avoid active epiphyseal regions in children
o Impaired sensation / DM
o Obesity
o Over metallic implants

Functional Electrical Stimulation—uses

electrical impulses to stimulate motor
neurons or denervated muscle fibers directly
to elicit a muscle contraction during a
functional activity

Motor Points Stimulation—the point with the

highest excitability of the muscle where
muscle contraction can be observed caused
by the least amount of electrical stimulation

Physiologic Effects:
o Increased circulation in the upright position
o Increased urinary drainage
o Increased muscle tone in antigravity
muscles
o Stimulation of joint proprioceptors, sensory
receptors of the sole of the foot and
semicircular canals
o Increased ventilation with gravity assisted
pulmonary drainage
o At 60° onward—patient will have the
Indications: physiological effect and sensation of
o Muscle atrophy/weakness standing upright
o Muscle reeducation of movement
o Lower limb sensory and/or motor loss Indications:
o Muscle contraction in partially denervated o Prolonged recumbence
muscles o Generalized weakness
 IDH Rotation—12/03/21
o Disturbance in balance and proprioception
o Orthostatic/postural hypotension

Therapeutic Benefits:
o Reintroduce patient to vertical position
o Facilitate early weight bearing
o Prevents muscle contractures
o Improves LE strength
o Increases arousal
o Cardiovascular conditioning by allowing
patient to become acclimated to an upright
position without rapid changes in blood
pressure
o Postural improvement
o Enhance bowel and bladder function
o Decreases prolonged bed rest
complications

Contraindications:
o Fresh fracture
o Fresh implants
o Neoplastic disease of the spine
o Pregnancy
o Acute spinal or pelvic fracture
o Acute cardiac infarctions

Extra Notes:

 Tilt table starts at 0° and take baseline

pressure
 Increase 20° and stay there for 2-3 minutes
 Increase to 40° after 3 minutes
 If BP drops by 10-20 mmHg—then stay put
for another 3 minutes
 Max time using the tilt table = 15-20 minutes
o Can’t keep patient upright to avoid
venous stasis = edema

 60° is the graduate after 10 minutes of

stable vitals
 Next session will directly go to standing

 If O2 sat drops below 94% we slowly go

back down
o Too low will make the patient
breathless or faint

 Heart rate should also be watched

 Fainting should be watched also
 Foot should also be watched for venous
stasis: looks like edema