This document summarizes neuromuscular electrical stimulation (NMES). NMES involves sending electrical impulses to nerves via electrodes placed on the skin to cause muscle contraction. It is used to improve muscle strength and range of motion, reduce spasticity and spasms, and increase cardiovascular function. Proper electrode placement and stimulation parameters are described. Contraindications include pacemakers, infected skin, and pregnancy. NMES sessions should be 20-30 minutes, 3 times per week for strengthening effects.

1. Suresh Gyan Vihar University
Topic:-
Neuromuscular And Muscular Electrical
Stimulation (NMES)
Presented By:- Anand Kumar
Semester:- 3rd
SID:- 2248164
Department:- Physiotherapy

2. INTRODUCTION
Neuromuscular and Muscular Electrical Stimulation
(NMES) is a modality that sends electrical impulses to
nerves which causes the muscles to contract. It may be
applied during functional movement or without
functional movement. It has been used throughout the
years for strengthening and maintaining muscle
strengthening.

3. Muscle Contraction

4. INDICATIONS
To improve muscle strength and prevent muscle
atrophy
To improve and maintain the range of motion around
a joint
To reduce muscle spasticity and spasms
To increase cardiovascular function through the
activity of large muscle groups

5. CONTRAINDICATIONS
When the patient has a pacemaker
When placed over the carotid sinus
When we have areas of active tissue infection and
devitalized skin
When the patient is unable to comprehend
instructions and provide feedback
When the patient is pregnant
When the patient has a peripheral vascular disease

6. Application
First, the patient should be seated comfortably in a
way that allows muscle relaxation which is necessary
for easier muscle stimulation. Then, the skin should be
inspected to make sure there are no skin abrasions and
injuries. Following that the skin should be properly
cleaned with a piece of cloth and water or alcohol-
based wipes and it's very important to make sure the
skin has been properly dried before the application of
the electrodes on the skin.

8. Electrodes:- There is a wide variety of
electrodes that can be used including self-
adhesive electrodes which are quick and easy
to use due to them already having a layer of
conductive material on their surface, unlike
carbon-rubber electrodes which are normally
coupled to the skin by electrical conductive
gel.

9. ELECTRODE PLACEMENTS
The electrodes should be placed away from the joints and
properly attached to the skin to avoid pain and discomfort.
The electrodes can be placed either in a way where the
cathode is placed on the motor point of the target muscle and
the anode proximally on a nearby muscle supplied by the same
nerve and this placement is called monopolar electrode
placement and used when targeting small muscles.
The bipolar electrode placement involves placing both
electrodes on the muscle belly or one at the proximal end and
another on the distal end of the muscle.

11. During electrical stimulation, it's important to increase
the intensity of the stimulation gradually and to the
maximum tolerable extent by the patient.
For innervated muscles normally, the shorter the
pulse duration, the greater the pulse amplitude should
be whereas for denervated muscles, both pulse
duration and pulse amplitude should be greater than
that of innervated muscles.

12. Deep Muscle Stimulation

13. PARAMETERS
Frequency (Hz) is the number of pulses in one second
(20-50 pulses per second).
Pulse Duration (microsecond) for small muscles is
approximately 150-200 and for large muscles 200-300.
Ramp time is at least 2 seconds.
ON: OFF time ratio should be set in a way where off
time is three times the on time.
Treatment time should be between 20 and 30 minutes.
The frequency of the sessions should be three times a
week.

14. If your body isn’t moving, it’s
not getting stronger—it’s just
getting stuck in place.
-Physio