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    Includes Expert Content
    Functional Electical Stimulation
    dgewhitney posted:
    I am interested if anyone out there has used electrical stimulation to assist with working on muscle strength. Specifically I want to know about large muscle groups such as hip abduction. I have very weak abductors which definitely affects my mobility. I am more familiar with using electrical stim for smaller muscles. I became interested in this after reading about Dr. Terry Wahls who talks about this,but doesn't give a lot of info. Would love to hear from experts as well, especially the PT

    Thanks, so much Gretchen
    Herb Karpatkin, PT, DSc, NCS, MSCS responded:
    The use of Functional Electrical Stimulation (FES) has been shown to be effective in helping with gait deviations due to foot drop, which is due to weakness of muscles called dorsiflexors. These are relatively small muscles. There are newer FES products which can stimulate larger muscles, particularly the hamstrings which bend the knee . I am not aware of FES products that are used to help stimulate the hip abductors during gait, although it is certainly possible to use FES to stimulate the hip abductors while you are seated or lying down. The problem with using FES to stimulate the hip abductors is that to stimulate them sufficiently to produce enough force to assist with gait would require an extremely large (and painful) amount of electric current. It is possible to use FES on the hip abductors during hip abduction exercises (like sidelying leg raises) which could theoretically increase hip abduction strength more than exercise by itself, but there is no research that i know of which has shown this to be better than hip abduction exercises alone
    The weakness of hip abductors in persons with MS can be quite serious , leading to significant problems in gait and balance. I have found that specific exercises that isolate the hip abductors done in conjunction with gait training to be very effective in treating addressing this.If you tell me more about the specifics of your hip weakness i can suggest some specific exercises for you
    dgewhitney replied to Herb Karpatkin, PT, DSc, NCS, MSCS's response:
    Hi Herb

    Thanks for replying to my email. Just to let you know I am a pediatric PT. I work in a school and haven't done a lot with FES. Plus our guys are little therefore muscle's are little. I definitely agree with you, and have only found it effective for small muscle groups. The reason I am interested in hip abduction is I feel like my muscle group needs to learn to refire. My hip abduction is a 2 / 3-. I would say most of my hip musculature is 3-, same ith knee as I can't go through full range. Docs say I have good strength 4/5. I laugh at this as it show difference btwn the two : ) Anyways exercises I'm doing are clam shells, abduction slides prone and supine. When I'm at the gym, I try to do the weight machines hip abd / add, knee flex / ext., knee press etc. My intent is to try it with prone abduction slides. I would eventually like to use it with side lying abd. Let me know if you can think of other things I should try Thanks Gretchen
    Herb Karpatkin, PT, DSc, NCS, MSCS replied to dgewhitney's response:
    I have several comments and questions about your exercise regime.
    1-First, it seems like all of the exercises you list are open chain. Do you do any closed chain exercises? This is important as most of the hip abductors function is as a lateral stabilizer of the pelvis during gait and balance while in a closed chain position. I can suggest several closed chain hip abduction exercises if youd like.
    2- In my practice I have found that 2 things are essential in increasing strength in MS
    first, increasing the emphasis on eccentric contractions. Eccentric contractions are less fatiguing, but can build strength just as well if not better than concentric contractions. Therefore for all of your exercises, I recommend making the concentric phase at a normal speed and the eccentric phase at a very slow speed
    Second, I strongly suggest you perform your exercise in an intermittent manner. What this means is that rather than performing a specific number of sets and reps, you exercise until you reach a moderate amount of fatigue, then recover for 10-30 seconds, then repeat. The reason for this is that MS neurogenic fatigue makes doing a high volume of quality repetitions difficult if done continuously. However, if rests are taken, a much greater number of repetitions can be achieved, resulting in a higher volume of work performed, and therefore greater functional improvment. In research i am currently conducting, we are having patients perform SLR's continuously (eg without breaks) and intermittently (taking breaks every 10 seconds after 2 repetitions. The results have been clear that in the intermittent condition MS patients have usually more than doubled the number of SLR's that they can perform.
    What are the functional repercussions of your hip weakness? Is your gait and balance affected? Is there a trendelenberg?
    Do you have spasticity or contractures? These can worsen the affects of hip abductor weakness.
    What medication do you take, specifically do you take baclofen or ampyra?
    Sorry to anser you with more questions, but the better picture i have of your situation the more i may be able to assist you
    dgewhitney replied to Herb Karpatkin, PT, DSc, NCS, MSCS's response:
    Thanks so much Herb. I would love suggestions to add &/or replace exercises, as I am trying to gain strength. So I will try to answer questions. 1). There are in my mind huge issues regarding my weakness. My gait has definitely been affected. I walk using a rollator walker and have also been trying two canes. I have a trendelenberg bilaterally. My gait is extremely varied. I go fom what I call "freezing" being unable to move to being able to walk short distances. This used to be 50ish feet at a time, and currently more like 10-20 feet. I use a scooter both in / out of house. I am also currently evaluating new AfO's. I have an old pair of plastic splints which I did not wear much too bulky, didn't like larger shoes etc. I am investigating carbon AFO's. I have a fair amount of spasticity, received a baclophen pump end of march. Having a difficult time getting an optimum dose. I have never used Amypra. I do not have any permanent contractures, although due to tone am limited in ankle dorsiflexion, hamstrings, and abduction. Do a fair amount of stretching as part of program. Thanks again Gretchen
    swampster1952 replied to dgewhitney's response:
    Hello you two,

    Facinating discussion but you use so much "jargon" that those of us who are not familiar with all the pt jargon can't understand a word!

    Many of us suffer from the same kind of physical musculature problems. So if you could, some how explain this stuff in laymans terms?


    Herb Karpatkin, PT, DSc, NCS, MSCS replied to dgewhitney's response:
    Sorry for the delay in getting back to you.
    First, i would talk to your Neurologist about Ampyra, which you seem to be a good candidate for.
    Second- what do you mean by "a fair amount of stretching" In my experience, most persons with MS stretch far too little.
    Third- what have been the issues with the baclofen pump? Optimization can be quite difficult and in my experience has is usually an ongoing process, but worth the trouble.
    Four- I suggest you try the intermittent exercises i described previously. They will result in a greater amount of exercise being performed with less fatigue
    Herb Karpatkin, PT, DSc, NCS, MSCS replied to swampster1952's response:
    Hello dave- sorry for the delay in responding to your email.Sorry for the PT jargon!
    Im not sure what terms you were having trouble with-let me know what they were and i will try my best to redefine them for you without the PT Jargon
    caregiver41 replied to Herb Karpatkin, PT, DSc, NCS, MSCS's response:
    Herb I can understand what Dave was saying about the techno term. I used to be a personal trainer, I found you have to keep it basic, Explaining those terms. Closed Chain, Open Chain I think these term are confusing Eccentric Contractions, Concentric Contraction. SLR's what do those terms mean. I agree not only MS patients but all those that train don't do enough stretching.


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