Recommended Electrode Placement for NMES of the Upper Extremity

Table 9-1 Bracciano pg. 208-209

Treatment Protocol
Wrist flexion
Power grasp
Thumb IP Flexion
Composite thumb flexion
Lumbricals 3 & 4
Combo power grasp and
extrinsic flexion w/ lumbricals
3&4
Wrist extension
Wrist extension with EDC
Digit Extension
Elbow Extension
1st dorsal interossei
Composite digital and wrist
extension
Wrist extension with grasp (2
channels, 4 leads)
Waveform (-) Pad location (BLACK)
(motor point=mp)
Asymmetrical Small electrode over mp of FCR, FCU
biphasic (flexor wad)
Symmetrical Small electrode over mp btw FDS/
biphasic FDP (mid volar forearm)
Asymmetrical biphasic Small electrode over mp of FPL (volar
mid-forearm radial side)
Symmetrical Small electrode over mp of FPL (volar
biphasic mid-forearm radial side)
Asymmetrical biphasic Small electrode over mp btw FDS/
FDP (mid volar forearm)
Asymmetrical biphasic Small electrode over mp btw FDS/
FDP (mid volar forearm) and Ulnar n
(at wrist)
Asymmetrical Small electrode btw mp of ECRB,
biphasic ECRL, & ECU (extensor wad)
Asymmetrical biphasic Small electrode btw mp of ECRB,
ECRL, & ECU (extensor wad)
Asymmetrical biphasic Small electrode btwn mp of EDC &
EIP (mid ulnar dorsal forearm)
Asymmetrical Small electrode over mp of medial
biphasic head of triceps
Asymmetrical biphasic Small electrode over 1st interossei
muscle (can also place over 2nd, 3rd,
4th)
Symmetrical biphasic Small electrode btw mp of ECRB,
ECRL, & ECU (extensor wad)
Asymmetrical biphasic Small electrodes:
Channel 1 (-)ulnar n-distal ulnar wrist
Channel 2 (-) proximal volar forearm
+ Pad location (RED)
(dispersive)
Volar Wrist
Ulnar n (at wrist)
Larger electrode over volar
wrist
Volar wrist
Volar wrist
Electrodes at volar ulnar &
radial mid-forearm wrist
Large electrode at dorsal
(distal) wrist
Large electrode at lateral
epicondyle
Large electrode at dorsal
(distal) wrist
Electrode between mp of
long head & lateral head of
triceps
Large electrode at dorsal
(distal) wrist
Electrode btwn mp of EDC &
EIP (mid ulnar dorsal forearm)
Channel 1 (+)mp FDS/ FDP
Channel 2 (+)mp FDS/ FDP

Clinical Tips (Bracciano pg 282)

 Larger electrode on positive lead will increase patient comfort
 Smaller electrode at motor point can help with specific motor recruitment (can increase
current density/decrease patient comfort level)
 Do not cut the wire when trimming electrodes
 If peripheral nerve is not intact, direct current will be required (yellow gun)
 Treatment duration should be based on rate of fatigue (higher pps faster fatigue will
occur)
TENS/NMES
 Introduce yourself and explain modality you are hoping to use and why
 Ask patient questions regarding contraindications
o Pacemaker or heart condition
o Hyper- or hypo-tension
o Peripheral vascular disease
o Cancer, infection, or active hemorrhage
o History of a muscular or nerve condition (polio, muscular dystrophy, MS,
peripheral neuropathy, etc.)
o Pregnancy
o Metal hardware
 Check skin for normal sensation
 Explain procedure and benefits to patient
 Explain to the patient what they should feel
o Pins and needles, muscle contraction, etc.
 Obtain permission from the patient
 Clean area of skin with alcohol wipe
 Correctly placement electrodes (may need to have patient active muscle)
 Set unit to appropriate settings
 Slowly increase unit until patient feels an appropriate/comfortable response

LAB ACTIVITIES:
 Review NMES parameters:
o Re-innervation but not voluntary contraction: Wrist Extension*
o Tendon Excursion and Edema Reduction: Wrist Flexion*
o Hemiplegic Shoulder: Shoulder subluxation* (supraspinatus and posterior deltoid)
o Muscle spasm/spasticity: Elbow extension
 Review TENS parameters
o Sensory Parameters-Your choice on location*
o Motor Parameters-Your choice on location*