Denervated; A) Introduction; B) Factors Guiding The Therapeutic Approach - CefarCompex Physio 5 Bedienungsanleitung

2.

Denervated

ENG
A. Introduction
In the current state of knowledge there is nothing to indicate that electrostimulation is
capable of influencing the re-innervation process of a partly or fully denervated muscle.
Electrostimulation of denervated muscle fibres, however, is essential insofar as it is the
only really effective means of retaining a certain trophicity and limiting the sclerosis
phenomenon of these fibres throughout the duration of their possible re-innervation
period. Indeed, after many months of being patient, nothing is more frustrating than
to find functional trouble caused by muscles that are certainly re-innervated but with a
sclerosis condition that prevents them from being used satisfactorily.
If stimulation enables the amyotrophy to be limited and sclerosis of the denervated muscle
to be avoided during its re-innervation period, it then becomes pointless if there is any
hope of re-innervation for the denervated fibres.
The choice of form and parameters of the electrical current depend on state of
denervation of the muscle: is it completely or partly denervated? Therefore, before
undertaking any electrostimulation treatment on a denervated muscle, the following two
questions should be answered:
1. Is there any hope of re-innervation? In other words, have the re-innervation times
elapsed or not?
2. Is the muscle completely or partly denervated?
B. Factors guiding the therapeutic approach
1. Are we within the re-innervation times?
To be able to answer this question, it is essential to have the following three pieces of
information:
A The date of the injury,
B The degree of the injury,
C The rate of nerve fibre regeneration.
• Interviewing the patient usually establishes how old the injury is and where it is
located.
• The rate of regeneration of an injured nerve is approximately 1 millimetre per
day, i.e. 3 centimetres a month.
• The following elementary calculation gives the re-innervation times:
Distance in cm between nerve fibre injury
and the motor point of the denervated muscle
2. Total or partial denervation?
How can we find out if the muscle is partly or totally denervated?
• An electromyogram examination is of course preferable but it must be recent
and the results must be passed on to the physiotherapist, which does not always
happen in day to day practice.
• Muscular testing is often worthwhile. However, with certain muscles,
especially if there are only very few innervated fibres left, the really analytical
contraction of the muscle is difficult to obtain because of the inevitable activity
of the agonist muscles.
• Nevertheless, there is a simple and easily reproducible way to find out the state
of denervation of a muscle. Biphase rectangular micro-pulses (lasting between
0.15 and 0.35 ms) are only capable of exciting the nerves but not of directly
exciting the denervated muscle fibres. It is sufficient, therefore, to test by
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Rate of nerve fibre regeneration
(= 3 cm per month)
= Re-innervation time