1 4 . H O W T O U S E T H E W I R E L E S S P R O F E S S I O N A L O N S P E C I F I C
I N D I C AT I O N S
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EN
WIRELESS PROFESSIONAL
14.5.2.3 electrode position
In this programme, 3 stimulation channels are used for the quadriceps.
This is because of the need to work with the knee extended in order not to cause excessive pressure on
the posterior side of the patella.
Indeed, this position places the quadriceps in inner range, which is not generally favourable to
electrostimulation techniques, since, in this position, the patient very often feels the contraction as being
uncomfortable and even painful (cramp sensation).
The use of high stimulation energies that ensure significant spatial recruitment can be difficult to achieve
in some patients.
The third stimulation channel overcomes this disadvantage by optimising spatial recruitment and therefore
the effectiveness of the treatment.
• Three small electrodes are placed respectively on the motor points of the vastus medialis, the vastus
lateralis and the rectus femoris.
• A large, two-way electrode is placed at the top of the thigh and a further small electrode is positioned
just above.
For optimum effectiveness, the positive pole should preferably be positioned on the motor point.
14.5.2.4 Patient position
For this indication, it is recommended to carry out the session with the patient’s knee extended.
14.5.2.5 Stimulation energy
In NMES, the stimulation energy is directly responsible for spatial recruitment: the higher the stimulation
energy, the higher the percentage of motor units recruited and the greater the impact of the progress.
The general rule is to always try to increase the energy to the maximum level tolerated by the patient. The
therapist plays a fundamental role by encouraging and reassuring the patient, who can then tolerate levels
of energy that produce powerful contractions. The levels of energy reached must increase throughout the
session, and also from session to session, because the patients quickly get used to the technique.
With this programme, the stimulation starts directly with a tetanic contraction, because the warm-
up phase has been eliminated so as not to produce muscle twitches that are likely to cause unwanted
microtraumas to the kneecap.