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
229
EN
WIRELESS PROFESSIONAL
14.7.3 electrode position
Two channels are used, one for stimulation of the gluteus maximus and the other for the gluteus medius.
• A small electrode is placed at the intersection of the orthogonal axes dividing the buttock into four
quadrants with the same area (motor point of the gluteus maximus).
• A second small electrode is placed above and outside of the upper external quadrant of the buttock on
the gluteus medius at the point where it passes over the gluteus maximus.
For optimum effectiveness, the positive pole should preferably be positioned on the motor point.
The other negative poles are connected to the two outputs of one large electrode positioned diagonally
in the lower-lateral quadrant of the buttock, taking care to avoid placing this electrode on a scarred/
wounded area.
14.7.4 Patient position
If the patient’s condition allows, the patient is placed in a standing position, which requires him/ her to
exert additional effort that is beneficial for proprioceptive control.
If this is not possible, all or part of the session can be conducted in a side lying or prone position.
14.7.5 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
vibrations on the prosthesis.