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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
269 EN WIRELESS PROFESSIONAL
14.11.3.4 Patient position
The patient is seated beside a table. The elbow and forearm rest on the table, the shoulder is in a
functional position, with the elbow bent and the hand in pronation.
14.11.3.5 Stimulation energy
Always work with an energy that is too low to produce diffusion of stimulation to the flexors of the fingers
and wrist.
Ideally, the stimulation energy should be adjusted so that the contraction of the extensors extends the
fingers and wrist to the maximum range of movement.
The complete movement cannot be carried out if the spasticity of the flexor muscles exceeds the
contraction strength of the atrophied extensors. Stimulation will only cause reduced movement, or even
no movement at all in extreme cases.
Treatment with NMES should be carried out even in this situation, because even subliminal stimulation has
a beneficial effect on the reduction of spasticity.
To complete the extension, passive stretching is also necessary.
Combined treatment of stimulation and passive motion is therefore given.
14.11.3.6 Manual activation of stimulation
When the mi-SCAN is activated, the stimulation session starts automatically with a measurement of
the chronaxy. This is a short test lasting around ten seconds, which allows the optimum duration of
the stimulation pulse to be adjusted, ensuring maximum comfort. The energy should then be gradually
increased to cause the first contraction of the antagonist muscle.
Each contraction is followed by a five-second rest period.
Once this rest period has finished, press any button on any channel to trigger the next contraction.
By doing so, each contraction is triggered and therefore controlled by a manual action. This technique
provides a clear psychological benefit for the patient, who can trigger contractions with his/her good
hand, and it also makes it possible to work synchronously with the associated movements.
14.11.3.7 associated actions
Passive mobilisation:
When contraction of the extensors is insufficient to mobilise the fingers and wrist to their maximum
range, the movement should be completed by passive extension.
The electrically-induced contraction is allowed to develop until the maximum extension it can produce is
achieved.
The movement is then completed by applying gentle and gradual pressure.