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Clinical Information on IMF Therapy®

Treatment of hemiplegia with intention-dependent
EMG-triggered muscle stimulation

J.Danz, S Guierrez-Lopez, Institute for Physiotherapy
(Head doctor: Prof. Dr. Med. Habil. J. Danz)
at the clinic of the City of Gera

Abstract:

Imagining a movement (intention) causes an increase in electric activity, even in muscles affected by palsy. The EMG-triggered muscle stimulation device registers intention potentials and uses them to trigger low-frequency impulses, which enables the antagonists of the spastic muscular system to contract. Thus the spastic movement pattern is interrupted and the muscular balance improves. The patient is now able to regain lost movement patterns.

Immediately after an apoplectic stroke (in the acute phase) intention-driven EMG-triggered muscle stimulation could be administered to approx. one third of our patients (n=40). A further group consisted of 20 outpatients. Of these 18 achieved a functional improvement of the paretic arm.

Intention-dependent EMG-triggered muscle stimulation is very different to peripheral electro stimulation, which is not carried out because of the risk of increasing spasticity (Senn 1990).

Imagining a movement (intention) increases the electric activity in the affected muscular system, even if the patient is suffering from palsy of the central-nervous system (Hansen 1979).

During treatment the patient is supposed to sit comfortably. He or she will be asked to try and relax both physically and mentally, and then to imagine a movement that incorporates all muscles affected by the spastic pattern (hanging up washing, picking fruit from a tree, waving etc.). The treatment is organised gradually from proximal to distal: Shoulder abduction (M. Deltoids, M. Supraspinatus), elbow traction (M. Triceps), hand and finger traction (extensors of the lower arm). Patients are usually only able to concentrate on one of these movements. We only proceeded to the next movement once the patient could carry one of them out actively. All patients were also being treated with physiotherapy.

All outpatients reported a reduction of the spasticity at the first check-up after only one month. Unfortunately we haven’t been able to objectify this effect yet.

There was a quick improvement for improved movement of the plegic arm (Ill. 1). This improvement was statistically proven after only one month. There was steady improvement in the following months: After six months 18 out of 20 patients reported functional improvement.

The functional improvement concerned all three individual movements, which initially had been considered as one (Ill. 2). It is worth pointing out that increased movement could be assessed in the area of hand and elbow traction statistically even before any of the patients actively trained these movements. This implies that intentional movement affects a complex structure of movement, and not just individual movements the patient might be concentrating on in one exercise.

Four patients didn’t make any functional improvements in the first four months of treatment. There was no statistic evidence that the duration of the illness (short-term illness: up to 24 months, long-term illness: more than 25 months) might affect the treatment (Ill. 3). There were no significant differences at any point between either group of patients.

The success of the treatment may be dependant on the patients’ age, but here – again- the differences between younger and older patients could not be verified statistically.

Discussion

There are several treatment methods available to try and achieve improvement of functional movement in spastic paraplegic limbs (Senn 1990): Stimulating the spastic muscles to inhibit spasticity after the contraction, and imitating locomotive activity through synchronous movement stimulation. The aims of these methods are to reduce spasticity, to channel lost movement patterns and functional stimulation in an educative sense or as substitutional therapy (Jantsch 1981).

The intention-dependant EMG-triggered muscle stimulation should therefore be classed as a channelling therapy. This therapeutic approach works in two ways: On the one hand it channels lost movement patterns through imagining movement and can therefore be compared to ideo-motor training (Wallisch 1993). On the other hand spasticity, which is responsible for the malfunctioning of movements, is reduced through changes to the innervation patterns towards normalisation (Edel et al 1973, Bowman et al. 1979, Dietz 1990)