title: Optimizing stimulation parameters in functional electrical stimulation of denervated muscles: a cross-sectional study.
abstract: BACKGROUND
  To counteract denervation atrophy long-term electrical stimulation with a high number of muscle contractions has to be applied. This may lead to discomfort of the patient and negative side effects like burns. A functional effective muscle contraction induced by the lowest possible stimulation intensity is desirable. In clinical practice a selective stimulation of denervated muscles with triangular pulses is used. The aim of the study was to evaluate the influence of polarity and pulse duration on the stimulation intensity of triangular pulses in denervated muscles in patients with peripheral nerve lesions.
  
  
  METHODS
  Twenty-four patients with denervated extensor digitorum communis muscle and twenty-four patients with denervated tibialis anterior muscle due to peripheral nerve lesions were included. Four different combinations of triangular pulses with various duration and polarity were delivered randomly to the denervated muscles. The threshold intensity to induce a functional effective muscle contraction was noted. One-way within subject ANOVA was used to assess changes in intensity. An alpha level of p less than or equal to 0.05 was the criterion for statistical significance.
  
  
  RESULTS
  Patients with a denervated tibialis anterior muscle presented significant lower intensities inducing a functional effective muscle contraction in favor of the stimulation with a duration of 200 ms and a polarity with the cathode proximally applied. No significant differences could be shown between the different stimulation protocols in case of denervated extensor digitorum communis muscle.
  
  
  CONCLUSIONS
  We recommend electrical stimulation of the denervated tibialis anterior muscle with triangular current with a duration of 200 ms and a polarity with the cathode proximally applied.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. karin.pieber@meduniwien.ac.at.
authors.forename: Karin
authors.initials: K
authors.lastname: Pieber
authors.affiliation: Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. malvina.herceg@meduniwien.ac.at.
authors.forename: Malvina
authors.initials: M
authors.lastname: Herceg
authors.affiliation: Institute of Physical Medicine and Rehabilitation, Donauspital, Vienna, Austria. tatjana.paternostro-sluga@wienkav.at.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Paternostro-Sluga
authors.affiliation: Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. othmar.schuhfried@meduniwien.ac.at.
authors.forename: Othmar
authors.initials: O
authors.lastname: Schuhfried
mesh_terms: D003430:Cross-Sectional Studies; D004599:Electric Stimulation Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D009121:Muscle Denervation / Q000534:rehabilitation*; D009133:Muscular Atrophy / Q000209:etiology / Q000534:rehabilitation