Front Matter

Chapter 7 Rehabilitation Physical Modalities 153

with a conductive polymer, while carbon sili­
cone‐rubber electrodes are used with an aque­
ous gel. Especially in dogs with thicker coats,
the hair may need to be clipped to improve
transmission, but the author has found that
additional gel is typically sufficient to provide a
route for the current to travel from the electrode
through the hair to the skin.
The size of the electrodes should fit the target
muscle. Small electrodes are available to accom­
modate smaller patients and/or treatment
areas (Figure  7.15), but can cause discomfort
with higher amplitudes due to the greater cur­
rent density. The electrodes selected should be
as large as possible to maximize comfort but
not so large that overflow of current to other
adjacent muscles occurs. The electrodes should
also not contact each other, nor should their
coupling medium, as this will result in the

current flowing directly from one electrode to

the other instead of into the patient’s tissues.

There does need to be sufficient distance

between the electrodes, however, as this

impacts the resulting strength of the muscle

contraction regardless of the stimulation inten­

sity (Vieira et al., 2016).

During initial treatments with NMES, the

patient may be more receptive in a relaxed

position. The author recommends using

the constant or continuous output mode (no

off‐time) while slowly increasing the inten­

sity/amplitude until the desired muscle

contraction is obtained, then switching to

the desired mode for the remainder of the

treatment. As the dog becomes more familiar

with the sensation, using NMES in a func­

tional position (e.g., standing) may result in

improved motor learning (Jochumsen et al.,

2016) (Figure 7.16).

Recommended NMES parameters for muscle

strengthening are as follows (Millis et al., 1997):

● Frequency between 25 and 50 Hz.

● Pulse duration between 100 and 400 μs.

● Ramp up and down of 2 to 4 s.

Figure 7.14 Patient receiving neuromuscular electrical
stimulation (NMES) to the hamstring muscle group.

Figure 7.15 Examples of various electrical stimulation
(ES) electrodes.

Figure 7.16 Neuromuscular electrical stimulation

(NMES) with the patient in a functional position.