Brain stroke results in hemiplegia in which one side of the body is paralysed. In addition to exercises, muscle stimulation is very important to regain the strength of the affected muscle and rehabilitate the sufferer. For this, we must know the correct electrode placement for stroke patients to give faradic or galvanic stimulation accordingly.
In this article, I will demonstrate to you that if you have a paralysis patient, then what will be the correct electrode placement to give muscle stimulation?
Electrode placement for stroke patients
In hemiplegia, one side of our body gets paralyses which mainly includes one side hand and leg. A severe brain stroke can also result in one-sided face muscle paralysis. For face paralysis, galvanic muscle stimulation is given; we have already discussed the facial paralysis motor point for muscle stimulation. Upper and lower limb paralysis involves our flexor group of muscles getting stiff and the extensor group of muscles becoming weak.
So physiotherapy would aim to stretch the tight extensor muscle group and strengthen the weak muscle group. To strengthen the extensor group of muscles, we will use a muscle stimulator. For the upper limb, electrode placement will be such that your passive electrode will be on the neck. It will be on the neck near C7 and T1. The best way is to use the sandbag I use in my clinical practice, and we will keep the sandbag under the neck.Â
Electrode placement for upper limb
In the muscle stimulator, there are two electrodes. The red one is the passive electrode, and the black one is the active electrode. The passive electrode, as I said, will be under the neck here. The purpose of the sandbag is that it will keep the active electrode compressed and stable at the neck. Now the black electrode, which is the active electrode, is placed on the motor point (usually the bulkiest point of muscle bulk) of the concerned muscle.
For the upper limb, our target muscles would be the triceps, wrist and finger extensor muscles. So, let us start with the triceps muscle.
Triceps electrode placement for stroke patients
In the supine lying position, the passive electrode is placed behind the neck as we just discussed. We have to place the active electrode to stimulate the triceps muscle. The triceps is present on the backside of the upper arm, its motor point will be roughly at the backside of the mid-arm i.e. the bulkiest part of the triceps.
Now, place the active electrode here and tie a strap. So this is the correct electrode placement for the triceps.
Forearm extensor electrode placement
Then let’s move ahead. We have to strengthen these forearm extensor muscles. The electrode placement for the passive electrode will remain the same; we just need to place the black electrode for the forearm extensor muscle group. So, the motor point for the forearm extensor muscle would be the bulkiest point of muscle, it is present on the outer side of the elbow.
It is the point from where this muscle originates and gets inserted into the fingers. We have to place the active electrode here and give stimulation for 10 minutes.
Electrode placement for wrist and finger extension
Let’s go to finger extensors. For finger extensors, the electrode placement will be different. In this, you must place both active and passive electrodes over the forearm. The wrist and finger extensor muscles are the same group of muscles that we just discussed above. The passive electrode is placed over the bulky muscle on the outer side of the wrist, and the active electrode is placed 2 inches above the wrist joint on the lower one-third of the forearm.
Then, increase the intensity of stimulation to stimulate wrist and finger extension. To make this more effective you can use a pillow and place the pillow below the forearm to give sufficient room for wrist movement.
Lower limb electrode placement for stroke patients
In our legs, too, we have to target the extensor group of muscles. The main extensor group of muscles are the Quadriceps muscles and the Tibialis Anterior muscle. The quadriceps muscle is present on the front of the thigh, and its action brings knee extension motion.
The tibialis anterior muscle is present in the front of the lower leg. Its action brings dorsiflexion motion to the foot. The weakness or paralysis of this muscle results in a disability known as foot drop. The weakness of these two groups of muscles alters the normal gait and makes walking difficult. The abnormal gait pattern in hemiplegia is known as circumduction gait or hemiplegic gait.
So, let us start with the quadriceps muscle.
Electrode placement for quadriceps muscle electrical stimulation
For quadriceps muscle electrical stimulation, you will need a passive electrode which should be placed over the upper end of the front thigh. The active electrode, on the other hand, is placed just about 2 inches above the patella.
To ensure proper placement of the active electrode, you will need to tie a strap above the patella and then place the electrode in this area. Once you have successfully placed both electrodes, allow the electrical stimulation to take place for a duration of 10 minutes. By following these steps, you can ensure that the quadriceps muscle is properly stimulated and ready for use.
Foot drop electrode placement
Now, let’s go to the Tibialis anterior. This is the Tibialis anterior, and it is necessary to strengthen it because it affects the gait pattern. The Foot Drop problem occurs because of this. If we strengthen this muscle, the Foot Drop problem will be greatly relieved. The bone on the inner side of the leg is called the Tibia, and the bone on the outer side is called the Fibula. A nerve comes through the lateral part of the Fibula and supplies the Tibialis anterior. So, our passive electrode will be just behind the tibial bone over the outer side of the upper part of the leg,
And the active electrode is on the bulky area in the middle of the Tibialis muscle i.e. on the mid part of the front of the leg. Place the electrode here and then if you increase stimulation, it will produce foot dorsiflexion motion. If foot motion is not produced, then move the passive electrode a little, a few millimetres lower, higher, left, or right; you can replace it and see if it produces the foot motion.
For Foot Drop, you can give stimulation in a sitting position also. Placement will be the same, but while sitting, you will know the effect of Foot Drop better. Along with that, if you ask the patient to move the foot up this way, it will be more effective.Â
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