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CHAPTER 33
FIG. 226. Deltoid examined in free sideways extension of the arm. Action potential
frequency in various normal subjects on fatigue resulting from identical working per
formance.
in the electrical exercise of denervated large muscles, such as triceps brachii or gastro-
enemius. This stroking technique also guarantees the inclusion of all muscle fibres in
the exercise. Some intelligent patients were taught to carry out the electrical stimulation
of the muscles themselves, which saves the physiotherapist's time.
It may be emphasized that the totally or partially denervated muscle needs a similar
individual training by electrical exercise as does the normal or recovering muscle by
active exercise. In this connection, attention may be drawn to a previous study on chronaxy
(Altenburger & Guttmann, 1928) on fatigue of normal muscles, such as deltoid and
quadriceps, examined under identical conditions, which revealed a definite, individual
variability in the reaction of these muscles to fatigue, as shown in Fig. 226. Yet, whatever
the individual differences in muscle behaviour, from all my experience I have come to
the conclusion that the fear of over-fatiguing denervated muscles by frequent electrical
stimulation has been grossly exaggerated in the past and has led all too often to quite
useless application of electrotherapy, such as 10 contractions only. Daily electrical
exercise following nerve suture or lesions in continuity which may regenerate, should be
continued until re-innervation and voluntary function of the muscles occur, so that active
exercise by the patient himself becomes possible. This naturally varies according to
the type and severity of the lower motor neuron lesion and, in particular, on the active
co-operation of the patient once re-innervation of the muscles has occurred.
As an example of the value of systemic electrotherapy in a cervical root lesion, the
following case may be quoted: A naval rating, aged 37, sustained a complete lesion of the
left 5th cervical root, as a result of a fall from a bicycle, resulting in a degenerative para
lysis of the deltoid muscle, with complete R.D., as a result of a fracture of the 6th cervical
vertebra. In this case, daily electrical stimulation was started 8 days after injury, with
gradually increasing number of contractions up to 800 per session of | to J hr. One
