For treatment of cardiorespiratory diseases (COPD) there are good results of Neuro Muscular Electrical Stimulation (NMES) in an very early stage of rehabilitation - already at the ICU.
The aim of treatment is to strengthen the muscles of the Quadriceps and calf muscles of both legs. The positive approach of NMES lies in the fact that already in bed, patients can work on their muscle strength in order to start active rehabilitation - but first of al to be able to make an easy transfer from the bed to a chair and to standing position. 
A total of eight disposable EN-Trode electrodes (disposable because of hygiene - single patient use) are placed on the target muscles (four electrodes on each leg): two pairs of 8 x 12 cm on the quadriceps muscles and two pairs of 4 x 6 cm on the calf muscles. The electrodes on the quadriceps muscles are placed transversally 5‐10 cm distal to the inguinal fold and 4‐8 cm proximal to the patella.
The electrodes on the calf muscles are placed longitudinally on the belly of the gastrocnemii muscles. The best NMES protocols are using a symmetrical biphasic square pulse with pulse duration of 400 µ sec. The contraction time is 6 seconds with 8 seconds relaxation excluding 1 second ramp‐up and 1 second ramp‐down. Thus, the total cycle length is 16 seconds. After a continuous warm‐up of 3 minutes at 5 Hz, intensity is adjusted to individual toleration during each session lasting 18 minutes. The frequencies used are 75 Hz (HF‐NMES) or 15 Hz (LF‐NMES) (12).
Note: The advantage of using a biphasic pulses with interphase interval is that it enhances the contraction force of quadriceps femoris muscle (Laufer 2013).
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