Popadich RN, MSN, FNP, in Practical Management of Pediatric and Adult Brachial Plexus Palsies, 2012 Muscle stimulation However, conclusions could not be drawn regarding its effect on functional abilities. The authors included six randomized control trials in their review and concluded that there is a positive effect of electrical stimulation on motor control. 51 assessed the effect of therapeutic electrical stimulation of the affected UE in improving motor control and functional abilities after stroke. 50 However, conclusions are limited by the methodology of the trials (small sample size, inadequate blinding), and the difficulty in correlating improved strength with improved function.
A meta-analysis of four studies concluded that FES enhanced strength. Several reviews and meta-analyses examining the benefit of NMES have been conducted. Alter position to decrease stretch on shortened tendons, or consider blocking proximal digit joints in neutral or slight flexion to allow better tendon excursion distally. If this is the case, then reducing intensity and evaluating the position of the wrist and hand to promote the most optimal tendon excursion is important.Įvaluate intensity by how much extension or flexion of digits can be elicited before hyperextension is noted. If an individual has moderate to severe tone with tendon shortening, use of electrical stimulation can elicit hyperextension of digit joints, which can threaten joint integrity. This promotes strengthening of both type I and type II muscle fibers and facilitates integration of motor performance into functional use. 141 NMES is most effective when used in conjunction with volitional muscle contractions. 141 It is proposed that this is why NMES can accelerate strengthening and shorten rehabilitation times. NMES recruits type II muscle fibers first because the axons of their motor units are larger and more superficial and offer lower resistance to electrical stimulation. 140 NMES preferentially strengthens type II muscle fibers because it recruits motor units with type II fibers before those with type I fibers, which is the opposite order from voluntary contractions where type I fibers are recruited first. 137-139įor NMES to increase muscle strength the electrical current must produce contractions that are at least 50% of the maximum volitional isometric contraction (MVIC) force for the targeted muscles. NMES has been shown to accelerate functional recovery after surgery, prevent disuse atrophy, reduce ROM deficits, and improve motor control in patients with strength deficits of various etiologies. NMES can help when the client is either unable or unwilling to volitionally elicit strong muscle contractions.
Neuromuscular electrical stimulation (NMES) can be an effective component of a rehabilitation program for muscle weakness.
Reiman, in Physical Rehabilitation, 2007 NEUROMUSCULAR ELECTRICAL STIMULATION
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