Introducing Stroke and NMES

The purpose of this blog is to provide our class mates with an in-depth guide to the use of Neuromuscular Electrical Stimulation (NMES) in the rehabilitation of the upper limb post stroke.  As physiotherapy students, we were already aware that stroke can commonly result in hemiplegia (Umphred, 2007). However, we were surprised to discover that a flaccid upper extremity is, in fact, evident in up to 90% of patients following the occurrence of a stroke (NMES Guidelines for Treatment, 2010). This results in a decreased ability to perform functional movements, with some of even the most basic activities of daily living becoming somewhat impossible (Porth & Matfin, 2009). 

Hemiplegia following stroke can affect an individuals ability to perform even the most basic ADL's, such as brushing the teeth.

Feeling somewhat upset by such a realization, we endeavored to find out more about hemiplegia, how it affects stroke victims lives and, most importantly, the methods by which it can be improved. We discovered that, according to Sheffer & Chae (2007), it is important to avoid stretching of the shoulder capsule during early rehabilitation of the upper limb post stroke in order to prevent further functional complications of this area, such as:

-          Difficulty with functional use of the upper extremity

-          Autonomic dysfunction of the upper limb

-          Shoulder pain

-          Potential damage to the brachial plexus as a result of prolonged separation of the joint.

An illustration of hemiplaegia that can occur post stroke.

Now we were confused. Hmmm, we wondered. If stretching and exercise cannot be utilized, what can be done for such individuals?

Our queries led us to discover that, increasingly, the role of NMES in the recovery of upper limb function following stroke is being recognized (Robertson, Ward, Low & Reed, 2006). According to Chae, Bethoux, Bohinc, Dobos, Davis & Freidl (1998), this electrotherapeutic device has the ability to reduce sublaxation of the shoulder joint (a common complication of stroke) by pulling the head of the humerus into the glenoid fossa. This means that is has the potential to prevent disuse atrophy, assist in muscle re-education of the upper limb (NMES Guidelines for Treatment, 2010) and ultimately lead to a faster recovery time post-stroke (Chae et al, 1998). Additionally, Robertson et al (1996) states that NMES may also be beneficial in improving the function of the wrist, hand and fingers following stroke.

WOW, we thought. Could this be true? Could a tiny machine really be capable of returning function to hemiplaegic individuals? We intend to further investigate the answer to this question throughout the duration of our blog posts, so stay tuned for further information. For additional understanding concerning stroke itself, please refer to the following website
http://www.strokefoundation.com.au/ or take the time to view the following short film. 

References

Chae, J., Bethoux, F., Bohinc, T., Dobos, L., Davis, T. & Friedl, A. (1998) Neuromuscular Stimulation for Upper Extremity Motor and Functional Recovery in Acute Hemiplegia. Stroke. (29) 975-979.

Porth, C.M. & Matfin, G. (2009). Pathophysiology: Concepts of Altered Health States (8^th Ed.). Lippincott Williams & Wilkins: Philadelphia, PA.

Robertson, V., Ward, A., Low, J. & Reed, A. (2006). Electrotherapy Explained: Principles & Practices (4^th Ed.). Elsevier: Philadelphia, PA.
Sheffer, L.,R. & Chae, J. (2007) Neuromuscular electrical stimulation in neurorehabilitation 35(5); 562- 590.
Umphred, D.A. (2007). Neurological  Rehabiliation (5^th Ed.). Mosby Elsevier: St. Louis, Missouri.
NMES Guidelines for Treatment. (2010) Retrieved February 25, 2011. http://www.empi.com/uploadedFiles/Empi_Products/Pain_Management_-_TENS/gait

Images
http://som.flinders.edu.au/FUSAWikis/dsrswiki01/doku.php?id=cerebral_palsy_-_athetoid09

http://www.thewellingtonrehabunit.com/images/occupational.jpg