Contraindications for the use of NMES post stroke.

In previous posts, we mentioned that we thought NMES was quite a viable method and potentially an important part in the rehabilitation of the upper limb post stroke. However, the more we thought about using NMES in this manner, the more we started thinking about safety with electrical equipment, such as NMES machines. Surely there must be some contraindications, precautions or safety procedures to follow when using these treatment methods?

Drussendorfer (2009) identifies a number of contraindications relating to the use of NMES in physiotherapy. These include:

• Stimulation through or across the chest, or over the carotid sinuses
•  Cardiac pacemakers or implanted stimulators
• Uncontrolled hypertension/hypotension
•  Peripheral vascular disease
• Pregnancy
• Acute inflammation
• Seizure history            
•  Confused patients or immature patients
• Obesity            
•  Osteoporosis

This was all well and good, however we decided to press on with our research in an attempt to find out whether there were any specific contraindications relating to the use of NMES on the upper limb post stroke,

The information we found was somewhat limited. However, the following conditions may be seen as factors which could, potentially, limit the use of NMES in post stroke clients. It should be noted, however, that this obviously depends on the magnitude of the stroke itself, the type of stroke suffered and the areas of the body affected as a result.

•         Diminished mental capacity: Porth & Matfin (2009), state that stroke can cause cognitive and behavioural deficits. Drussendorff (2009), identifies such deficits as possible contraindications in the use of NMES, especially when this diminished mental capacity decreases the ability of the individual to make informed decisions or understand the intended procedure.
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•          Sensory Deficits: Additionally, Porth & Matfin (2009) identify sensory deficits as extremely common amongst individuals post stroke. Drussendorfer (2009), identifies this decrease in sensation as a possible contraindication to the use of NMES. This is due to the fact that such individuals may be unable to recognize changes in the response of their body to the treatment, which can potentially lead to injuries such as skin burns.

Whilst we are now aware of the contraindications that may prevent individuals from using NMES in their rehabilitation programs post stroke, we also feel pretty happy with the fact that, in the majority of cases, it is both a safe and accessible treatment technique for such individuals. In our next and final post, we will endeavour to provide you with a summary of the most important findings of our topic.

Until then,
Hayley and Meg.
:-)

References

Drussendorfer, R. (2009). Stroke: Activities of Daily Living. Reviewed on the 30^th March (2011) at http://www.ebscohost.com/uploads/discovery/pdfs/topicFile-152.

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