As we have been reviewing the relevant available literature in regards to NMES and its involvement with upper limb recovery post stroke, we have discovered that the majority of the studies we have analysed are supportive of the effective role NMES has on this condition. The literature supports the idea of electrical stimulation of the upper limb post stroke and its ability to reduce existing subluxation of the shoulder joint, decrease upper limb pain and facilitate recovery of upper limb function (Linn, Malcolm & Lees 1999). Thus, it has become apparent to us that NMES can be thought of as a ‘supportive backbone’ for stroke recovery.
Additionally, a randomized controlled study conducted by Linn et al (1999) was used to determine the efficacy of electrical stimulation in preventing shoulder subluxation in patients post stroke. Patients involved in the study were assessed within 48 hours of their stroke and those in the treatment group were immediately put on a regime of electrical stimulation for 4 weeks. All patients were assessed at 4 weeks and 12 weeks after stroke with assessments being made of shoulder subluxation, pain and motor control of the upper limb. Results indicated that the treatment group had significantly less subluxation and pain after the treatment period of four weeks, however at the end of the follow-up period (12 weeks) there were no significant difference between the 2 groups. Therefore, from analysing this study, it became apparent to us that NMES can prevent shoulder sublaxation and upper limb pain post stroke. However, the effects may be withdrawn when the patient stops receiving the treatment. We therefore began to wonder, is NMES only effective when the patient is receiving regular treatment?
Figure 5.1. Examples of the facilitation of muscle contractions in hemiparetic hands
Kimberly & Carey (2002) discuss the use of NMES in promoting recovery of the upper limb post stroke and make the brief statement that NMES can be seen as being beneficial in reducing shoulder subluxation but inconsistent in reducing shoulder pain. Basically what Kimberly & Carey (2002) are saying is that, whilst NMES has been found to have a positive effect on reducing sublaxation of the shoulder post stroke, it may not have this same positive result on reducing shoulder pain.
The study conducted by Vuagnat & Chantraine (2003) only had positive outcomes from NMES treatment. According to Vuagnat et al (2003) when NMES was applied early after the onset of the stroke in patients with shoulder pain and subluxation, only positive, beneficial effects on subluxation, pain and mobility of the upper limb were evident.
Furthermore, Yu, Chae, Walker, Kirsteins, Elovic, Flanagna, Harvey, Zorowitz, Frost, Grill, Felstein & Fang (2004) also support the effective use of NMES on upper limb post stroke recovery. In a single-blinded, randomized clinical trial where the subjects received NMES to the supraspinatus, posterior deltoid, middle deltoid and trapezius for 6 weeks, NMES reduced post stroke shoulder pain among those with shoulder subluxation. The effect was also maintained for at least 6 months post treatment, this highlighting the potential long term benefits NMES can have on the patients condition. This result differs from that previously discussed in the study by Linn et al (1999), as they suggest the benefits of NMES are only effective when the patient is receiving regular treatment.
Stroke Survivor's Hand Video Clip- this particular movie effectively illustrates NMES evoking electrical muscle contractions on the patient’s hemiparetic hand. This short clip is particularly confronting as the impairments which prevail post stroke are extremely apparent.
http://www.youtube.com/watch?v=VoAuB27RjDQ&feature=related
Hand Stimulation Video Clip- Although the following movie does not portray the same personal and emotional response as the first, it demonstrates electrical stimulation of just the forearm, hand and fingers. Examples of short pulses of electrical current which stimulate the muscles in the hand and fingers are demonstrated followed by sustained, long contractions which effectively stretch the hand and fingers. Both forms of electrical stimulation are effective in increasing function and muscular strength of the hand and fingers post stroke.
http://www.youtube.com/watch?v=kkT-SYFpw7M
We could continue analysing studies which support the literature on the effective and positive outcomes achieved through NMES in the recovery of upper limb function post stroke. However, we feel we have made our point crystal clear. The majority of relevant literature is supportive in the role of NMES treatment post stroke!
Our next blog may not be as rosy as we will look into the literature which believes NMES may actually impede recovery of upper limb recovery post stroke. We will also discuss the quality of literature and what the future holds for NMES.
However until then, keep smiling!
Hayley and Meg
REFERENCES;
Linn, S. L., Malcolm. H. & Lees, K.R. (1999) Prevention of Shoulder Subluxation After Stroke With Electrical Stimulation. American Heart Association, Inc. (30) 963-968.
Kimberly, T.T. & Carey, J.R. (2002) Neuromuscular electrical stimulation in stroke rehabilitation. University of Minnesota, USA.
Vuagnat. H. & Chantraine. A. (2003) Shoulder pain in hemiplegia revisited: contribution of functional electrical stimulation and other therapies. Journal of Rehabilitation Medicine 35(2):49-54.
Yu. D., T., Chae. J., Walker. M.E., Kirsteins. A., Elovic. E.P,, Flanagan. S.R., Harvey. R.L., Zorowitz. R.D., Frost. F.S., Grill. J.H., Feldstein. M. & Fang. Z.P. (2004) Intramuscular Neuromuscular Electric Stimulation for Post Stroke Shoulder Pain. Arch Phys Medicine Rehabilitation (85) 695-704.
Images;
http://www.mechanical-writings.com/post-stroke-rehabilitation/
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