NMES - exploring alternative viewpoints.

Well, what can we say? We did warn you in the previous post that this entry may not be too rosy, and it seems we have not failed to deliver. Over the past week we were saddened to find out that, unbelievably, not everyone is as supportive of the role of NMES in the rehabilitation of the upper limb post stroke as we detailed in our last post. We knew such universal praise was too good to be true!


Whilst the majority of the evidence we have discovered has been supportive of the role of NMES; Church, Price, Pandyan, Curless, Huntley & Rodgers (2006) not only failed to support the use of NMES, but went as far to say that they believed it can have negative consequences in relation to the recovery of the upper limb post stroke. They believe NMES may actually impede recovery by producing abnormal afferent stimulation proximally, which can later interfere with the recovery of distal tissues through maladaptive plasticity (Church et al, 2006). Once we managed to digest this rather intense lump of information, we realized that this was not good news. How many other professionals would dispute the use of NMES in such situations? We were determined to find out.

Figure 1.1. There is conflicting evidence for the role of NMES in increasing upper limb function post stroke.

In the days that followed we continued our search for information but were unable to find much other evidence that supported the statements presented by Church et al (2006). However, according to Maffiuletti (2010), there is often considerable variation between the conclusions drawn from various different studies. Basically, this infers that NMES current parameters are often poorly reported, and therefore may affect the outcome of such studies. In the same way, the methods used by researchers to evaluate NMES retraining effectiveness are usually quite heterogeneous, thereby rendering it difficult to compare the outcomes of the different NMES studies (Vanderthommen et al, 2007) to guage the overall effectiveness of this technique.


Confusion and sadness has now given way to clarity and a new optimism for the potential healing capacity of NMES. Comparison of our research over past posts identifies the fact that the majority of the literature supports the use of NMES in the recovery of the upper limb post stroke. Personally, we support this point of view, and believe in the abilities of NMES to aid recovery in such situations. What do you think?


Additionally, it was also indicated in our last blog that we would be discussing the future direction of NMES and its role in rehabilitation of the upper limb post stroke. Although difficult to find information relating to this specifically, we were able to determine that the future for this method is bright. With an ageing population who now enjoy increases in cardiovascular survival and many of whom also engage in other risk factors such as inactivity and smoking, it is predicted by many that the incidence of stroke will increase over the coming years (Niessen, Barendregt, Bonneux & Koudstaal, 1993). We believe that the use of NMES will therefore become more crucial and accepted as the demand for rehabilitation post-stroke increases, especially due to the cost-effective nature of NMES and the demand placed on the health care system from increased disease states in an ageing population (Yu, Chae, Walker, Kirsteins,, Elovic, Flanagan, Harvey, Zorowitz, Frost, Grill, Feldstein & Fang, 2004). Yu et al (2004) also believe in the future capabilities of NMES, especially due to recent technological advances which have increased the practicaliy and availability of clinical implementation. However they also state that, due to the somewhat poor quality of the research available, further studies are needed to expand upon proposed clinical applications and define more optimally advanced prescriptive parameters.


In our next and what will be our final post, we will endeavour to discuss relevant contraindications and safety procedures in regards to NMES and its use on individuals post-stroke.

Until then,
Hayley and Meg

References

Church, C., Price, C.  Pandyan, A.D., Huntley, S., Curless, R., & Rodgers, H. (2006). Randomized Controlled Trial to Evaluate the Effect of Surface Neuromuscular Electrical Stimulation to the Shoulder After Acute Stroke. Stroke: Journal of the American Heart Association, 37, 2995-3001.


Maffiuletti., N.A. (2010). Physiological and methodological considerations for the use of neuromuscular electrical stimulation. European Journal Applied Physiology (110) 223–234.


Niessen, L. W., Barendregt, J. J., Bonneux, L. & Koudstaal, P. J. (1993). Stroke Trends in an Ageing Population. Stroke, 24, 931-939.


Vanderthommen. M. & Duchateau. J. (2007). Electrical stimulation as a modality to improve performance of the neuromuscular system. Exercise Sport Science Review (35)180–185.


Yu, D.T., Chae, J., Walker, M. E., Kirsteins, A., Elovic, E. P., Harvey, R. L., Zorowitz, R. D., Frost, F. S., Grill, J. H., Feldstein, M. & Fang, Z. (2004). Intramuscular Neuromuscular electrical stimulation for post stroke shoulder pain: A multicentre randomized clinical trial. Archives of Physical Medicine and Rehabilitation, 85 (5), 695-704. 


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