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Signal transduction and exercise
Published in Adam P. Sharples, James P. Morton, Henning Wackerhage, Molecular Exercise Physiology, 2022
Brendan Egan, Adam P. Sharples
While exercise-in-a-pill is often represented in the public domain as a shortcut for people who simply do not want to exercise – and no doubt that would be a large and lucrative market – the truest spirit of the exercise mimetic concept is pharmacotherapy to mimic the effects of exercise in persons unable to do so for a variety of reasons, such as physical disability, coma or paralysis. To date, perhaps the only alternative to obtain the benefits of exercise for such individuals is neuromuscular electrical stimulation, which can bring about metabolic benefits and adaptive changes through involuntary exercise (123). However, the value of pharmacotherapy in support of modified or bespoke exercise interventions should not be discounted, i.e. compounds serving as adjunct treatments to exercise that potentiate or augment the acute benefit or adaptive response to exercise.
Rehabilitation in the intensive care unit
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Piero Ceriana, Nicolino Ambrosino
Neuromuscular electrical stimulation is considered as a means to prevent the ICU neuromyopathy. Stimulation of the lower limbs can induce changes in muscle function without any form of ventilatory stress and can be easily performed in the ICU with patients lying in bed. Nevertheless, no clinical studies have completely demonstrated additional effects of NMES on exercise tolerance when compared with conventional training in ICU patients (30). Electrical stimulation of abdominal muscles is also a clinically feasible technique for acute ventilator-dependent tetraplegic patients, which may improve respiratory function and enable faster weaning from MV (47–49). In a single-centre RCT in ICU patients, the early addition of in-bed leg cycling plus NMES of the quadriceps muscles to a standardized early rehabilitation programme did not improve global muscle strength at the time of discharge from the ICU (50).
Clinical Management of Spasticity and Contractures in Stroke
Published in Anand D. Pandyan, Hermie J. Hermens, Bernard A. Conway, Neurological Rehabilitation, 2018
Judith F. M. Fleuren, Jaap H. Buurke, Alexander C. H. Geurts
Physical therapy is not primarily aimed at spasticity reduction. In stroke patients, physical therapy is commonly applied to facilitate active muscle control and to maintain the joints’ range of motion and muscle length. There are some techniques that can reduce spasticity, but only for a short time period, such as application of heat, stretching of the muscles, and hippotherapy. Surface neuromuscular electrical stimulation is used, but spasticity treatment is usually not the main goal. Although the intervention may have a short-term inhibiting effect on spasticity, possibly via reciprocal inhibition by stimulation of the (non-spastic) antagonist or by exhausting the stimulated spastic muscle, a long-term effect on upper limb spasticity in stroke patients without functional arm movement has not been shown (Malhotra et al., 2013). Post-stroke, orthotic devices are often applied to the wrist and hand. Although it is controversial as to whether orthotic treatment is effective in the reduction of muscular contracture (Tyson and Kent, 2011), it is suggested that in combination with botulinum toxin treatment, prescription of an orthotic device may aid in the preservation of muscle length.
Effect of Trunk Targeted Interventions on Functional Outcomes in Children with Cerebral Palsy- A Systematic Review
Published in Developmental Neurorehabilitation, 2023
Aishwarya J. Talgeri, Akshatha Nayak, Shreekanth D. Karnad, Preyal Jain, Jaya Shanker Tedla, Ravi Shankar Reddy, Devika Rani Sangadala
The findings of our review draw us to a conclusion that trunk targeted training should be used along with conventional therapy program to bring about an overall functional improvement in children with CP. The trunk targeted interventions also improved gross motor function and balance along with trunk control. These interventions should be provided either in the form of exercises focusing on strengthening the trunk using electrical stimulation for the trunk musculature, using taping to provide stable posture, or using external stabilizers like trunk belt which provide support to the trunk. Neuromuscular electrical stimulation is superior to kinesiotaping, when provided in adjunct to the conventional therapy. In addition, incorporating NDT/Bobath-based protocol for a minimum duration of 6 weeks will improve balance in children with spastic CP. However, the results of this review are restricted to children with spastic CP, since majority of the study population were children with spastic CP. Therefore, future studies must include other types of cerebral palsy as well, so that the results can be generalized.
Gait synchronized neuromuscular electrical stimulation to the gluteus medius on a patient with right hemiparesis: a case report
Published in Physiotherapy Theory and Practice, 2022
Molly E. Warshaw, Mathew J. Baltz, John H. Hollman
Neuromuscular electrical stimulation was applied over two days during both morning and afternoon physical therapy sessions which varied in length of 45–60 minutes per session, resulting in four total sessions of gait synchronized neuromuscular electrical stimulation. During the second to last session the NMES was utilized for five sequential steps and then remained off for the next five steps. This process was repeated throughout the gait training during this treatment session. Meanwhile, the patient was verbally alerted of the timing of the use of NMES in order to provide varying feedback and promote carry-over. During the last session, the trigger NMES was utilized randomly without verbally alerting the patient in order to provide random feedback in hopes of promoting carry-over. After completing the fourth session, the patient had an observed decrease in Trendelenburg gait pattern without use of the NMES; therefore, the intervention of electrical stimulation to the gluteus medius was discontinued. The level of assistance and assistive device utilized during intervention are outlined in Table 2.
Risk and associated factors for hemiplegic shoulder pain in people with stroke: a systematic literature review
Published in Physical Therapy Reviews, 2022
Praveen Kumar, Chiara Fernando, Deanna Mendoza, Riya Shah
People with stroke with persistent motor impairment should be educated regarding positioning and appropriate handling of the affected arm. Patients with little voluntary function may benefit from neuromuscular electrical stimulation. A recent randomized controlled trial (RCT) reported improvement in pain but not in joint range of motion, arm function and activities of daily living after application of electrical stimulation in 36 patients with stroke [60]. Also, given the role of rotator cuff muscles (supraspinatus, infraspinatus, teres minor) in shoulder stability, early rehabilitation programmes should target these muscles to both prevent and reduce secondary complications such as HSP. Evidence from people with shoulder pain in the general population suggests that using concentric and eccentric exercises to rotator cuff muscles are effective in reducing shoulder pain [61, 62].