Rehabilitation in the intensive care unit
Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein in Pulmonary Rehabilitation, 2020
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
Anand D. Pandyan, Hermie J. Hermens, Bernard A. Conway in Neurological Rehabilitation, 2018
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.
Chronic back pain
Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen in Clinical Pain Management, 2008
Transcutaneous electrical nerve stimulation (TENS) has been used for CLBP for years based on the gate control theory of pain reduction by Melzack and Wall.126 The attractiveness of TENS is that the units themselves are portable. They easily hang from a belt or fit in a pocket, with electrodes attached to the back. Many variations of treatment duration and stimulation settings exist. Typical treatment is 30 minutes, four times per day. Evidence of efficacy in CLBP is limited and inconsistent.127[II] When combined with neuromuscular electrical stimulation, there is an increase in benefit compared to either modality alone.128[III] Percutaneous electrical nerve stimulation (PENS) combines electrical stimulation with acupuncture-type needles placed in the skin and appears to be more effective than the TENS for CLBP.129[III] Randomized, controlled trials have shown PENS superior to sham PENS for LBP.130[II]
Establishing the NeuroRecovery Network Community Fitness and Wellness facilities: multi-site fitness facilities provide activity-based interventions and assessments for evidence-based functional gains in neurologic disorders
Published in Disability and Rehabilitation, 2018
Heather Tolle, Andrew Rapacz, Barry Weintraub, Carrie Shogren, Susan J. Harkema, Jeremy L. Gibson
Neuromuscular electrical stimulation is an activity-based intervention where a client performs specific motor tasks facilitated by 12 channels of alternating electrical current via percutaneous electrodes placed over specific muscles that show the most impairment from pre-injury abilities. Task-specific activities and progression through stages of recovery are based on the Neuromuscular Recovery Scale [25,26]. The Neuromuscular Recovery Scale helps to assist trainers and clients to determine current recovery levels and provides a picture for trainers to use in determining goals for the client. The neuromuscular electrical stimulation intervention has clients perform tasks based on the three lowest scores of Neuromuscular Recovery Scale. Motor tasks are executed through facilitation by the stimulation and manually by trainers. The standardized threshold for a neuromuscular electrical stimulation intervention is 60 min of activity including performance of the motor task both with and without stimulation and manual facilitation. Pulse widths are standardized at 1000 µs and frequency is standardized at 100 Hz. Amplitude during neuromuscular electrical stimulation varies from client to client based on tolerance and muscle response.
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].
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.
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