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  • Meta-Analysis Backs Use of Electrical Stimulation on Patients Posttroke

    Editor's note: this republication corrects an earlier version of this story that identified pulse duration in minutes instead of milliseconds.

     Authors of a review and analysis of studies on neuromuscular electric stimulation (NMES) in the treatment of patients poststroke say they've taken a step toward settling some of the debate about the technique's effectiveness. Bottom line: it's an option that they recommend to reduce spasticity and increase range of motion.

    The study, which appears in the August edition of Stroke (abstract only available for free), examined 29 randomized clinical trials that were focused on the use of NMES either alone or in combination with other treatment techniques, compared with a control group that did not receive NMES. Application sites were limited to lower or upper extremities, but researchers did not put upper or lower limits on NMES dosage. A total of 940 individuals were included in the combined trials.

    Authors of the analysis evaluated pre- and posttreatment spasticity by looking at participant scores on the Modified Ashworth Scale (MAS). Range of motion (ROM) was analyzed through Goniometer data. Treatment time varied (although studies that involved fewer than 3 days of intervention were excluded), as did the amount of time that passed between stroke and first treatment—from 1.5 months to more than 1 year.

    Despite the variation, what they found was that on average, use of NMES resulted in a significant .30 improvement on the MAS (14 of the 29 studies reviewed), and a 2.87 average increase in ROM (15 of the 29 studies reviewed). The most notable improvements came when NMES was used in conjunction with other interventions.

    "NMES combined with other intervention modalities is a treatment option that provides improvements in spasticity and range of motion in stroke patients," authors write. "This data provides support for further NMES use as an additional therapy technique," though they note more study is needed.

    In terms of actual frequencies used in the studies, in 22 trials, NMES frequencies ranged from 18 to 50 Hz, and pulse duration from .1 to .4 milliseconds; 3 studies used frequencies from 80 to 100 Hz with durations of .1 to .3 milliseconds; 4 of the studies did not describe the frequencies and durations. Intervention time across the studies was averaged to 3038.7 minutes, with all but 1 study occurring in an outpatient environment.

    Authors see the control of spasticity as a precursor to the application of any therapies that target motor control, and recognize NMES as an effective way of meeting that challenge.

    "From our findings, the application of NMES to reduce spasticity in these patients can be recommended," authors write. "It would lead to a bigger benefit from the motor control programs and a better improvement in the functional activity. The use of NMES could not inhibit the use of the unaffected hand, but it could enhance and facilitate the patient to use the affected hand for day-to-day tasks, resulting in improvements in [ROM]."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.  

    Comments

    • Pulse duration units of measure should be ms (millisecond) not mins (minutes).

      Posted by Ruth Maher on 7/22/2015 4:06 PM

    • Interesting! Would love to see and participate as an investigator in a study looking at the benefits of the use of neurotoxins plus electric stimulation combined versus electric stimulation alone.

      Posted by Caryn McAllister, PT, DPt on 7/22/2015 4:26 PM

    • What neurostimulator unit was used?

      Posted by Robert N Incitti PT DPT OCS CSCI on 7/22/2015 6:44 PM

    • The length of time that ROM was improved in the majority of the studies was not very clinically significant. In a lot of the individual studies it was only measured post intervention or for a short time (up to 30 minutes). Even at 30 minutes after tx the effect had gone away in several studies.

      Posted by David Levine on 7/23/2015 10:33 AM

    • This is exciting and encouraging news for NMES. As more clinical research reports positive outcomes following the use of a variety of biophysical energies interventions, maybe our profession will return to the use of one of the original pillars of PT practice.

      Posted by Luther C Kloth PT, MS, FAPTA, FACCWS on 7/23/2015 3:12 PM

    • I agree with Luther! If you haven't read Tuxedo Park you should. Many of the tools we have use have fallen into the trash bucket because of cost not good research. We have become a profession not based on science but fads, beliefs and marketing. I have advocated for infra-red studies on the use of manual techniques to document the effectiveness but to date I have seen none!

      Posted by Max Morton PhD, LPT, ATC on 7/25/2015 3:28 PM

    • Even if the gains in ROM are temporary, we can use that window of improved flexibility to more easily apply splints for contracture management.

      Posted by Jerry on 7/31/2015 11:50 AM

    • I'm a cancer survivor with peripheral neuropathy in my feet due to the chemo. This is a common side effect in the hands or feet. I hypothesize that it's due to the pooling of the drugs, which tend to consist of large molecules, in the extremities. Estim to the extremities during treatment could prevent this. This would be hugely beneficial to thousands of patients if proven.

      Posted by Patrick Barry on 8/24/2015 9:50 AM

    • I had 4 treatment of electrical stimulation I must say the first 2 treatmentso were not great but afterwards resting and 2 years after my stroke I must admit I did benefit from the treatment. As a stroke survivor through hard work and continted Hard work with patience never giving up and my faith I will rise stay strong . Teresa daniels

      Posted by Teresa on 10/1/2015 12:41 PM

    • Kudos Patrick and Teresa for active partnership in driving your own treatment. I am always impressed how well the children and parents that I see are able to implement NMES interventions at home. You're the best!

      Posted by Debi Craddock, PT, DPT, PCS on 6/1/2016 11:11 AM

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