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Background: Sarcopenia is highly prevalent in haemodialysis (HD) patients and linked to a poor prognosis regarding comorbidities and premature mortality. Previous studies assessed the effects of neuromuscular electrical stimulation in haemodialysis patients. This study adds to the relevance of neuromuscular electrical stimulation (NMES) applications combined with a virtual reality (VR) distraction to increase intensity, dosage, and efficiency of NMES and slow sarcopenia progression in HD patients. Methods: We conducted a 12-week multicenter prospective randomised controlled trial. The patients were randomly assigned to one of the three groups: neuromuscular electrical stimulation with or without combined virtual reality distraction or control group. Results: The final analysis included 32 haemodialysis patients (mean age of 68 ± 10 years, 26 men). Interaction effects between groups and time (12 weeks) were significant regarding serum albumin levels (p = 0.008) and left quadriceps femoris muscle (QFM) force (p = 0.026). Both endpoints were increased in the NMES compared to the CO group at the end of the intervention. The NMES group increased serum albumin levels significantly after 12 weeks. The main effect of time was an increase in mean right QFM force between beginning and end of the intervention (p = 0.021). Functional capacity improved after 12 weeks in the NMES and NMES + VR but not in the control group, with a significant difference between the three groups (p = 0.022). Weight and body mass index increased in the NMES and NMES + VR groups, albeit not significantly. The effects of VR distraction on NMES efficiency were inconclusive. Conclusion: Intradialytic NMES increases serum albumin level, functional capacity, muscle strength in lower limb and in tendency weight and body mass index of HD patients. Effects on VR distraction are inconclusive. Large-scaled follow-up studies on integrated sports programs with NMES and active training in combination with VR as distraction and motivation accelerator are needed. Trial registration: German Clinical Trial Register: DRKS00029276 (Retrospectively registered: 30/06/2022). [ABSTRACT FROM AUTHOR]

Background: The mirror neuron system (MNS) plays a key role in the neural mechanism underlying motor learning and neural plasticity. Action observation (AO), action execution (AE), and a combination of both, known as action imitation (AI), are the most commonly used rehabilitation strategies based on MNS. It is possible to enhance the cortical activation area and amplitude by combining traditional neuromuscular electrical stimulation (NMES) with other top-down and active rehabilitation strategies based on the MNS theory. Objective: This study aimed to explore the cortical activation patterns induced by NMES synchronized with rehabilitation strategies based on MNS, namely NMES+AO, NMES+AE, and NMES+AI. In addition, the study aimed to assess the feasibility of these three novel rehabilitative treatments in order to provide insights and evidence for the design, implementation, and application of brain-computer interfaces. Methods: A total of 70 healthy adults were recruited from July 2022 to February 2023, and 66 of them were finally included in the analysis. The cortical activation patterns during NMES+AO, NMES+AE, and NMES+AI were detected using the functional Near-Infrared Spectroscopy (fNIRS) technique. The action to be observed, executed, or imitated was right wrist and hand extension, and two square-shaped NMES electrodes were placed on the right extensor digitorum communis. A block design was adopted to evaluate the activation intensity of the left MNS brain regions. Results: General linear model results showed that compared with the control condition, the number of channels significantly activated (PFDR < 0.05) in the NMES+AO, NMES+AE, and NMES+AI conditions were 3, 9, and 9, respectively. Region of interest (ROI) analysis showed that 2 ROIs were significantly activated (PFDR < 0.05) in the NMES+AO condition, including BA6 and BA44; 5 ROIs were significantly activated in the NMES+AE condition, including BA6, BA40, BA44, BA45, and BA46; and 6 ROIs were significantly activated in the NMES+AI condition, including BA6, BA7, BA40, BA44, BA45, and BA46. Conclusion: The MNS was activated during neuromuscular electrical stimulation combined with an AO, AE, and AI intervention. The synchronous application of NMES and mirror neuron rehabilitation strategies is feasible in clinical rehabilitation. The fNIRS signal patterns observed in this study could be used to develop braincomputer interface and neurofeedback therapy rehabilitation devices. [ABSTRACT FROM AUTHOR]

Functional electrical stimulation (FES) can be effective in assisting physical and psychosocial difficulties experienced by people with spinal cord injury. Perceived benefits and barriers of the current and future use of FES within the wider spinal cord injury community is currently unknown. The main objective of this research was to explore the spinal cord injury community's views of the use of FES to decrease disability in rehabilitation programmes. An online and paper questionnaire was distributed to people with spinal cord injury, health care professionals and researchers working in spinal cord injury settings in the United Kingdom. A total of 299 participants completed the survey (152 people with spinal cord injury, 141 health care professionals and 6 researchers). Common views between groups identified were: (1) FES can be beneficial in improving physical and psychosocial aspects and that (2) adequate support and training for FES application was provided to users. Barriers to FES use included a lack of staff time and training, financial cost and availability of the equipment. Sixty three percent of non-users felt they would use FES in the future if they had the opportunity. Users' views were important in identifying that FES application can be beneficial for people with spinal cord injury but also has some resourceful barriers. In order to increase use, future research should focus on reducing the cost of FES clinical service and also address implementation of awareness and training programmes within spinal units and community rehabilitation settings. Users of functional electrical stimulation think that it is beneficial for improving physical and psychosocial limitations after spinal cord injury Barriers to FES use include a lack of staff time and training, financial cost and availability of the equipment have been suggested by people with spinal cord injury and health care professionals Education and implementation programs for health care professionals and people with spinal cord injury are now necessary to increase the awareness about functional electrical stimulation application Reduction of FES cost could also increase its uptake in spinal cord injury clinical services [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the effectiveness of neuromuscular electrical stimulation (NMES) blended with early rehabilitation on the diaphragm and skeletal muscle in sufferers on mechanical ventilation (MV). Method: This is a prospective randomized controlled study. Eighty patients on MV for respiratory failure were divided into a study group (40 cases) and a control group (40 cases) randomly. The study group adopted a treatment method of NMES combined with early rehabilitation and the control group adopted the method of early rehabilitation only. The diaphragmatic excursion (DE), diaphragmatic thickening fraction (DTF), variation of thickness of intercostal muscles (TIM), variation of thickness of rectus abdominis (TRA), and variation of the cross-sectional area of rectus femoris (CSA-RF) were measured to evaluate the therapeutic effect by ultrasound before and after intervention at the first day of MV, the 3rd and 7th day of intervention and the day discharged from ICU. Results: No significant difference was found in the general demographic information and ultrasound indicators between the two groups before treatment (all P > 0.05). After treatment, the variation of DTF (0.15 ± 0.05% vs. 0.12 ± 0.04%, P = 0.034) was significantly higher in the study group than that in the control group on the day discharged from ICU. The variation of TRA (0.05 ± 0.09% vs. 0.10 ± 0.11%, P = 0.029) and variation of CSA-RF (0.13 ± 0.07% vs. 0.19 ± 0.08%, P < 0.001) in the study group were significantly lower than that in the control group. The duration of MV in the study group was significantly shorter than that in the control group [109.5 (88.0, 213.0) hours vs. 189.5 (131.5, 343.5) hours, P = 0.023]. The study group had better muscle strength score than the control group at discharge (52.20 ± 11.70 vs. 44.10 ± 15.70, P = 0.011). Conclusion: NMES combined with early rehabilitation therapy is beneficial in reducing muscle atrophy and improving muscle strength in mechanically ventilated patients. This treatment approach may provide a new option for patients to choose a rehabilitation program; however, more research is needed to fully evaluate the effectiveness of this treatment option. [ABSTRACT FROM AUTHOR]

Background: Children with Down syndrome (DS) are increased probability of suffer from feeding difficulties, which can have long-term health effects, such as growth deficits and lower scholastic and cognitive performance that causes a negative impact on children's well-being. Purposes: This study aimed to investigate the effect of neuromuscular electrical stimulation on oral motor skills and swallowing and feeding functions in children with Down syndrome. Methods: Forty-eight children with DS from both sexes contributed to this research, with ages ranging from 3-6 years. They were randomly divided into two groups of equal numbers. The control group received an especially designed physical therapy program and oral motor training program. The study group received neuromuscular electrical stimulation (NMES) in addition to a specially designed physical therapy program and oral motor training program given to the control group. Both groups received the treatment program 3 times / week for 3 successive months. Assessment of oral motor skills was conducted by oral motor assessment scale (OMAS) and the pediatric eating assessment tool (Pedi-EAT) was used for assessment of swallowing and feeding functions. Assessment was performed before and after 3 months of intervention. Results: The results of the present study showed statistically significant improvement within both groups in all measured variables when comparing their pre- and post-treatment mean values. Statistically significant differences were observed in all measured variables between the two groups in favor of the study group. Conclusion: Neuromuscular electrical stimulation in conjunction with oral motor exercises is more effective than using oral motor exercises alone in improving oral motor skills and swallowing function in children with Down syndrome. [ABSTRACT FROM AUTHOR]

Introduction: Neuromuscular electrical stimulation (NMES) is a treatment modality that has been used to accelerate the rehabilitation of patients with neurological damage. However, it is unclear whether NMES of the deltoid can lead to the early restoration of shoulder function after reverse total shoulder arthroplasty (RSA). Materials and methods: In this prospective and randomized study, 88 patients who underwent RSA with the same prosthesis design for cuff tear arthropathy or irreparable rotator cuff tear were assessed. The patients were divided into two groups (NMES group and non-NMES group, 44 patients each). For the NMES group, two pads of the NMES device were placed over the middle and posterior deltoid area, and NMES was maintained for 1 month after surgery. Shoulder functional outcomes and deltoid thickness were compared at 3, 6, and 12 months postoperatively. Shoulder functional outcomes were assessed based on the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES), and Constant scores and the range of motion (ROM) and power of the affected shoulder. The thickness of the anterior, middle, and posterior deltoid was measured by ultrasonography. Results: A total of 76 patients (NMES group, 33 patients; non-NMES group, 43 patients) were enrolled in the final analysis. The preoperative demographics and status of the remaining rotator cuff of both groups were not significantly different. At postoperative 3 months, the ROM and power of external rotation of the NMES group were significantly greater than those of the non-NMES group (ROM, 36° ± 14° vs. 29° ± 12°; P =.003; power, 4.8 kg ± 1.8 kg vs. 3.8 kg ± 1.0 kg; P <.002). The ROM of external rotation of the NMES group at postoperative 6 months was also greater than that of the non-NMES group (41° ± 12° vs. 34° ± 11°; P =.013). However, there was no significant difference in the VAS, ASES, and Constant scores at all follow-up points despite gradual improvements until 1 year postoperatively. Serial measurements of the thickness of the anterior, middle, and posterior deltoid of both groups did not show significant differences. Conclusions: Postoperative NMES of the deltoid after RSA contributed to significantly faster ROM restoration and considerable improvement in the power of external rotation. Therefore, NMES following RSA could lead to the early restoration of external rotation and recovery of deltoid function. [ABSTRACT FROM AUTHOR]

Purpose: The effectiveness of a neuromuscular electrical stimulation (NMES) program has been shown to be proportional to the maximal evocable torque (MET), which is potentially influenced by pulse characteristics such as duration and frequency. The aim of this study was to compare MET between conventional and wide-pulse NMES at two different frequencies. Methods: MET—expressed as a percentage of maximal voluntary contraction (MVC) torque—and maximal tolerable current intensity were quantified on 71 healthy subjects. The right quadriceps was stimulated with three NMES protocols using different pulse duration/frequency combinations: conventional NMES (0.2 ms/50 Hz; CONV), wide-pulse NMES at 50 Hz (1 ms/50 Hz; WP50) and wide-pulse NMES at 100 Hz (1 ms/100 Hz; WP100). The proportion of subjects reaching the maximal stimulator output (100 mA) before attaining maximal tolerable current intensity was also quantified. Results: The proportion of subjects attaining maximal stimulator output was higher for CONV than WP50 and WP100 (p < 0.001). In subjects who did not attain maximal stimulator output in any protocol, MET was higher for both WP50 and WP100 than for CONV (p < 0.001). Maximal tolerable current intensity was lower for both WP50 and WP100 than for CONV and was also lower for WP100 than for WP50 (p < 0.001). Conclusion: When compared to conventional NMES, wide-pulse protocols resulted in greater MET and lower maximal tolerable current intensity. Overall, this may lead to better NMES training/rehabilitation effectiveness and less practical issues associated with maximal stimulator output limitations. [ABSTRACT FROM AUTHOR]

Currently, Chronic Obstructive Pulmonary Disease (COPD) is perceived not only as a pulmonary disease, but more as a systemic disease affecting the functioning of other organs including the locomotor system. The application of physical therapy in patients with COPD has been found to be safe and beneficial. Neuromuscular Electrical Stimulation (NMES) treatment is particularly beneficial for patients who are unable or unwilling to participate in daily activities or regular physical exercise. The efficacy of this technique has not yet been fully demonstrated in patients with COPD. Therefore, this study aimed to evaluate the effects of NMES on peripheral muscle strength and exercise tolerance in COPD patients. As part of the literature review for this study, seven studies over the last 19 years have been taken into consideration. The review included the following databases: Physiotherapy Evidence Database (PEDro), Google Scholar, and PubMed. Based on our literature review, we concluded that NMES has positive effects on increasing peripheral muscle strength and exercise tolerance in COPD patients. Future research should examine whether the therapeutic effects are long-lasting, whether they are experienced by all COPD patient groups, and which frequency or type of NMES delivers the most effective results. [ABSTRACT FROM AUTHOR]

Dysphagia is a serious cause of morbidity and mortality in stroke survivors. Electrical stimulation is often included as part of the treatment plan for dysphagia and can be applied at a sensory or motor level intensity. However, evidence to support these different modes of stimulation is lacking. This study compared the effectiveness of sensory and motor level stimulation on post-stroke dysphagia. This is a randomized trial conducted in an inpatient rehabilitation facility. Thirty-one participants who had dysphagia caused by stroke within 6 months prior to enrolment were included. Participants were excluded if they had a contraindication for electrical stimulation, previous stroke, psychiatric disorder, contraindications for modified barium swallow study (MBSS), or pre-morbid dysphagia. Each patient received ten sessions that included 45 min of anterior neck sensory or motor level electrical stimulation in addition to traditional dysphagia therapy. Motor stimulation was administered at an intensity sufficient to produce muscle contractions. Sensory stimulation was defined as the threshold at which the patient feels a tingling sensation on their skin. Swallow functional assessment measure (FAM), dysphagia outcome severity scale (DOSS), national outcome measurement system (NOMS), penetration aspiration scale (PAS), diet change, and the swallowing quality of life questionnaire (SWAL-QOL). Clinical outcomes were analyzed using a Wilcoxon signed-rank test, Mann–Whitney U test, RM ANOVA, or chi-square analysis. There was no significant difference in age, length of stay, or initial swallow FAM between groups. Patients in the sensory group showed significant improvement on swallow FAM, DOSS, and NOMS, while those in the motor group did not (Sensory: Swallow FAM (S = 48, p = 0.01), DOSS (S = 49.5, p = 0.001), NOMS (S = 52.5, p = 0.006); Motor: Swallow FAM (S = 20.5, p = 0.2), DOSS (S = 21, p = 0.05), NOMS (S = 29.5, p = 0.2)). When the groups were combined, there was statistically significant improvement on all measures except the PAS (Swallow FAM (S = 138.5, p = 0.003), DOSS (S = 134.5, p < 0.001), NOMS (S = 164, p = 0.0004)). When comparing motor to sensory NMES, there was no significant difference between groups for Swallow FAM (p =.12), DOSS (p = 0.52), or NOMS (p = 0.41). There was no significant difference in diet change for solid food or liquids among the groups, although 50% more participants in the sensory group saw improvement in diet. This study supports the use of electrical stimulation as part of the treatment plan for post-stroke dysphagia. Sensory-level stimulation was associated with greater improvement on outcome measures compared to motor level stimulation. [ABSTRACT FROM AUTHOR]

The study aimed to evaluate the effects of traditional dysphagia therapy (TDT) and neuromuscular electrical stimulation (NMES) combined with TDT on functionality of oral intake, dysphagia symptom severity, swallowing- and voice-related quality of life, leakage, penetration–aspiration, and residue levels in patients with post-stroke dysphagia (PSD). Thirty-four patients with PSD were included in our prospective, randomized, controlled, and single-blind study. The patients were divided into two groups: (1) TDT only (control group, n = 17) and (2) TDT with NMES (experimental group, n = 17). TDT was applied to both groups for three consecutive weeks, 5 days a week, 45 min a day. Sensory NMES was applied to the experimental group for 45 min per session. Patients were evaluated by the functional oral intake scale (FOIS), the eating assessment tool (EAT-10), the swallowing quality of life questionnaire (SWAL-QOL), and the voice-related quality of life questionnaire (VRQOL) at baseline, immediately post-intervention, and at the 3rd month post-intervention. Fiberoptic endoscopic evaluation of swallowing (FEES) with liquid and semi-solid food was performed pre- and post-intervention. A significant post-intervention improvement was observed on all scales in both groups, and these improvements were maintained 3 months post-intervention. Leakage and penetration–aspiration levels with semi-solid food declined only in the experimental group. In conclusion, TDT is a non-invasive and inexpensive method that leads to improvement in many swallowing-related features in stroke patients; however, NMES as an adjunct therapy is costly but can provide additional benefits for improving features, such as penetration–aspiration and residue levels. [ABSTRACT FROM AUTHOR]

ObjectiveTo examine the combined effects of neuromuscular electrical stimulation-resistance training (NMES-RT) and functional electrical stimulation-lower extremity cycling (FES-LEC) compared to passive movement training (PMT) and FES-LEC in adults with SCI on (1) oxygen uptake (VO2), insulin sensitivity and glucose disposal in adults with SCI; (2) Metabolic and inflammatory biomarkers; (3) skeletal muscle, intramuscular fat (IMF) and visceral adipose tissue (VAT) cross-sectional areas (CSAs).Materials and methodsThirty-three participants with chronic SCI (AIS A-C) were randomized to 24 weeks of NMES-RT + FES or PMT + FES. The NMES-RT + FES group underwent 12 weeks of evoked surface NMES-RT using ankle weights followed by an additional 12 weeks of progressive FES-LEC. The control group, PMT + FES performed 12 weeks of passive leg extension movements followed by an additional 12 weeks of FES-LEC. Measurements were performed at baseline (BL; week 0), post-intervention 1 (P1; week 13) and post-intervention 2 (P2; week 25) and included FES-VO2 measurements, insulin sensitivity and glucose effectiveness using the intravenous glucose tolerance test; anthropometrics and whole and regional body composition assessment using dual energy x-ray absorptiometry (DXA) and magnetic resonance imaging to measure muscle, IMF and VAT CSAs.ResultsTwenty-seven participants completed both phases of the study. NMES-RT + FES group showed a trend of a greater VO2 peak in P1 [p = 0.08; but not in P2 (p = 0.25)] compared to PMT + FES. There was a time effect of both groups in leg VO2 peak. Neither intervention elicited significant changes in insulin, glucose, or inflammatory biomarkers. There were modest changes in leg lean mass following PMT + FES group. Robust hypertrophy of whole thigh muscle CSA, absolute thigh muscle CSA and knee extensor CSA were noted in the NMES-RT + FES group compared to PMT + FES at P1. PMT + FES resulted in muscle hypertrophy at P2. NMES-RT + FES resulted in a decrease in total VAT CSA at P1.ConclusionNMES-RT yielded a greater peak leg VO2 and decrease in total VAT compared to PMT. The addition of 12 weeks of FES-LEC in both groups modestly impacted leg VO2 peak. The addition of FES-LEC to NMES-RT did not yield additional increases in muscle CSA, suggesting a ceiling effect on signaling pathways following NMES-RT.Clinical trial registrationidentifier NCT02660073.

Quadriceps contracture is a condition where the muscle–tendon unit is abnormally shortened. The treatment prognosis is guarded to poor depending on the progress of the disease. To improve the prognosis, we investigated the effectiveness of therapeutic ultrasound and NMES in treating quadriceps contracture in an immobilized rat model. Thirty-six Wistar rats were randomized into control, immobilization alone, immobilization and spontaneous recovery, immobilization and therapeutic ultrasound, immobilization and NMES, and immobilization and therapeutic ultrasound and NMES combination groups. The continuous therapeutic ultrasound (frequency, 3 MHz, intensity 1 W/cm2) and NMES (TENS mode, frequency 50 Hz; intensity 5.0 ± 0.8 mA) were performed on the quadriceps muscle. On Day 15, immobilization-induced quadriceps contracture resulted in a decreased ROM of the stifle joint, reduction in the sarcomere length, muscle atrophy, and muscle fibrosis. On Day 43, therapeutic ultrasound, NMES, and combining both methods improved muscle atrophy and shortening and decreased collagen type I and III and α-SMA protein. The combination of therapeutic ultrasound and NMES significantly reduced the mRNA expression of IL-1β, TGF-β1, and HIF-1α and increased TGF-β3. Therefore, the combination of therapeutic ultrasound and NMES is the most potent rehabilitation program for treating quadriceps contracture.

Background: Neuromuscular electrical stimulation (NMES) is used for muscle strengthening. While voluntary muscle contraction follows Henneman et al.’s size principle, the NMES-in-duced muscle training disrespects the neurophysiology, which may lead to unwanted changes (i.e., declined balance ability).Objects: We examined how the balance was affected by abdominal muscle training with the NMES.Methods: Fifteen young adults (10 males and 5 females) aged between 21 and 30 received abdominal muscle strengthening with NMES for 23 minutes. Before and after the training, participants’ balance was measured through one leg standing on a force plate with eyes open or closed. Outcome variables included mean distance (MDIST), root mean square dis-tance (RDIST), total excursion (TOTEX), mean velocity (MVELO), and 95% confidence circle area (AREA) of center of pressure data. Two-way repeated measures analysis of variance was used to test if these outcome variables were associated with time (pre and post) and vision.Results: All outcome variables were not associated with time (p > 0.05). However, all out-come variables were associated with vision (p = 0.0001), and MVELO and TOTEX were 52.4% (45.5 mm/s versus 95.6 mm/s) and 52.4% (364.1 mm versus 764.5 mm) smaller, respectively, in eyes open than eyes closed (F = 55.8, p = 0.0005; F = 55.8, p = 0.0005). Furthermore, there was no interaction between time and vision (F = 0.024, p = 0.877).Conclusion: Despite the different neurophysiology of muscle contraction, abdominal muscle strengthening with NMES did not affect balance.

The research on the effect of neuromuscular electrical stimulation (NMES) protocol on skin temperature (Tsk) in individuals with spinal cord injury (SCI) is a prospective non-controlled intervention study. 47 individuals with SCI were recruited from the outpatient clinic. NMES was applied to the tibial anterior (TA) muscles. Four assessments were performed: baseline, shortly after the end of NMES session (t0), 10 min after the end of NMES (t10) and 20 min after the end of NMES (t20). The intensity used was 1.5 mA RMS (root mean square) depending on the individuals. The variables were Tsk at forehead, dermatome C2 and L5 bilaterally. The dermatome C2 and forehead were measured only at baseline and t20. The measurement device was a noncontact infrared thermometer. Results of this study demonstrated that after NMES the stimulated dermatome (L5), showed an increase in local Tsk. In addition, the t20 showed that the Tsk did not drop to the baseline, being still significant in the analyzed group. The implications for rehabilitation practice and the positive effects of NMES are fundamental to improvement of the blood microcirculation and local metabolism.

Background: Dysphagia is one of the common complications after stroke. It is closely related to lung infection and malnutrition. Neuromuscular electrical stimulation (NMES) is widely used in the treatment of post-stroke dysphagia, but the evidence-based medical evidence of NMES is limited. Therefore, this study aimed to evaluate the clinical effcacy of NMES in patients with post-stroke dysphagia by systematic review and meta-analysis. Methods: We searched the CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science databases for all randomized controlled trials (RCTs) of NMES in the treatment of post-stroke dysphagia from the establishment of the database to 9 June 2022. The risk of bias assessment tool recommended by Cochrane and the GRADE method was used to assess the risk of bias and the quality of evidence. RevMan 5.3 was used for statistical analysis. Sensitivity and subgroup analyses were performed to evaluate the intervention effect more specifically. Results: A total of 46 RCTs and 3,346 patients with post-stroke dysphagia were included in this study. Our meta-analysis showed that NMES combined with routine swallowing therapy (ST) could effectively improve swallowing function in Penetration-Aspiration Scale (MD = -0.63, 95% CI [-1.15, -0.12], P = 0.01), Functional Oral Intake Scale (MD = 1.32, 95% CI [0.81, 1.83], P < 0.00001), Functional Dysphagia Scale (MD = - 8.81, 95% CI [-16.48, -1.15], P = 0.02), the Standardized Swallowing Assessment (MD = -6.39, 95% CI [-6.56, -6.22], P < 0.00001), the Videofluoroscopic Swallow Study (MD = 1.42, 95% CI [1.28, 1.57], P < 0.00001) and the Water swallow test (MD = -0.78, 95% CI [-0.84, -0.73], P < 0.00001). Furthermore, it could improve the quality of life (MD = 11.90, 95% CI [11.10, 12.70], P < 0.00001), increase the upward movement distance of hyoid bone (MD = 2.84, 95% CI [2.28, 3.40], P < 0.00001) and the forward movement distance of hyoid bone (MD = 4.28, 95% CI [3.93, 4.64], P < 0.00001), reduce the rate of complications (OR = 0.37, 95%CI [0.24, 0.57], P < 0.00001). Subgroup analyses showed that NMES+ST was more effective at 25Hz, 7mA or 0-15mA, and at courses (≤4 weeks). Moreover, patients with an onset of fewer than 20 days and those older than 60 years appear to havemore positive effects after treatment. Conclusion: NMES combined with ST could effectively increase the forward and upward movement distance of the hyoid bone, improve the quality of life, reduce the rate of complications, and improve the swallowing function of patients with post-stroke dysphagia. However, its safety needs to be further confirmed. the rate of complications, and improve the swallowing function of patients with post-stroke dysphagia. However, its safety needs to be further confirmed. [ABSTRACT FROM AUTHOR]

Electrical stimulation exercise has become an important modality to help improve the mobility and health of individuals with spinal cord injury (SCI). Electrical stimulation is used to stimulate peripheral nerves in the extremities to assist with muscle strengthening or functional activities such as cycling, rowing, and walking. Electrical stimulation of the peripheral nerves in the upper extremities has become a valuable tool for predicting the risk of hand deformities and rehabilitating functional grasping activities. The purpose of this paper is to provide healthcare providers perspective regarding the many rehabilitation uses of electrical stimulation in diagnosing and treating individuals with SCI. Electrical stimulation has been shown to improve functional mobility and overall health, decrease spasticity, decrease the risk of cardiometabolic conditions associated with inactivity, and assist in the diagnosis/prognosis of hand deformities in those with tetraplegia. Studies involving non-invasive stimulation of the spinal nerves via external electrodes aligned with the spinal cord and more invasive stimulation of electrodes implanted in the epidural lining of the spinal cord have demonstrated improvements in the ability to stand and enhanced the stepping pattern during ambulation. Evidence is also available to educate healthcare professionals in using functional electrical stimulation to reduce muscle spasticity and to recognize limitations and barriers to exercise compliance in those with SCI. Further investigation is required to optimize the dose-response relationship between electrical stimulation activities and the mobility and healthcare goals of those with SCI and their healthcare providers. [ABSTRACT FROM AUTHOR]

BACKGROUND: Spinal cord injury (SCI) leads to spinal nerve fiber tract damage resulting in functional impairments. Volumetric muscle loss (VML), a skeletal muscle volume abnormal reduction, is represented by atrophy below the injury level. The strategies for VML management included personalized approaches, and no definite indications are available. OBJECTIVE: To identify the rehabilitation effects of VML in subjects with SCI (humans and animals). METHODS: PubMed, Scopus, and Web of Science databases were systematically searched to identify longitudinal observational studies with individuals affected by traumatic SCI as participants; rehabilitation treatment as intervention; no control, sham treatment, and electrical stimulation programs as control; total lean body and lower limb lean mass, cross-sectional area, functional gait recovery, muscle thickness, and ultrasound intensity, as outcome. RESULTS: Twenty-four longitudinal observational studies were included, evaluating different rehabilitation approaches' effects on the VML reduction in subjects affected by SCI. The data showed that electrical stimulation and treadmill training are effective in reducing the VML in this population. CONCLUSION: This systematic review underlines the need to treat subjects with traumatic SCI (humans and animals) with different rehabilitation approaches to prevent VML in the subacute and chronic phases. Further clinical observations are needed to overcome the bias and to define the intervention's timing and modalities. [ABSTRACT FROM AUTHOR]

Purpose: The combination of motor imagery (MI) and neuromuscular electrical stimulation (NMES) can increase the corticospinal excitability suggesting that such association could be efficient in motor performance improvement. However, differential effect has been reported at spinal level after MI and NMES alone. The purpose of this study was to investigate the acute effect on motor performance and spinal excitability following MI, NMES and combining MI and NMES. Methods: Ten participants were enrolled in three experimental sessions of MI, NMES and MI + NMES targeting plantar flexor muscles. Each session underwent 60 imagined, evoked (20% MVC) or imagined and evoked contractions simultaneously. Before, immediately after and 10 min after each session, maximal M-wave and H-reflex were evoked by electrical nerve stimulation applied at rest and during maximal voluntary contraction (MVC). Results: The MVC decreased significantly between PRE-POST (− 12.14 ± 6.12%) and PRE-POST 10 (− 8.1 ± 6.35%) for NMES session, while this decrease was significant only between PRE-POST 10 (− 7.16 ± 11.25%) for the MI + NMES session. No significant modulation of the MVC was observed after MI session. The ratio Hmax/Mmax was reduced immediately after NMES session only. Conclusion: The combination of MI to NMES seems to delay the onset of neuromuscular fatigue compared to NMES alone. This delay onset of neuromuscular fatigue was associated with specific modulation of the spinal excitability. These results suggested that MI could compensate the neuromuscular fatigue induced acutely by NMES until 10 min after the combination of both modalities. [ABSTRACT FROM AUTHOR]

Upper- and lower-limb neuromuscular electrical stimulation (NMES) is known to modulate the excitability of the neural motor circuits. However, it remains unclear whether short-duration trunk muscle NMES could achieve similar neuromodulation effects. We assessed motor evoked potentials (MEPs) elicited through transcranial magnetic stimulation of the primary motor cortex representation of the trunk extensor muscles to evaluate corticospinal excitability. Moreover, cervicomedullary motor evoked potentials (CMEPs) were assessed through cervicomedullary junction magnetic stimulation to evaluate subcortical excitability. Twelve able-bodied individuals participated in the MEP study, and another twelve in the CMEP study. During the interventions, NMES was applied bilaterally to activate the erector spinae muscle and produce intermittent contractions (20 s ON/20 s OFF) for a total of 20 min while participants remained seated. Assessments were performed: (i) before; (ii) during (in brief periods when NMES was OFF); and (iii) immediately after the interventions to compare MEP or CMEP excitability. Our results showed that MEP responses were not affected by trunk NMES, while CMEP responses were facilitated for approximately 8 min during the intervention, and returned to baseline before the end of the 20 min stimulating period. Our findings therefore suggest that short-duration NMES of the trunk extensor muscles likely does not affect the corticospinal excitability, but it has a potential to facilitate subcortical neural circuits immediately after starting the intervention. These findings indicate that short-duration application of NEMS may be helpful in rehabilitation to enhance neuromodulation of the trunk subcortical neural motor circuits. [ABSTRACT FROM AUTHOR]

Muscle weakness acquired in the intensive care unit (ICU) adversely affects outcomes of ICU patients. This article reports the short-term respiratory effects of neuromuscular electrical stimulation (NMES) in critically ill patients. Patients were randomly assigned to an intervention group (NMES + conventional physiotherapy) and a control group (sham NMES + conventional physiotherapy). The application of NMES in the intervention group resulted in a significant decrease in the duration of mechanical ventilation and reduced the number of weaning trial failures. Other positive outcomes included reductions in the length of ICU stays and decreased mortality when compared with the control group. [ABSTRACT FROM AUTHOR]

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Background ICU-acquired weakness (AW) is a common complication in the ICU, which needs more attention because it affects the patients’ outcome. It has subtypes that differ in its pathology. Many risk factors contribute to that problem through different mechanisms. ICU-AW is diagnosed clinically and by other investigations. Objective To assess whether early recognition of ICU-AW and early rehabilitation in respiratory ICU might improve patients’ functional recovery and outcomes. Patients and methods A randomized controlled study was conducted on 50 patients in the respiratory ICU, who were divided into two groups. Both groups received the same rehabilitation program, but the study group received neuromuscular electrical stimulation, whereas the control group received sham treatment. The program was 4 days per week for 2 weeks. All patients were assessed before and after treatment by measuring midthigh, midleg, and midarm circumferences and assessment of the muscle strength using the Medical Research Council sum score. Results Both groups were matched demographically and in the pretreatment assessment. There were posttreatment significant changes in both groups, but when comparing the changes, it was more significant in the study group. The outcomes for both groups regarding ICU-AW were similar. Conclusion ICU-AW can be ameliorated by focusing on early rehabilitation, especially with the usage of neuromuscular electrical stimulation. [ABSTRACT FROM AUTHOR]

Post‐stroke sequelae includes loss functions, such as cognitive and sensory‐motor which lead to emotional and social problems, reducing quality of life and well‐being. The main aim of our study was to investigate the effects of transcranial laser photobiomodulation together with neuromuscular electrical stimulation (NMES) in post‐stroke patients. We performed a clinical trial and an ex vivo study. For the clinical trial, hemiplegic patients were separated into two groups: Treated Group (TG): Hemiplegics treated with transcranial laser (on) associated with NMES (on) and; Placebo Group (PG): Hemiplegics treated with placebo transcranial laser (off) associated with NMES (on). The cluster prototype includes 12 diode laser beams (4 × 660 nm, 4 × 808 nm and 4 × 980 nm) with average power of 720 mW per cluster applied during one minute, leading to 43.2 J energy per cluster. Fifteen regions for all head were irradiated by cluster, leading to 648 J energy per session. The parameters of NMES of the paretic limbs to generate extension wrist and ankle dorsiflexion were symmetrical biphasic rectangular waveforms, 50 Hz frequency, 250 μs pulse duration, and adjustable intensity to maintain the maximum range of motion (amplitude between 0 and 150 mA). Our clinical trial showed improvement of cognitive function, pain relief, greater manual dexterity, enhancement of physical and social–emotional health which lead to better quality of life and well‐being. There was also increased temperature in the treated regions with laser and NMES. For the ex vivo study, the distribution of infrared and red radiation after penetration through the cranium and hemihead of cadavers were showed. Therefore, transcranial laser photobiomodulation associated with NMES can be an important therapeutic resource for rehabilitation after stroke. [ABSTRACT FROM AUTHOR]

• Combining physical therapy, NMES and high protein nutrition with standard care restored positive nitrogen balance in critically ill subjects. • The intervention group experienced less muscle lower extremity muscle loss (volume and cross-sectional area) when compared to standard care. • The intervention group experienced less delirium compared to the group who received standard care. Neuromuscular electrical stimulation (NMES) with high protein supplementation (HPRO) to preserve muscle mass and function has not been assessed in ICU patients. We compared the effects of combining NMES and HPRO with mobility and strength rehabilitation (NMES+HPRO+PT) to standardized ICU care. To assess the effectiveness of combined NMES+HPRO+PT in mitigating sarcopenia as evidenced by CT volume and cross-sectional area when compared to usual ICU care. Additionally, we assessed the effects of the combined therapy on select clinical outcomes, including nutritional status, nitrogen balance, delirium and days on mechanical ventilation. Participants were randomized by computer generated assignments to receive either NMES+HPRO+PT or standard care. Over 14 days the standardized ICU care group (N = 23) received usual critical care and rehabilitation while the NMES+HPRO+PT group (N = 16) received 30 min neuromuscular electrical stimulation of quadriceps and dorsiflexors twice-daily for 10 days and mean 1.3 ± 0.4 g/kg body weight of high protein supplementation in addition to standard care. Nonresponsive participants received passive exercises and, once responsive, were encouraged to exercise actively. Primary outcome measures were muscle volume and cross-sectional area measured using CT-imaging. Secondary outcomes included nutritional status, nitrogen balance, delirium and days on mechanical ventilation. The NMES+HPRO+PT group (N = 16) lost less lower extremity muscle volume compared to the standard care group (N = 23) and had larger mean combined thigh cross-sectional area. The nitrogen balance remained negative in the standard care group, while positive on days 5, 9, and 14 in the NMES+HPRO+PT group. Standard care group participants experienced more delirium than the NMES+HPRO+PT group. No differences between groups when comparing length of stay or mechanical ventilation days. The combination of neuromuscular electrical stimulation, high protein supplementation and mobility and strength rehabilitation resulted in mitigation of lower extremity muscle loss and less delirium in mechanically ventilated ICU patients. Trial Registration: Clinicaltrials.gov identifier: NCT02509520. Registered July 28, 2015 [ABSTRACT FROM AUTHOR]

ackground: Neuromuscular electrical stimulation (NMES) is a physical modality used to activate skeletal muscles for strengthening. While voluntary muscle contraction (VMC) follows the progressive recruitment of motor units in order of size from small to large, NMES-induced muscle contraction occurs in a nonselective and synchronous pattern. Therefore, the outcome of muscle strengthening training using NMES-induced versus voluntary contraction might be different, which might affect balance performance.Objects: We examined how the NMES training affected balance and proprioception.Methods: Forty-four young adults were randomly assigned to NMES and VMC group. All participants performed one-leg standing on a force plate and sat on the Biodex (Biodex R Corp.) to measure balance and ankle proprioception, respectively. All measures were conduct-ed before and after a training session. In NMES group, electric pads were placed on the tibialis anterior, gastrocnemius, and soleus muscles for 20 minutes. In VMC group, co-contraction of the three muscles was conducted. Outcome variables included mean distance, root mean square distance, total excursion, mean velocity, 95% confidence circle area acquired from the center of pressure data, and absolute error of dorsi/plantarflexion.Results: None of outcome variables were associated with group (p > 0.35). However, all but plantarflexion error was associated with time (p < 0.02), and the area and mean velocity were 37.0% and 18.6% lower in post than pre in NMES group, respectively, and 48.9% and 16.7% lower in post than pre in VMC group, respectively.Conclusion: Despite different physiology underlying the NMES-induced versus VMC, both training methods improved balance and ankle joint proprioception.

Abstract Background Pressure injuries (PIs), especially in the sacral region are frequent, costly, and increase morbidity and mortality of patients in an intensive care unit (ICU). These injuries can occur as a result of prolonged pressure and/or shear forces. Neuromuscular electrical stimulation (NMES) can increase muscle mass and improve local circulation, potentially reducing the incidence of PI. Methods We performed a randomized controlled trial to assess the efficacy and safety of NMES in preventing PI in critically ill patients. We included patients with a period of less than 48 h in the ICU, aged ≥ 18 years. Participants were randomly selected (1:1 ratio) to receive NMES and usual care (NMES group) or only usual care (control group—CG) until discharge, death, or onset of a PI. To assess the effectiveness of NMES, we calculated the relative risk (RR) and number needed to treat (NNT). We assessed the muscle thickness of the gluteus maximus by ultrasonography. To assess safety, we analyzed the effects of NMES on vital signs and checked for the presence of skin burns in the stimulated areas. Clinical outcomes were assessed by time on mechanical ventilation, ICU mortality rate, and length of stay in the ICU. Results We enrolled 149 participants, 76 in the NMES group. PIs were present in 26 (35.6%) patients in the CG and 4 (5.3%) in the NMES group (p ˂ 0.001). The NMES group had an RR = 0.15 (95% CI 0.05–0.40) to develop a PI, NNT = 3.3 (95% CI 2.3–5.9). Moreover, the NMES group presented a shorter length of stay in the ICU: Δ = − 1.8 ± 1.2 days, p = 0.04. There was no significant difference in gluteus maximus thickness between groups (CG: Δ = − 0.37 ± 1.2 cm vs. NMES group: Δ = 0 ± 0.98 cm, p = 0.33). NMES did not promote deleterious changes in vital signs and we did not detect skin burns. Conclusions NMES is an effective and safe therapy for the prevention of PI in critically ill patients and may reduce length of stay in the ICU. Trial registration RBR-8nt9m4. Registered prospectively on July 20th, 2018, https://ensaiosclinicos.gov.br/rg/RBR-8nt9m4

We aimed to investigate the acute effects of blood flow restriction (BFR) combined with neuromuscular electrical stimulation (NMES) on muscle strength, thigh circumference, and knee joint reposition sense in female amateur football players, as well as to determine whether this procedure is safe. Methods: This was a pilot trial. Twenty female amateur football players were randomized into two groups: group 1 (n = 10) received a single NMES session; group 2 (n = 10) received NMES + BFR. The measured variables included maximal voluntary eccentric contraction (MVEC) and maximal voluntary concentric contraction (MVCC), thigh circumference, and knee joint reposition sense test. The type of electrical current used was TENS (symmetrical biphasic rectangular pulse, 350 μs, and 50 Hz), combined simultaneously with active knee extension (75 repetitions in 4 sets, 20% MVCC, 30 s rest between sets), for both groups. Group 2 had BFR added (80% of arterial occlusion pressure). Results: Statistically significant differences (p ≤ 0.05) were obtained for thigh circumference in both groups. The comparison between groups did not show statistically significant differences (p ≤ 0.05) in MVEC, MVCC, thigh circumference, or the knee joint reposition sense test. Conclusions: Both the isolated NMES intervention and its combination with BFR induced immediate changes in thigh circumference without impairing the muscle strength or proprioceptive ability of the football players. However, these results should be interpreted with caution, and future studies including a control group and isolated BFR application are needed.

Background: Neuromuscular electrical stimulation (NMES) is effective in muscle strengthening after orthopedic injury particularly when muscle activation failure is present, but the associated pain can be a barrier. Pain itself can produce a pain inhibitory response called Conditioned Pain Modulation (CPM). CPM is often used in research studies to assess the state of the pain processing system. However, the inhibitory response of CPM could make NMES more tolerable to patients and could improve functional outcomes in people with pain. This study compares the pain-inhibitory effect of NMES compared to volitional contractions and noxious electrical stimulation (NxES). Methods: Healthy participants, 18–30 years of age experienced 3 conditions: 10 NMES contractions, 10 bursts of NxES on the patella, and 10 volitional contractions on the right knee. Pressure pain thresholds (PPT) were measured before and after each condition in both knees and the middle finger. Pain was reported on an 11-point VAS. Repeated measures ANOVAs with 2 factors: site and time were performed for each condition followed by post-hoc paired t-tests, with Bonferroni correction. Results: Pain ratings were higher in the NxES condition compared to NMES (p =.000). No differences in PPTs prior to each condition were observed but PPTs were significantly higher in the right and left knees after the NMES contractions (p =.000, p =.013, respectively) and after the NxES (p =.006, P-.006, respectively). Pain during NMES and NxES did not correlate with pain inhibition (p >.05). Self-reported pain sensitivity correlated with pain during NxES. Conclusion: NxES and NMES produced higher PPTs in both knees but not in the finger, suggesting that the mechanisms responsible for the reduction in pain are located in the spinal cord and local tissues. Pain reduction was elicited during the NxES and NMES conditions regardless of the self-reported pain ratings. When NMES is used for muscle strengthening significant pain reduction can also occur, which is an unintended benefit of the intervention that could improve functional outcomes in patients. [ABSTRACT FROM AUTHOR]

Background: Various therapies have been used to restore blood flow and stabilize renal function in patients with pregnancy related acute kidney injury (AKI-P). There are favorable effects of electrical stimulation on muscle metabolism, microcirculation and possibly renal function; therefore, this study suggests for the first time that neuromuscular electrical stimulation (NMES) has a positive effect on renal functions of women with AKI-P. Methods: This randomized controlled design study evaluated the effect of NMES on renal blood flow and hemodynamics for women with AKI-P. Patients were randomized into two groups; NMES group (Group ES) versus Control group (Group C). Group ES received routine care and NMES while Group C received routine care only, data was collected from obstetric ICU. Improvement of renal functions was considered the primary outcome and secondary outcome was improvement of hemodynamics. Results: NMES application had caused no a statistical significant change in serum creatinine in Group ES than Group C on mid period and last day of the study (230.13 ± 83.69 in Group ES versus 258.3 ± 115.77 in Group C) and (180.21 ± 63.65 in Group ES versus 201.32 ± 84.78 in Group C) (P = 0.285 & P = 0.297) respectively. Conclusion: Application of NMES had no effect on their renal functions but there are improvements on hemodynamics. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to assess the effects of neuromuscular electrical stimulation on the upper limbs of patients with cerebral palsy. Design: We searched PubMed, Cochrane, Embase, and Scopus databases for randomized controlled trials examining the effects of neuromuscular electrical stimulation on the upper limbs of children with cerebral palsy. Results: Eight randomized controlled trials (N = 294) were included in the meta-analysis. Compared with traditional physical therapy, sensorimotor training and task-oriented training, constraint-induced movement therapy, dynamic bracing, and conventional robot-assisted therapy, neuromuscular electrical stimulation in combination with these therapies resulted in significantly greater functional scale scores (standardized mean difference = 0.80; 95% confidence interval = 0.54 to 1.06), muscle strength of upper limbs (standardized mean difference = 0.57; 95% confidence interval = 0.25 to 0.88), and spasticity of upper limbs (relative risk = 2.53; 95% confidence interval = 1.46 to 4.39; standardized mean difference = −0.18; 95% confidence interval = −0.29 to −0.06) but did not improve the wrist range of motion (standardized mean difference = 0.43; 95% confidence interval = −0.04 to 0.91). In addition, the effect of neuromuscular electrical stimulation on functional scale scores remained after 3-mo follow-up (standardized mean difference = 0.68; 95% confidence interval = 0.16 to 1.2). Conclusions: Neuromuscular electrical stimulation effectively improved hand function, muscle strength, and spasticity in patients with cerebral palsy. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of virtual reality balance training combined with neuromuscular electrical stimulation (NMES) on knee function, hamstring muscle strength and walking function after anterior cruciate ligament reconstruction (ACLR). Methods: 96 patients with anterior cruciate ligament (ACL) injury who were treated in our hospital from August 2019 to December 2021 were selected, and ACLR was successfully implemented. They were randomly divided into control group (n=48, routine rehabilitation training, virtual reality balance training) and study group (n=48, outine rehabilitation training, virtual reality balance training combined with intervention) by random number table method. The excellent and good rate of knee function, knee function, hamstring muscle strength and walking function of the two groups were compared. Results: The excellent and good rate of knee joint function in the study group was 93.75% (45/48) higher than 68.75% (33/48) in the control group, and the difference was statistically significant (P<0.05). After intervention, knee function score and knee range of motion were increased in the two groups, and the study group was higher than the control group (P<0.05). After intervention, the isometric strength of the affected side hamstring muscle in the two groups increased, and the study group was higher than the control group (P<0.05). There was no significant difference in isometric strength of the unaffected side hamstring muscle in the two groups after intervention (P>0.05). After intervention, the step length and step speed in the two groups increased, and the study group was higher than the control group, the affected side swing phase decreased, and the study group was lower than the control group (P<0.05). After intervention, the threshold of passive activity perception and conduct passive angle regeneration test decreased in two groups, and the study group was lower than the control group (P<0.05). Conclusion: Virtual reality balance training combined with NMES has a significant effect on patients with ACLR after operation, which is helpful to the recovery of knee joint function, improve hamstring muscle strength and improve walking function. [ABSTRACT FROM AUTHOR]

Objective To analyze the effect of neuromuscular electrical stimulation therapy combined with citric acid popsicle for pharyngeal ice stimulation training in patients with dysphagia after stroke. Methods A total of 100 patients with dysphagia after stroke admitted to the Department of Neurology and Department of Rehabilitation Medicine of this hospital from October 2009 to December 2017 were selected and divided into the study group and the control group by random number table method, with 50 cases in each group. The study group received self-made citric acid popsicle pharyngeal stimulation training combined with neuromuscular electrical stimulation treatment, while the control group received pharyngeal ice stimulation training with large cotton swab dipped in ice water combined with neuromuscular electrical stimulation treatment. The scores of swallowing function and clinical efficacy of the two groups were compared before and after treatment. Results The total effective rate of the study group [96%（48/50）] was higher than that of the control group [90%（45/50）], but the difference was not statistically significant（P>0.05）.After 2 and 4 weeks of treatment, the grade of water swallow test in both groups was significantly lower than before treatment, with statistical significance（P<0.05）.The differences were not statistically significant when the patients in both groups were graded by the water swallow test after 2 and 4 weeks of treatment（P>0.05）.Conclusion Neuromuscular electrical stimulation combined with citric acid popsicle for pharyngeal ice stimulation training is more effective for patients with dysphagia after stroke. [ABSTRACT FROM AUTHOR]

The conventional procedure in retraining a muscle has been physiotherapy, but persistence is required, which often proves to be a limitation in most patients. The electrical stimulation technique has great potential in comparison to conventional methods that are employed in retraining muscles. The neuromuscular electrical stimulation method uses a device that sends electrical impulses to neurones. This input causes the muscle to contract. It can be used to re-educate or retrain a muscle. In this review article, how different types of stimulation strategies can be used for re-educating muscles in different diseased conditions is studied. The force and quality of the muscle contraction depend upon several parameters such as frequency, amplitude, pulse duration and waveforms of stimuli. The Analysis of parameters involved in different stimulation techniques can help in understanding how a particular muscle can be stimulated in different diseased conditions. There are several studies that have reported the efficacy of muscle stimulation strategies. In this review, we investigated 30 research studies that used the muscle stimulation method for re-educating muscle and discussed many considerations in context to muscle stimulation techniques: the stimulation strategies and parameters, electrodes and results. With this review, we investigated a potential intervention for re-educating muscle and tried to recognise the limitations and benefits of the current strategies involved. [ABSTRACT FROM AUTHOR]

Mounting evidence suggests neuromuscular electrical stimulation (NMES) as a promising modality for enhancing lower limb muscle strength, yet the functional effects of a single electrical stimulation session for improving the function of the intrinsic foot muscles (IFM) has not been evaluated. To investigate the immediate effects of an NMES session compared with a sham stimulation session on foot force production, foot dome stability, and dynamic postural control in participants with static foot pronation. Randomized controlled clinical trial. Laboratory. A total of 46 participants (23 males, 23 females) with static foot pronation according to their Foot Posture Index (score ≥ 6) were randomly assigned to an NMES (n = 23) or control (n = 23) group. The NMES group received a single 15-minute NMES session on the dominant foot across the IFM. The control group received a 15-minute sham electrical stimulation session. All outcome measurements were assessed before and after the intervention and consisted of foot force production on a pressure platform, foot dome stability, and dynamic postural control. Statistical analysis was based on the responsiveness of the outcome measures and responder analysis using the minimum detectable change scores for each outcome measure. In the NMES group, 78% of participants were classified as responders for at least 2 of the 3 outcomes, compared with only 22% in the control group. The relative risk of being a responder in the NMES group compared with the control group was 3.6 (95% CI = 1.6, 8.1]. Interestingly, we found that all participants who concomitantly responded to foot strength and navicular drop (n = 8) were also responders in dynamic postural control. Compared with a sham stimulation session, a single NMES session was effective in immediately improving foot function and dynamic postural control in participants with static foot pronation. These findings support the role of NMES for improving IFM function in this population. [ABSTRACT FROM AUTHOR]

This study investigated the effects of massage therapy (MT), high-intensity interval training (HIIT), and neuromuscular electrical stimulation (NMES) as three physical therapies on pain perception and negative emotional state (NES) in males with chronic joint pain (CJP). This double-blind randomized experimental study was done with three pretest, posttest, and follow-up stages within three experimental groups and the control group. Participants recruited by a random sampling method in each group that they were 160 patients with CJP. A demographic questionnaire, the Short-Form-McGill Pain Questionnaire (SF-MPQ), and Depression, Anxiety and Stress Scale- 21 (DASS-SF-21) were used in this study. Findings showed significant differences in the effectiveness of MT, HIIT, and NMES on pain symptoms and NES in experimental and control groups during post-test and follow-up stages. The MT, HIIT, and NMES were effective in decreasing the sensory experience of pain, the affective experience of pain, the present pain intensity (PPI), and depression, anxiety, and stress among outpatients with CJP in the experimental groups during post-test and follow-up stages. NMES, HIIT, and MT may be considered by health professionals as effective interventions to reduce pain perception and NES in patients with CJP. [ABSTRACT FROM AUTHOR]

Pain and muscles weakness often delays regaining independent mobility following hip fracture surgery. Electrical stimulation may relieve pain and improve muscle strength and function. To systematically review and evaluate available literature examining the effectiveness of using electrical stimulation to promote clinical outcomes after hip fractures. Two researchers independently searched MEDLINE, CINAHL, EMBASE, Web of Science, Cochrane Reviews, Physiotherapy Evidence Database, and PsycInfo from inception to July 1, 2018, with no restrictions. The quality and fidelity of the included interventions were assessed, and expert consultation was conducted to help explain the results. We identified 432 records through database searching. Initial screening indicated 24 articles were appropriate for full-text review, and four articles met the inclusion criteria. In included studies, electrical stimulation (i.e. TENS) reduced pain (mean difference (MD) = 3.3 points on 10-point Visual Analogue Scale, p <.001), improved range of motion (ROM) (MD: 25.7°, p <.001), and accelerated functional recovery immediately after hip fracture (p <.001). Conflicting evidence existed when using neuromuscular electrical stimulation to improve muscle strength and other functional outcomes (e.g. mobility); however, nine experts advised that longer-term interventions might be necessary to achieve significant improvment in muscle strength. Available evidence, albeit limited, supports the early application of noninvasive electrical stimulation (e.g. TENS) for improving clinical outcomes (i.e. reducing pain, improving ROM, and accelerating functional recovery after hip fractures). We could not find conclusive evidence on the effectiveness of using electrical stimulation to improve muscle strength. This review establishes the need for future additional high-quality trials in this field. [ABSTRACT FROM AUTHOR]

Regular exercise involves daily muscle contractions helping metabolize up to 70% of daily ingested glucose. Skeletal muscle increases glucose uptake through two distinct pathways: insulin signaling pathway and muscle contraction mediated AMPK pathway. People with paralysis are unable to contract their muscles which atrophy, transform into insulin resistant glycolytic muscle, and develop osteoporosis. Our goal is to determine if low force electrically induced exercise (LFE) will modulate the post prandial insulin and glucose response in people with and without spinal cord injury (SCI). 18 people with SCI and 23 without SCI (Non-SCI) participated in an assessment of metabolic biomarkers during passive sitting (CTL) and a bout of LFE delivered to the quadriceps/hamstring muscle groups after a glucose challenge. Baseline fasting insulin (p = 0.003) and lactate (p = 0.033) levels were higher in people with SCI, but glucose levels (p = 0.888) were similar compared to the non-SCI population. After 1-h of muscle contractions using LFE, heart rate increased (p < 0.001), capillary glucose decreased (p = 0.004), insulin decreased (p < 0.001), and lactate increased (p = 0.001) in the SCI population. These findings support that LFE attenuates certain metabolic blood biomarkers during a glucose challenge and may offer a lifestyle strategy to regulate metabolic responses after eating among people with SCI. [ABSTRACT FROM AUTHOR]

Purpose: The effectiveness of neuromuscular electrical stimulation hinges on the evoked torque level, which can be attained through either conventional (CONV) or wide-pulse high frequency (WPHF). However, the best electrode placement is still unclear. This study adopted a crossover design to compare the effects of WPHF applied to the tibial nerve trunk (N-WPHF) or muscle (M-WPHF) with CONV in healthy participants., Methods: A total of 30 participants (age: 22.4 [4.5]) were involved in 4 sessions. During each session, participants performed: 2 maximal voluntary contractions, 2 contractions at maximal evoked torque, and 2 contractions at submaximal evoked torque at 20% maximal voluntary contraction. Neuromuscular electrical stimulation intensity-evoked torque, efficiency, and discomfort were measured in maximal and submaximal conditions. Statistical analyses were conducted using a 1-way mixed-model analysis of variance with repeated measures., Results: N-WPHF and M-WPHF showed higher evoked torque than CONV (P = .002 and P = .036) and greater efficiency than CONV for maximal evoked torque (P = .006 and P = .002). N-WPHF induced higher efficiency than M-WPHF and CONV for submaximal evoked torque (P = .004). Higher discomfort was observed for both N-WPHF and M-WPHF for submaximal evoked torque compared with CONV (P = .003 and P < .001)., Conclusion: Our results suggest that WPHF applied at either the nerve or muscle could be the best choice for the maximal condition, whereas nerve application is preferred for the submaximal condition.

Neurostimulation delivers electrical pulses to modulate neuromuscular activity. Commonly used in medical interventions from pain relief to rehabilitation, neurostimulation typically uses manually placed hydrogel electrodes over the treated region. However, this method limits interventions requiring frequent, long-term daily use. To address this, novel fully textile electrodes are developed using industrial programmable knitting machines. These electrodes are designed to be washable, reusable, flexible, and breathable, with embedded interconnects. Textile electrodes are made of yarns with stainless steel and PEDOT-coated stainless steel conductive components. The electrodes' performance are compared with gel electrodes, characterizing impedance, sensorimotor stimulation thresholds, recruitment of induced movements, sensation levels, and perceived sensations. The effects of residential wash cycles and continuous use duration are also investigated. The proposed electrodes are found to perform similarly to hydrogel electrodes in all characterized metrics. No degradation in electrode performance is found after at least 30 wash cycles. Electrodes remained functionally intact after 1000 cycles of stretch loading at 50% of break strain. The textile electrodes consistently induced comfortable sensorimotor responses for at least six hours after donning. The proposed textile electrodes offer a novel and effective solution for neurostimulation interventions, paving the way for integration into smart garments and long-term wearable health technologies., (© 2024 Wiley‐VCH GmbH.)

Background: In hallux valgus, morphological changes and functional weakness of intrinsic foot muscles occur, especially in the abductor hallucis muscle., Objectives: This study aimed to investigate how a conservative treatment with the addition of neuromuscular electrical stimulation affects the volume and strength of the muscle, the correction of deformity, passive range of motion, pain, and disability., Methods: Twenty-eight female participants (48 feet) were randomly assigned to two groups. The interventions included orthoses and exercise (Ortho) in both groups. One group received additional neuromuscular electrical stimulation of abductor hallucis muscle to activate it. Each group received the treatments for one month and was assessed two times, at baseline before starting and after one month of treatment. Mixed within-between ANOVA, analysis of covariance, and nonparametric tests were used for data analysis., Results: The muscle volume, abduction strength, goniometric angle, and passive hallux dorsi/plantar flexion showed significant changes in both groups ( p  < .001). Subscales of the foot and ankle ability questionnaire, significantly changed ( p  ≤ .05). Pain decreased significantly in the two groups ( p  < .001 and p  = .02). Intermetatarsal angle did not significantly differ between the two groups ( p  = .86, partial eta effect size = 0.001). But, the hallux valgus angle mean (on MRI) in the Ortho group was less than that of the orthoNMES group ( p  = .007, partial eta effect size = 0.15)., Conclusion: Both groups showed nearly identical treatment effects in the primary volume and hallux valgus correction outcome measures. In this study, adding neuromuscular electrical stimulation did not have an additional effect compared to conservative in the treatment of hallux valgus., Trial Registration Number: The RCT Code is IRCT20200915048725N1.

There have been few studies that have examined hemodynamic responses to low-frequency neuromuscular electrical stimulation (LF-NMES), and the effects of combining passive cycle ergometry are still unclear. The purpose of this study was to examine the effects of a combination of LF-NMES and passive cycle ergometry on hemodynamic responses with a primary focus on the Fick principle in healthy adults. A randomized, crossover trial was conducted to evaluate the responses to three types of supine exercises (LF-NMES alone, LF-NMES with passive cycle ergometry, and voluntary cycle ergometry) adjusted to the same exercise intensity as the oxygen consumption of 14 mL/kg/min in 13 healthy adult men. Blood pressure, heart rate, blood lactate concentration, stroke volume (SV), cardiac output (CO), and left ventricular end-diastolic volume (LVEDV) were measured during each exercise in all subjects. The arterial-venous oxygenation difference (A-V̇o 2 difference) was calculated based on Fick's equation. LVEDV, SV, and CO were lower, and the A-V̇o 2 difference and blood lactate concentration were higher in LF-NMES alone than those in voluntary cycle ergometry and LF-NMES with passive cycle ergometry ( P < 0.05). The blood lactate concentration was lower in LF-NMES with passive cycle ergometry than that in LF-NMES alone, but slightly higher than that in voluntary cycle ergometry ( P < 0.05). Hemodynamic and metabolic responses of exercise with LF-NMES alone seemed consistent with insufficient peripheral perfusion based on the elevation of A-V̇o 2 difference and blood lactate concentration. The findings suggest that combining passive cycle ergometry with LF-NMES improves the insufficient peripheral perfusion induced by LF-NMES alone. NEW & NOTEWORTHY This is the first study to evaluate cardiac output, oxygen consumption, and A-V̇o 2 difference during LF-NMES of endurance exercise modality. LF-NMES alone may not demonstrate hemodynamic responses induced by voluntary endurance exercise, however, demonstrates those when combined with passive cycle ergometry. LF-NMES with passive cycle ergometry may be a more effective approach in cardiac rehabilitation for patients without the ability of voluntary exercise because it may increase cardiac output and venous return as represented by the LVEDV.

Introduction: Electrical stimulation (E-stim) can reduce the impact of complications, like spasticity, bladder dysfunction in people with spinal cord injuries (SCIs), enhancing quality of life and health outcomes. With SCI prevalence high in regional Australia and a shift towards home-based community integrated care, the perspectives of people with SCI and healthcare professionals on current and future use of E-stim home-devices are needed., Methods: A mixed-methods concurrent triangulation approach was used. A cross-sectional survey collected demographics and perspectives on E-stim technology from 84 individuals with SCI and healthcare professionals. Focus groups with 36 participants explored the experiences, facilitators, and barriers of using E-stim home-devices., Results: Healthcare professionals prioritised the use of E-stim for muscle strength and functional improvements, whereas people with SCI prioritised alleviating secondary complications. Healthcare professionals emphasised personal responsibility; however, people with SCI saw the clinical relationship as an important facilitator. Both groups agreed on the cost, accessibility, and funding as major barriers., Conclusions: Different expectations between healthcare professionals and people with SCI highlight the need for improved communication when establishing goals and expected outcomes. Successful E-stim home-device implementation relies on device availability and tailoring education to suit people with SCI and healthcare professionals.

Background/objectives: Innovative therapies are needed to reduce disability, facilitate activities of daily living, and improve the quality of life in patients with stroke. Non-invasive methods of stimulating the peripheral and central nervous system are increasingly being used to enhance the effects of existing therapies in stroke rehabilitation. One potentially relevant method for achieving greater improvement is repetitive peripheral magnetic stimulation (rPMS). This randomized controlled trial (RCT), the Peripheral MAgnetic stimulation in patients with spastic hemiparesis after Stroke Trial (REPMAST), will investigate whether rPMS improves upper extremity function, spasticity, and activities of daily living in patients with stroke compared with neuromuscular stimulation (NMS)., Methods: REPMAST is an interventional, randomized controlled single-blinded study. Patients with subacute stroke are randomized to receive rPMS or NMS five days a week for three weeks in addition to standard rehabilitation therapy. The primary outcome is the change in the Fugl-Meyer Assessment for Upper Extremity between the beginning and end of the stimulation sessions. Secondary outcomes include changes in the Katz Index of Independence in Activities of Daily Living, the Timed Up and Go Test, the Modified Ashworth Scale, and the Tardieu Scale. A total sample size of 138 patients (69 in each group) is required to investigate the superiority of rPMS compared with NMS., Conclusions: The aim of this RCT is to provide evidence for an effective peripheral stimulation treatment for stroke recovery.

Neuromuscular electrical stimulation (NMES) is widely used for improving muscle strength, preventing muscle atrophy, and decreasing pain. Recently, NMES has become a substitute for exercise therapy for metabolism improvement and functional capacity improvement. However, NMES has several disadvantages. First, slow-twitch muscle contractions are insufficient because the recruitment pattern of NMES does not obey Henneman's size principle. Second, when using surface electrodes, it is difficult to contract deep skeletal muscles at the application site. Third, electrical stimulation causes discomfort. Therefore, we devised a simultaneous combination of NMES and voluntary muscle contractions to overcome the weak points of NMES. A hybrid training system (HTS) that resists the motion of a volitionally contracting agonist muscle with force generated by its electrically stimulated antagonist was developed as a technique to combine the application of NMES and volitional contractions. This motion sensor makes it possible to simultaneously combine voluntary movements with NMES. Our HTS synchronizes with voluntary movements, enhancing safety and reducing discomfort. This HTS enhances the exercise effect of even simple exercise. So far, our HTS has been reported to be effective for muscle strength enhancement, prevention of muscle atrophy, improvement of physical function, pain relief, enhancement of physical fitness, and improvement of metabolic function. HTS are expected to be useful methods in environments where sufficient exercise load is not available or for individuals with low exercise tolerance.