This study demonstrated that specific training of the scapula muscles shows a benefit for shoulder strength, endurance and function of the shoulder in subjects with tetraplegia and should be part of the rehabilitation program. Besides, the SSE can be performed by subjects with tetraplegia themselves on a regular basis.

Objective To evaluate the effect of neuromuscular electrical stimulation on spasticity in patients with spinal cord injury. Methods The study included eleven subjects with spinal cord injuries (C4 to T5). The modified Ashworth scale and pendulum test, which is accomplished through the Pendular Test Device - PTD (equipment which has a quartz crystal transducer accelerometer and optic fiber flexible electrogoniometer measuring the tensions and angular displacements). Patients underwent neuromuscular electrical stimulation (NMES) to the quadriceps muscle from fibular nerve, and the tests were administered before and after therapy. Results The data show a decrease in spasticity after NMES, with features such as increased variation between maximum and minimum peaks, i.e. increased amplitude of the curves. Furthermore, data from the subjective scale, and modified Ashworth scale after neuromuscular electrical stimulation also showed a reduction in the values of spasticity. Conclusion The data suggest that NMES is effective in reducing spasticity immediately after completion. Level of Evidence II, Therapeutic Studies-Investigating the Results of Treatment.

OBJECTIVE:To identify changes in blood pressure and heart rate in individuals with chronic paraplegia undergone neuromuscular electrical stimulation treatment. METHOD: Design: Observational prospective. Participants: Twenty individuals with chronic paraplegia (neurological level above T6) belonging to two different groups (G1 and G2) were submitted to an upper limb exercise test. G1 patients (n=13) had been treated with neuromuscular electrical stimulation (25Hz, pulses of 300μs, 100V) for 2 years or more, at least once a week; G2 patients (n=7) did not receive neuromuscular electrical stimulation treatment; G3 individuals (n=6) were healthy volunteers. Procedures: Arterial blood pressure and heart rate were measured during four phases of the exercise test: at initial rest, during warmup, during the exercise itself, and at rest after the exercise. RESULTS: Systolic and diastolic blood pressures showed no statistical difference between groups. In the comparison between exercise phases, regardless of the group, systolic pressure was significantly higher and diastolic pressure significantly lower at the end of the exercise itself, when compared to all other phases. Resting heart rate was significantly lower in healthy controls vs. G1 and G2, which were not significantly different between themselves. Exercise increased heart rate in all groups. CONCLUSION: This study showed that the groups are normotensive and homogeneous in their results; heart rate was higher in both paraplegic groups compared to healthy controls, but no difference was found between treated vs. untreated groups. Thus, neuromuscular electrical stimulation is a safe and effective way to treat individuals with chronic paraplegia.

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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.