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Road, Manchester M6 8HD, UK. Recent studies, in combination with advances in modern electronics, suggest a role for electrotherapy in reversing muscle wasting. However, its effects on human subjects are not always clear-cut. The authors propose that conventional uniform frequency stimulation may deprive the muscle of adaptive information normally encoded in the nonuniform discharge of its motoneuron. This hypothesis was tested in a double blind control trial by stimulating the quadriceps femoris (QF) of elderly subjects with osteoarthritis of the knee. A stimulation pattern replicating that occurring in a normal, fatigued QF motor unit (patterned neuromuscular stimulation) was compared with uniform stimulation of the same mean frequency and random pattern stimulation (created by shuffling the order of the interpulse intervals in the replicated stimulus train). A'sham' stimulation protocol provided an effective placebo. Subjects were assessed at the level of impairment (muscle strength, endurance and cross-sectional area), disability (timed 10-metre walk, timed sit-to-stand) and handicap (part II of the Nottingham Health Profile).Following stimulation, some descriptive improvements in outcome measures were observed in favour of PNMS, particularly in functional tests such as walking speed and sit-to-stand time. No stimulation pattern emerged as being significantly better than another, although statistically significant ( p ≤ 0.05) differences between individual stimulation patterns were observed at a number of assessment weeks.

IntroductionPhysical therapy has been found to improve sensorimotor function following stroke.–5 Early intervention might be better than late6 but even late poststroke physical therapy may be beneficial.3,7–9 Increased intensity of physical therapy may bring increased benefit,10–12 but this might not always be the case,13 as the severity of motor impairment may influence response to additional treatment.14 Not surprisingly, the content of physical therapy might also influence sensorimotor response,15 but at present, choice of treatment by physiotherapists appears to be mostly determined by the treatment approach which was prevalent during their training.16,17 As there are several different physical therapy approaches (Partridge18 describes nine), the potential for variation is extensive. Variation also arises from location of groups of therapists, e.g. the emphasis on the Movement Science Approach in Australia and the emphasis on the Bobath approach in the UK. There is a strong impression that physiotherapy practice has often been shaped by fashion, underpinned by clinical intuitions, based on uncontrolled observations and rationalized by quasi-scientific theories. An example of this is the Bobath approach, which we shall use as an illustration of the current inadequate scientific basis for commonly-used physical therapies.