Non-invasive neuromuscular electrical stimulation in patients with central nervous system lesions: An educational review

Abstract

The aim of this educational review is to provide an overview of the clinical application of transcutaneous electrical stimulation of the extremities in patients with upper motor neurone lesions. In general two methods of electrical stimulation can be distinguished: (i) therapeutic electrical stimulation, and (ii) functional electrical stimulation. Therapeutic electrical stimulation improves neuromuscular functional condition by strengthening muscles, increasing motor control, reducing spasticity, decreasing pain and increasing range of motion. Transcutaneous electrical stimulation may be used for neuromuscular electrical stimulation inducing repetitive muscle contraction, electromyography-triggered neuromuscular electrical stimulation, position-triggered electrical stimulation and subsensory or sensory transcutaneous electric stimulation. Functional electrical stimulation provokes muscle contraction and thereby produces a functionally useful movement during stimulation. In patients with spinal cord injuries or stroke, electrical upper limb neuroprostheses are applied to enhance upper limb and hand function, and electrical lower limb neuroprostheses are applied for restoration of standing and walking. For example, a dropped foot stimulator is used to trigger ankle dorsiflexion to restore gait function. A review of the literature and clinical experience of the use of therapeutic electrical stimulation as well as of functional electrical stimulation in combination with botulinum toxin, exercise therapy and/or splinting are presented. Although the evidence is limited we conclude that neuromuscular electrical stimulation in patients with central nervous system lesions can be an effective modality to improve function, and that combination with other treatments has an additive therapeutic effect.

Cortical Changes After Mental Imagery Training Combined With Electromyography-Triggered Electrical Stimulation in Patients With Chronic Stroke

“…In comparison, generalized EMG-triggered electric stimulation or constraint- induced movement therapy are universally applicable in patients with Medical Research Council Grade 2 or greater muscle strength. 3 Thus, these findings suggest that MIT-EMG can be recommended as a tool to improve motor function of paretic extremities in stroke patients before other interventions.…”

Immediate Effects of Dermatomal Electrical Stimulation on Task-Oriented Movements in Patients with Chronic Hemiplegia

“…Active muscle contraction by repetitive task-oriented movements is the best way to train and regain muscle functions if spasticity can be controlled 11) . According to Schuhfried et al, submotoric electrical stimulation can be used to reduce spasticity and improve motor control through increased afferent inputs, and TENS can improve the effectiveness of task-related exercise in hemiparetic stroke patients 12) .…”

Multifractality, Interactivity, and the Adaptive Capacity of the Human Movement System: A Perspective for Advancing the Conceptual Basis of Neurologic Physical Therapy

“…Examples (other than a metronome) include movements influenced by virtual reality, 41 robotic cues, 42 whole body vibration, 43–46 vibratory insoles to the feet, 47,48 and neuromuscular electrical stimulation). 49 Very recently, non-invasive brain stimulation also has been added to the array of stimulation-based tools that might augment neurorehabilitation practices. 50 Generally speaking, these devices are designed to deliver predictable, linear patterns of stimulation for the purpose of facilitating movement (e.g., muscle activation, kinematics, etc).…”