Neuromuscular Electrical Stimulation: A Review of the Literature

Neuromuscular Electrical Stimulation: A Review of the

Literature

By: Jessica Stewart B.A.Wayne State University Graduate Student

Neuromuscular electrical stimulation (NMES) has been used for many decades a part of rehabilitative therapy

In the early 2000’s, the Food & Drug Administration approved NMES for use with dysphagia treatment

UsesO NMES applies electrical impulses to

the nervous system to stimulate sensory and/or motor neurons

O Common Uses• Relaxation of muscle spasms• Prevention or retardation of disuse

atrophy• Improvement of local blood circulation• Re-education of the muscle

ApplicationTranscutaneous

O Stimulates sensory nerves under the skins surface

O Benefits• Non invasive• Generally inexpensive

O Cons• Needs higher amplitude to reach

deeper muscles

Application

O Percutaneous • Electrodes temporarily placed in

muscle

O Surgical • Permanent Placement

CandidatesO Ideal

• Individuals who have central nervous system abnormalities with intact peripheral nerve functions

O Contraindications• Individuals with motor neuron death• Individuals with progressive fatigue• Individuals with pacemaker, metal implant,

skin breakdown, cancer, cardiac or seizure disorder, impaired peripheral nerves, pregnant

Swallowing TherapyO Speech Language Pathologists

typically administer transcutaneous applications

O One to Two sets of electrodes placed on anterior neck

O NMES is most effective if paired with the actual swallowing of a bolus

StudiesPermsirivanich et al. (2009) O Participants: stroke survivors with

dysphagiaO Group 1: NMESO Group 2: Traditional

• Postural adjustment• Supraglottic swallowing• Mendelsohn maneuver• Effortful swallow

O Results: NMES greater increase in functional oral intake

StudiesChristiaanse et al. (2011)O Participants: pediatric patients with

dysphagiaO Group 1: NMESO Group 2: Traditional therapy

• Oral motor training• Diet modification

O Results: MNES did lead to improvement but not more than traditional therapy

StudiesHeijnen, Speyer, Baijens, and Bogaardt (2011) O Participants: Parkinson's patients with

oropharyngeal dysphagiaO Group 1: Traditional Therapy

• Oral motor exercises, airway protection maneuvers, posture adjustments

O Group 2: Traditional Therapy listed above and MNES to suprahyoid musculature at motor level

O Group 3:Traditional Therapy listed above and MNES to suprahyoid musculature at sensory level

O Results: all the groups demonstrated a significant increase in health related qualities of life, however there was no difference between the groups

StudiesBulow, Speyer, Baijens, Woisard, and Ekberg (2008) O Participants: 25 individuals who received

swallowing therapy from three area hospitalsO Group 1: NMESO Group 2: Traditional Therapy

• Diet modification• Oral motor exercise• Varying postures and maneuvers

O Results: Both groups demonstrated significantly positive results; however, there was not a statically significant difference between groups

StudiesCarnaby-Mann and Crary (2007) O Meta Analysis of 7 transcutaneous

neuromuscular electrical stimulation studies

O Results: Significant, but small, results support use of NMES to improve swallowing and therapeutic effects maintain present even after the stimulation has been removed

Biggest ChallengeO Lack of standardized and objective

outcome measurement• All results are based on clinician’s

subjective judgment

Should I Do It?O Review current literature

O Safety of patient

O Cost

O Client’s needs and values

Conclusion & Questions

ReferencesBailey, R., Fletcher, K., Gosa, M., Miller, J.L., Saavedra, J., Scarborough, D., & Miller, C.K. (2009). Frequently asked questions regarding the use of electrical stimulation to treat feeding and swallowing disorders in the pediatric population. Retrieved June 26, 2012, from www.asha.org.  Bulow, M., Speyer, S., Baijens, L., Woisard, V., & Ekberg, O. (2008). Neuromuscular electrical stimulation (NMES) in stroke patients with oral and pharyngeal dysfunction. Dysphagia, 23, 302-309. Doi: 10.1007/s00455-007-9145-9 Carnaby-Mann, G.D., & Crary, M.A. (2007). Examining the evidence on neuromuscular electrical stimulation for swallowing. Arch Otolaryngol Head Neck Surgery, 133, 564-571. Clark, H., Lazarus, C., Arvedson, J., Schooling, T., & Frymark, T. (2009). Evidence-based systematic review: Effects of neuromuscular electrical stimulation on swallowing and neural activation. American Journal of Speech-Language Pathology, 18, 361-375.  Christiaanse, M.E., Mabe, B., Russell, G., Long Simeone, T., Fortunato, J., & Rubin, B. (2011). Neuromuscular electrical stimulation is no more effective than usual care for the treatment of primary dysphagia in children. Pediatric Pulmonology, 46, 559-565. Groher, M.E., & Crary, M.A. (2010). Dysphagia: Clinical management in adults and children. Maryland Height, Missouri: Mosby, Inc.  Heijnen, B.J., Speyer, R., Baijens, L.W.J., & Bogaardt, B.C.A. (2011). Neuromuscular electrical stimulation versus traditional therapy in patients with Parkinson’s disease and oropharyngeal dysphagia: Effects on quality of life. Dysphagia, doi: 10.1007/s00455-011-9371-z  

ReferencesHuckabee, M., & Doeltgen, S. (2007). Emerging modalities in dysphagia rehabilitation: neuromuscular electrical stimulation. The New Zealand Medical Journal, 120, (1263).

Humbert, I., & Ludlow, C.L. (March 16, 2004). Electrical stimulation aids dysphagia. The ASHA Leader. Retrieved from www.asha.org/publications.leader/2004/040316/040316c.htm

Linkov, G., Branski, R.C., Amin, M., Chernichenko, N., Chen, C., Alon, G., Langmore, S., Wong, R.J., & Kraus, D.H. (2011). Murine model of neuromuscular electrical stimulation on squamous cell carcinoma: Potential implications for dysphagia therapy. Head & Neck, doi: 10.1002/hed Ludlow, C.L. (March 4, 2008). Electrical stimulation and dysphagia: What we do and don’t know. The ASHA Leader, 13 (3), 8-11. www.asha.org/publications.leader/2008/080304/f080304a Permsirivanich, W., Tipehatyotin, S., Wongchai, M., Leelamait, V., Setthawatcharawanich, S. Sathirapanya, P., Phabphal, K., Juntawises, U., & Boonmeeprakob, A. (2009). Comparing the effects of rehabilitation swallowing therapy vs. neuromuscular electrical stimulation therapy among stroke patients with persistent pharyngeal dysphagia: A randomized controlled study. Journal of the Medical Association of Thailand, 92 (2), 259-265. Steel, C.M., Thrasher, A.T., & Popovid, M.R. (2007). Electric stimulation approaches to the restoration and rehabilitation of swallowing: a review. Neurological Research, 29, 9-15.  United States Food and Drug Administration 510 (k) summary (June 6, 2001). Dysphagia Treatment Device.