Effects Of Neuromuscular Electrical Stimulation Research Articles

Effects of 1 Hz Low Frequency Repetitive Transcranial Magnetic Stimulation with Neuromuscular Electrical Stimulation Applied to Contralateral Cerebral Cortex on Muscle Activity, Muscle Tone and Upper Limb Motor Function in Stroke Patients

This study was to investigate effects of NMES with 1 Hz low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) applied to unaffected cerebral cortex on muscle activities, tone, and motor function of upper limb (UL) in stroke patients. 16 patients were randomly divided into two groups, and experimental group (EG) was subjected to 1 Hz LF-rTMS and neuromuscular electrical stimulation (NMES). In control group (CG), Facilitation of hand intrinsic muscles and NMES were performed. It was evaluated using electromyography (EEG), MyotonePRO, and Fugl-Meyer assessment (FMA). As a result, there were significant differences on EMG of the anterior deltoid, triceps brachii (TB), MyotonePRO, and FMA in the EG. CG showed a significant difference in EMG of TB. Between groups, there was a significant difference in the biceps brachii and TB. It’s thought that 1 Hz LF-rTMS and NMES can have a positive effect to improve muscle activity and UL in stroke patients.

Effects of Neuromuscular Electrical Stimulation with and without Kinesio Taping Application on Sitting Balance Among Children with Cerebral Palsy

Abstract
 
 Background: Children with spastic cerebral palsy often show difficulty to maintain posture and function, therefore displaying the weak sitting postural balance such as the flexed trunk. Objective: The study was designed to determine the effectiveness in terms of alignment and function with neuromuscular electric stimulation, Kinesio tape above the trunk muscles in combination with conventional physiotherapy for improving sitting balance in young children with spastic diplegic cerebral palsy that has presented with weak trunk control. Methods: In this randomized trial children aged between 5 to 12 years were involved in this study. Group A received electric stimulation and conventional physical therapy while group B received Kinesio tape, electric stimulation and conventional physiotherapy for 12 weeks, 3 alternate days per week. Data were collected at baseline, 5th and 10th week after the last session of the week. Sitting balance is evaluated by the seated postural control measurement score. Results: Significant differences were observed in both groups in the total score of seated postural control measurement alignment section (p<0.015) and functional section (p<0.01) after the 10th week; the change in group B was higher as compared to other group. There is no significant difference were seen in pre-treatment and after the 5th week in alignment and functional section in comparison of technique. Conclusion: With the help of neuromuscular electric stimulation, and Kinesio tape in combination with conventional physiotherapy enhance the sitting balance, in terms of alignment and function in children with spastic cerebral palsy.
 *Corresponding author: Jawad Tahir, Central Park Medical College, Lahore, Pakistan; Email: dr.jd2917@gmail.com
 Citation: Tahir J., S. Ahmad, A.A. Rana. 2021. The effects of neuromuscular electrical stimulation with and without Kinesio taping application on sitting balance among children having cerebral palsy. The Healer Journal of Physiotherapy and Rehabilitation Sciences, 1(2):41-49

Effects of Neuromuscular Electrical Stimulation with and without Kinesio Taping Application on Sitting Balance Among Children with Cerebral Palsy

Background: Children with spastic cerebral palsy often show difficulty to maintain posture and function, therefore displaying the weak sitting postural balance such as the flexed trunk. Objective: The study was designed to determine the effectiveness in terms of alignment and function with neuromuscular electric stimulation, Kinesio tape above the trunk muscles in combination with conventional physiotherapy for improving sitting balance in young children with spastic diplegic cerebral palsy that has presented with weak trunk control. Methods: In this randomized trial children aged between 5 to 12 years were involved in this study. Group A received electric stimulation and conventional physical therapy while group B received Kinesio tape, electric stimulation and conventional physiotherapy for 12 weeks, 3 alternate days per week. Data were collected at baseline, 5th and 10th week after the last session of the week. Sitting balance is evaluated by the seated postural control measurement score. Results: Significant differences were observed in both groups in the total score of seated postural control measurement alignment section (p<0.015) and functional section (p<0.01) after the 10th week; the change in group B was higher as compared to other group. There is no significant difference were seen in pre-treatment and after the 5th week in alignment and functional section in comparison of technique. Conclusion: With the help of neuromuscular electric stimulation, and Kinesio tape in combination with conventional physiotherapy enhance the sitting balance, in terms of alignment and function in children with spastic cerebral palsy.

Effects of Neuromuscular Electrical Stimulation on Plantarflexors Spasticity, Gait Performance, and Self-Reported Health Outcomes in People With Chronic Stroke: A Study Protocol for a Double-Blinded Randomized Clinical Trial.

Introduction: Rehabilitation approaches have been used for people with stroke to decrease spasticity and improve functions, but little is known about the effect of neuromuscular electrical stimulation (NMES) in this population. Therefore, the primary purpose of this study was to establish a protocol for a double-blinded randomized clinical trial to examine using NMES on plantarflexors spasticity, dorsiflexor muscle strength, physical functions, and self-reported health outcomes in people with chronic stroke in Saudi Arabia.Material and Methods: This randomized clinical trial with two arms and double-blinded registered in ClinicalTrials (NCT04673045) will enroll 44 participants with chronic stroke and randomized them into either the experimental group (EG), including electrical stimulation (ES) with conventional therapy or the control sham group (NMESsham) including placebo electrical stimulation with conventional therapy. The frequency will be set at 80 Hz for 30 min. The intervention will be three times a week for 4 weeks for both groups. Data collection for pre- and post-intervention outcomes will include measurements for the primary outcomes including paretic limb (plantarflexor spasticity, ankle range of motion, and dorsiflexor muscles strength), and gait speed using 10-m walk test (10-MWT). The secondary outcomes including mobility function using Timed Up and Go (TUG), walking endurance using 6 Minutes Walk Test (6-MWT), activity of daily living using the Arabic version of Barthel Index (BI), and self-reported health measures such as quality of life using the Medical Outcomes Survey (Short Form 36, SF-36), physical activity using Rapid Assessment of Physical Activity (RAPA), depression symptoms using Patient Health Questionnaire-9 (PHQ-9), fatigue level using Fatigue Severity Scale (FSS), and risk of fall using Fall Efficacy Scale International (FES-I). An independent t-test will be utilized to examine the effect of the intervention on the outcome measures.Results: The recruitment has started and is ongoing.Conclusions: Using 4 weeks of NMES will provide information about its effect in improving plantarflexor spasticity, dorsiflexor muscles strength, gait speed, mobility functions, and other self-reported health outcomes in people with chronic stroke when compared to NMESsham.

109 Effectiveness of Neuromuscular Electrical Stimulation for Children with Dysphagia: A Systematic Review

Abstract Primary Subject area Complex Care Background Dysphagia is common in children with medical complexity and can result in undernutrition, respiratory complications and negatively impact child and caregiver quality of life; however, evidence on the effectiveness of treatments for dysphagia in children is limited. Neuromuscular electrical stimulation (NMES) is a novel proposed treatment for dysphagia where electrical current is applied to neck muscles using cutaneous electrodes during swallowing therapy. It is hypothesized that NMES improves dysphagia by strengthening swallowing muscles and/or enhancing sensory signals of the swallowing response. Objectives To systematically review the evidence on the effectiveness of NMES for treatment of oropharyngeal dysphagia in children. Design/Methods MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL and Scopus databases were searched from inception to November 2020. Studies of children (18 years and younger) diagnosed with oropharyngeal dysphagia using NMES in the throat/neck region were included. Screening, data extraction, and risk of bias assessment followed PRISMA guidelines. Risk of bias was assessed using the Cochrane Collaboration’s tool for RCTs and the Newcastle-Ottawa tool for observational studies. [Registration: PROSPERO CRD42019147353] Results Of the 844 records screened, 26 were identified for full text review, and 8 studies were included (4 RCTs and 4 cohort studies). These studies represented 338 children, with a mean (or median) age below 7 years, including children with and without neurological impairments. In all studies, swallowing function as measured by imaging studies improved after NMES treatment; in the trials, the standardized mean difference ranged from 0.32 (95% CI -0.56, 1.20) to 1.18 (95% CI 0.40, 1.97) compared to control groups who received usual care without NMES. Seven of eight studies reported on the child’s feeding ability, and, with one exception, there was improvement in feeding ability (Figure 1). Few studies reported on health status (N=1), child’s quality of life (N=1), and adverse events and harms (N=1). No studies reported on the social impact on the child, impact on the caregiver, and the caregiver’s quality of life. In most studies, outcome follow-up was limited to less than 6 months. Overall, the studies demonstrated moderate to high risk of bias. A pooled intervention effect and meta-analysis was not conducted due to clinical heterogeneity. Conclusion NMES treatment may be beneficial in improving swallowing function for children with dysphagia, however, given the quality of the studies, inadequate outcome reporting, and short follow-up duration, additional well-designed RCTs are needed to establish its effectiveness.

Effects of neuromuscular electrical stimulation on functional capacity and quality of life among patients after cardiac surgery: A systematic review and meta-analysis

BackgroundNeuromuscular electrical stimulation (NMES) is a possible adjunctive therapy applied to cardiac surgery patients to improve physical function, but the results are still controversial. A systematic review and meta-analysis was conducted to investigate the effects of NMES on functional capacity and quality of life (QoL) in cardiac surgery patients. MethodsThe following databases PubMed, Embase, Medicine, CINAHL, and the Cochrane Central Register of Controlled Trials were searched for the English language from inception up to March 2021. A systematic targeted literature search evaluating the effects of NMES on physical function and QoL in cardiac surgery patients. The effect size of NMES was presented as the mean difference (MD)/standardized mean difference (SMD) and its 95% confidence interval using fixed/random effect models according to heterogeneity. Two reviewers independently screened and appraised each study by using the Cochrane Risk of Bias Tool. ResultsSix studies were included involving 400 cardiac surgery patients. The meta-analysis showed that NMES had effect on knee extensor strength (SMD=1.68; p=0.05), but had no effects on 6-minute walking distance (MD=44.08; p=0.22), walking speed (MD=0.05; p=0.24), grip strength (MD=3.01; p=0.39), or QoL (SMD=0.53; p=0.19). ConclusionsNMES use in cardiac surgery patients is limited by low to moderate quality. Existing evidence shows that NMES is safe and effective for improving knee extensor strength.

Meta-analysis of effects of neuromuscular electrical stimulation of lower limbs on patients with mechanical ventilation in intensive care unit

To evaluate the effect of lower limb neuromuscular electrical stimulation (NMES) on mechanical ventilation patients in intensive care unit (ICU). Databases including the Cochrane Library, PubMed, Web of Science, Embase, SinoMed, CNKI, VIP and Wanfang database were searched from inception to May 2021. Randomized controlled trails (RCT) about the influence of NMES of lower limbs in patients with mechanical ventilation in ICU were collected. Routine rehabilitation measures were implemented in the control group, while the combination of routine rehabilitation and NMES on the lower limbs was implemented in the observation group. The literature screening, data extracting, and bias risk assessment of included studies were conducted independently by two reviewers. RevMan 5.3 software was used to perform Meta-analysis. Funnel plot was used to test publication bias. A total of 8 RCT were eventually enrolled. The literature quality evaluation results showed that 1 study was grade A and 7 studies were grade B, suggesting that the quality of the included literature was relatively high. The Meta-analysis results showed that NMES in the lower extremities could effectively shorten the duration of mechanical ventilation in ICU patients [standardized mean difference (SMD) = -0.51, 95% confidence interval (95%CI) was -0.72 to -0.31, P < 0.000 01], increase the maximum inspiratory pressure [MIP; mean difference (MD) = 14.19, 95%CI was 9.30 to 19.09, P < 0.000 01], and improve the functional status of critically ill patients [functional status score for ICU (FSS-ICU); MD = 10.44, 95%CI was 3.12 to 17.77, P = 0.005] with statistically significances. However, there were no significant advantages in increasing the Medical Research Council (MRC) score (MD = 2.13, 95%CI was -1.38 to 5.63, P = 0.23), reducing ICU mortality [relative risk (RR) = 0.80, 95%CI was 0.51 to 1.24, P = 0.31], shortening length of ICU stay (MD = -0.54, 95%CI was -3.67 to 2.59, P = 0.74), and the combined effect was not statistically significant. Funnel plot based on the duration of mechanical ventilation showed that the distribution of included articles was basically symmetrical, and no publication bias was detected. NMES of the lower limbs can not only shorten the ventilation duration effectively, but also improve the MIP and functional status of mechanically ventilated patients in ICU. However, it has no significant effect on the MRC score, ICU mortality and length of ICU stay of patients with mechanical ventilation. In the future, high-quality, large sample size and multi-center RCT are needed to verify the effects of NMES.

The effects of neuromuscular electrical stimulation on strength, pain, and function in individuals with knee osteoarthritis: a systematic review with meta-analysis

ABSTRACT We aimed to investigate the effects of neuromuscular electrical stimulation on muscle strength, pain relief, and improvement in function in patients with knee osteoarthritis. Databases were searched from December 2017 to July 2020 and included PubMed, Embase, LILACS, and the Cochrane Central Register of Controlled Trials. A manual search was also performed by checking the reference lists of eligible articles. The PRISMA guidelines were followed. The studies selected compared NMES with an exercise program on isometric muscle strength as a primary outcome. The secondary outcomes were pain and function. The quality of the studies was assessed using the Risk of Bias assessment and PEDro scale, and the overall quality of the evidence was assessed using the GRADE approach. Eight studies were included in this systematic review. A total of 571 patients were analyzed. Neuromuscular electrical stimulation associated with exercise promoted an increase in isometric strength of the quadriceps muscle compared to the active control group, demonstrating heterogeneity and statistical difference (95% CI=1.16 to 5.10, I2=97%, p=0.002; very low-certainty evidence). NMES associated with exercise did not improve physical function (95% CI=−0.37 to 0.59, I2=0%, p=0.67; low-certainty evidence) and showed controversial results for pain compared to an active control group (qualitative assessment). In conclusion, NMES induces an increase in muscle strength in patients with osteoarthritis compared to an active control group. No differences were found for physical function and pain outcomes. Further research is needed due to the uncertain level of evidence.

Effectiveness of NMES and Taping on Diastasis Recti in Postnatal Women

The release of hormones like relaxin and estrogen occur during the gestational period and the fetal growth takes place which expands the uterus resulting in increased pressure against the abdominal wall. This causes stretching of the connective tissue, linea alba and as the weeks proceed the fetal growth occurs more and more rapidly resulting in further stretching of the connective tissue and the abdominal muscles causing an eventual decrease contraction strength weakening of muscles and can lead to a separation and widening of the space between the two rectus abdomen is muscles known as Diastasis of Recti Abdominis Muscles (DRAM). Diastasis recti is thus most common during pregnancy having a prevalence of 100% at gestational week 35 and can lead to various secondary problems like low back pain, shallow breathing and pelvic region pain. Though it is the most commonly occurring condition, it might not be painful in most cases initially and thus goes unnoticed and untreated. Purpose of the study was to compare the effects of NeuroMuscular Electrical Stimulation (NMES) and Kinesiotaping along with core stabilization exercises on diastasis recti in postnatal women, in terms of inter recti distance, abdominal muscle strength and low back pain. A total of 40 women with significant diastasis recti, 6 weeks postnatal, participated in the study. They were equally divided with random selection of 20 subjects in two groups each, Group A was treated with NMES and Group B received Kinesiotaping and both the groups in addition received core stabilization exercises. The results revealed very significant improvement in both the groups in all the measured parameters, (p&amp;lt;0.05). However, the intergroup comparisons showed significant improvement in all the measured parameters in group A (p&amp;lt;0.05). Thus, the study concluded that NMES along with core stabilization exercises is effective in recovery of diastasis recti and increasing abdominal muscle strengthas well as improvement in its complications like low back pain.

Does Neuromuscular Electrical Stimulation Have an Additive Effect on Disability, Pain and Abdominal and Lumbar Muscle Thickness in Chronic Low Back Pain? – A Randomized Controlled Double-Blind Study

Abstract Objective To examine the effect of neuromuscular electrical stimulation (NMES) combined with core stabilization exercises (CSE) in patients with chronic low back pain (CLBP). Methods Thirty-six patients (mean age 33.6±12.6 years) with CLBP were randomly assigned to 4 weeks (12 sessions) of NMES group (NMES combined with CSE) (n=18) vs. Control group (sham NMES and CSE) (n=18). After the 4 weeks, same exercises were given as home exercise program without NMES. The outcome measures were Oswestry Disability Index (ODI), Visual Analog Scale (VAS), Nottingham Health Profile (NHP) and ultrasonography. Ultrasonography was used for measuring transversus abdominis (TrA), internal oblique (IO), external oblique (EO) muscles thickness and lumbar multifidus muscle thickness and area. Assessments were performed at baseline and 4th week and eighth week follow-up. Results In both groups, the change of ODI, VAS and NHP values of the first measurement according to the values of the 4th week and the eighth week were found statistically significant (p=0.001; p&lt;0.01). There were no statistically significant differences in ODI, VAS and NHP scores between the 4th week and the eighth week in both groups (p&gt;0.05). None of NMES and control group measurements with US showed a statistically significant increase in the TrA, IO, EO thickness and multifidus thickness and area (p&gt;0.05). Conclusions It was shown that NMES can be tolerated by patients with CLBP, but the addition of simultaneus NMES to CSE had no contribution to the clinical outcome measures.

Effects of neuromuscular electrical stimulation on energy expenditure and postprandial metabolism in healthy men.

It is unclear whether neuromuscular electrical stimulation (NMES) has meaningful metabolic effects when users have the opportunity to self-select the intensity to one that can be comfortably tolerated. Nine healthy men aged 28 ± 9 y (mean ± SD) with a body mass index 22.3 ± 2.3 kg/m2 completed 3 trials involving a 2-h oral glucose tolerance test whilst, in a randomised counterbalanced order, (1) sitting motionless (SIT), (2) standing motionless (STAND); and (3) sitting motionless with NMES of quadriceps and calves at a self-selected tolerable intensity. The mean (95% confidence interval [CI]) total energy expenditure was greater in the NMES trial (221 [180-262] kcal/2 h) and STAND trial (178 [164-191] kcal/2 h) than during SIT (159 [150-167] kcal/2 h) (both, p < 0.05). This was primarily driven by an increase in carbohydrate oxidation in the NMES and STAND trials compared with the SIT trial (p < 0.05). Postprandial insulin iAUC was lower in both NMES and STAND compared with SIT (16.4 [7.7-25.1], 17 [7-27] and 22.6 [10.8-34.4] nmol·120 min/L, respectively; both, p < 0.05). Compared with sitting, both NMES and STAND increased energy expenditure and whole-body carbohydrate oxidation and reduced postprandial insulin concentrations in healthy men, with more pronounced effects seen with NMES. Self-selected NMES is a potential strategy for improving metabolic health. This trial is registered at ClinicalTrials.gov (ID: NCT04389736). Novelty: NMES at a comfortable intensity enhances energy expenditure and carbohydrate oxidation, and reduces postprandial insulinemia. Thus, self-selected NMES represents a potential strategy to improve metabolic health.

Effects of neuromuscular electrical stimulation on torque and performance in recreational distance runners: A randomized controlled trial

IntroductionNeuromuscular electrical stimulation (NMES) is used by athletes to improve muscle performance. However, evidence on the use of NMES in long distance runners is scarce. As such, this study aimed to evaluate the effects of NMES on the muscle torque and sports performance of long-distance recreational runners. MethodsThis was a blinded randomized controlled trial. Data from 30 volunteers were analyzed. Participants were randomly allocated to an experimental (n = 15) or control group (n = 15). The experimental group was submitted to running training (RT) and a strengthening protocol with NMES (1 kHz, modulated in 2 ms bursts, 50 Hz modulated burst frequency and 10% duty cycle, 15 min totaling 18 contractions per sessions) for 6 weeks, with 3 sessions per week, while controls were submitted to RT alone. The following variables were analyzed: peak isometric (ISO), concentric (CON), and eccentric (ECC) torque of the quadriceps muscle in voluntary contractions, ventilatory anaerobic thresholds (VATs), maximal oxygen uptake (VO2max), and oxygen cost of transport (OCT). ResultsThe NMES group obtained higher values of ISO, 21.04% (p = 0.001), CON, 21.97% (p = 0.001) and ECC, 18.74% (p = 0.001) peak torque and VAT1, 9.56% (p = 0.001), as well as a statistically significant improvement in oxygen cost of transport at VAT1 when compared to controls (p = 0.001). ConclusionNMES was effective in improving peak isometric, concentric and eccentric quadriceps muscle torque, in addition to being an interesting resource for enhancing sports performance in long-distance recreational runners and future clinical trials should be performed to compare the use of NMES to different forms of training over longer training periods.

Combined neuromuscular electrical stimulation with motor control exercise can improve lumbar multifidus activation in individuals with recurrent low back pain

Motor control exercise (MCE) is commonly prescribed for patients with low back pain. Although MCE can improve clinical outcomes, lumbar multifidus muscle (LM) activation remains unchanged. Neuromuscular electrical stimulation (NMES) can be used to re-activate motor units prior to MCE which should result in increased LM activation. Therefore, this study aimed to explore the immediate effects of NMES combined with MCE on LM activation and motor performance. Twenty-five participants without low back pain (NoLBP) and 35 participants with movement control impairment (MCI) were recruited. Participants with MCI were further randomized to combined NMES with MCE (COMB) or sham-NMES with MCE (MCE) group. Ultrasound imaging was used to measure LM thickness at rest, maximum voluntary isometric contraction (MVIC), and NMES with MVIC. These data were used to calculate LM activation. Quadruped rocking backward was used to represent motor performance. LM activation and motor performance were measured at baseline and after one-session of intervention. Results showed that both COMB and MCE groups had significantly lower (P < 0.05) LM activation compared with NoLBP group at baseline. Additionally, both COMB and MCE groups demonstrated significant improvement (P < 0.05) in motor performance while COMB group demonstrated significantly greater improvement (P < 0.05) in LM activation compared with MCE group. Individuals with MCI still have persisting LM activation deficit. Our key findings suggest that combined NMES and MCE may have better ability to improve LM activation in individuals with MCI. These findings would support the utility of NMES to induce a priming effect before MCE.

Effect of Neuromuscular Electrical Stimulation Combined with Traditional Dysphagia Rehabilitation on Masseter Muscle Thickness and Bite Force in Stroke with Dysphagia Patient

Effect of Neuromuscular Electrical Stimulation Combined with Traditional Dysphagia Rehabilitation on Masseter Muscle Thickness and Bite Force in Stroke with Dysphagia Patient

Neuromuscular Electrical Stimulation Improves Muscle Strength, Biomechanics of Movement, and Functional Mobility in Children With Chronic Neurological Disorders: A Systematic Review and Meta-Analysis.

Chronic neurological disorders (CNDs) generally produce deleterious effects on the musculoskeletal system and can affect physical activity and increase sedentary behavior in children, hindering the execution of training programs and the attainment of a correct dose of exercise. The purpose of this systematic review was to analyze the effect of neuromuscular electrical stimulation (NMES) on skeletal muscle and then on biomechanics of movement, functional mobility, strength, spasticity, muscle architecture, and body composition of children and adolescents with CNDs and chronic diseases. The search was conducted in April 2020 in PubMed, MEDLINE, Scopus, the Cochrane Library, and Web of Science, without publication period restriction. Publications investigating the effect of NMES on children and adolescents with CNDs and other chronic diseases were independently selected by 2 researchers. One author independently extracted data from the studies selected, and a second author cross-checked. Eighteen studies with 595 participants aged between 3 and 14years were included. Quality assessment showed that 50% of the studies presented a low risk of bias. The pooled effect of NMES on gross motor functional measure, calculated as a standardized mean difference using a random effects model, was 0.41 (95% CI = 0.19-0.64). The use of NMES programs for children diagnosed with cerebral palsy, spinal muscular atrophy, and obstetric injury of the brachial plexus was effective in improving muscle strength, biomechanics of movement, and functional mobility. NMES can be a useful tool to prevent the reduction of mobility that results from CNDs.

Effects of Neuromuscular Electrical Stimulation on Quadriceps Muscle Strength and Mass in Healthy Young and Older Adults: A Scoping Review.

Although neuromuscular electrical stimulation (NMES) has been used as a safe and relevant complement to voluntary resistance training, its effectiveness in increasing quadriceps femoris muscle strength and mass in healthy young and older adults has not been determined. The aim of this scoping review was to assess the effects of NMES on quadriceps muscle strength and mass in healthy young and older adults. CENTRAL, Pedro, MEDLINE, and PubMed were searched from inception to September 2019. Randomized controlled trials (RCTs) that compared NMES with control group or voluntary resistance training for healthy young and older adults were included. Study characteristics, primary and secondary outcome parameters, and details of the NMES intervention were extracted by 2 reviewers. Only studies for which full text was available in English were included. Thirty-two RCTs including 796 healthy participants were identified as being eligible for young adults, and 5 RCTs including 123 healthy participants were identified as being eligible for older adults. The available evidence strongly suggests that NMES improves quadriceps muscle strength compared with a control group in young adults, but its efficacy seems lower than that of voluntary resistance training. The available limited evidence regarding the effects of NMES on quadriceps muscle mass compared with control in young adults is inconclusive, with 3 RCTs showing positive effects and 3 RCTs not showing positive effects. The very limited available evidence from 5 RCTs in older adults suggests that NMES might be beneficial for increasing quadriceps muscle strength and mass. Overall, the evidence indicates that NMES is an efficacious method for increasing quadriceps muscle strength in young adults, whereas its impact on muscle mass requires further investigations. In addition, the effectiveness of NMES needs to be confirmed in older adults on the basis of more high-quality RCTs with larger sample sizes. This scoping review of 37 RCTs including 919 people is the first study, to the authors' knowledge, to show that the use of NMES increases quadriceps muscle strength in young adults and might improve quadriceps muscle strength compared with control interventions in older adults. In both young and older adults, the effects of NMES on quadriceps muscle mass are still unclear.

Assessment of Changes in Laryngeal Configuration and Voice Parameters Among Different Frequencies of Neuromuscular Electrical Stimulation (NMES) and Cumulative Effects of NMES in a Normophonic Subject: A Pilot Study

Neuromuscular electrical stimulation (NMES) is a complementary resource to voice therapy that can be used for the treatment of hypofunctional voice disorders. Although positive clinical studies have been reported, neutral and even potentially harmful effects of NMES are also described in the literature. Furthermore, in the studies examined by the authors, the use of different methods of NMES have been identified, which further contributes to the inconsistent results found among studies. Moreover, limited rationale is provided for the chosen NMES parameters such as electrode placement, frequency of NMES and length of treatment. The aims of this pilot study were to investigate the a) impact of different frequencies of NMES on glottal configuration and vocal fold vibration patterns and b) changes in laryngeal configuration and vocal output across 12 minutes of NMES. Three experiments were carried out looking at changes in laryngeal configuration and voice output using different imaging techniques (fibreoptic nasolaryngoscopy and high-speed video), acoustical analysis (F0, formant analysis, SPL, CPPS and LHSR values), electroglottography (EGG) and Relative Fundamental Frequency (RFF) analyses. Glottal parameters and acoustical measures were recorded before, during, and after stimulation. Data was collected at rest and during phonation. Overall the results showed global changes in laryngeal configuration from normal to hyperfunctional (ie, increased RFF, SPL, CQ, and stiffness). Changes were more pronounced for lower frequencies of NMES and were significant within less than three minutes of application. NMES is an effective resource for the activation of intrinsic laryngeal muscles producing significant levels of adduction within few minutes of application. Lower NMES frequencies produced greater muscle activation when compared to higher frequencies.

The Combined Effect of Neuromuscular Electrical Stimulation and Insulin Therapy on Glycated Hemoglobin Concentrations, Lipid Profiles and Hemodynamic Parameters in Patients with Type-2-Diabetes and Hemiplegia Related to Ischemic Stroke: A Pilot Study.

Type-2-diabetes mellitus (T2DM) is a global problem of medical, social and economic consequences. Physical activity is a vital therapy in patients with T2DM, but some of them cannot exercise for various reasons. The purpose of our pilot study was to determine whether a combination of neuromuscular electrostimulation (NMES) and insulin therapy could improve the management of T2DM patients with hemiplegia caused by an ischemic stroke. Fifteen immobile patients with T2DM on insulin therapy were enrolled in the study. NMES was applied to their lower limbs for 60 min, 5 days a week, over a period of 12 weeks. The intervention caused statistically significant reductions in the blood concentrations of glycated hemoglobin, total cholesterol and low-density cholesterol in the participants. Furthermore, systolic and diastolic blood pressure levels were significantly lower. More randomized clinical trials are needed to accurately measure the effect of NMES on T2DM treatment and to determine whether it can be an alternative for physical activity for immobile patients with T2DM.

Combined Effect of Proprioceptive Neuromuscular Facilitation And Electrical Muscle Stimulation In Hemiplegic Stroke Patients To Enhance Upper Extremity Function: A Research Protocol

Background- : Stoke is characterized as rapid clinical signs of focal (or global) impairment of brainfunction, with symptoms that last longer than one day or lead to death, with no other apparent cause thanvascular origin. Globally, Cerebrovascular(CVE)damage is the second-biggest root cause of death and thethird-largest cause of disability. This is 1 in 19 deaths. Stroke is a significant source of injury in the longterm and is more disabled than fatal. This protocol has been created that describes the design of experimentalstudy to evaluate the combined effect of Neuromuscular Electrical Stimulation(NMES) with ProprioceptiveNeuromuscular Facilitation(PNF) to enhance the upper- extremity functions in hemiplegic stroke patients.Methods-The participants (n=26) will be recruited in the study suffering from stroke and meeting theinclusion criteria. Two groups will be formed such that patients in group A will be treated with conventionaltherapy and PNF group B will be treated with PNF and NMES in alongwith conventional therapy. Theprotocol will cover 6 weeks of treatment. Regular assessment at 0,3rdand 6th week will be carried out.In the rehabilitation period, we will evaluate upper extremity function, activities of daily living(ADLs),mental status examination at regular interval during the rehab.Our outcome measures will be- Glasgowcoma scale (GCS), Mini-Mental Scale Examination (MMSE), Modified Ashworth Scale (MAS), ModifiedBarthelIndex(MBI) and Action Research Arm Test(ARAT).Discussion-Efficacy of the intervention will be evaluated by analyzing the upper extremity function usingAction Research Arm Test (ARAT) and level of disability by using Modified Barthel Index Scale. The resultof the study will significantly provide affirmation on using combination therapy of PNF with NMES instroke patients

Effect of neuromuscular electrical stimulation associated with swallowing-related muscle training for post-stroke dysphagia: A protocol for systematic review and meta-analysis.

Background:Swallowing dysfunction is a common dysfunction after stroke, and its incidence exceeds 50%. Aspiration pneumonia and malnutrition induced by dysphagia not only cause psychological shock to patients after stroke, but also burden the medical payment. Neuromuscular electrical stimulation, which stimulates the cortex and cortical bulb pathways to improve swallowing function, has been one of the emerging treatments for the post-stroke deglutition disorder. These therapy operators require the proficiency in professional knowledge, limiting clinical large sample studies, so there is an absence of evidence-based medicine. The research is to evaluate the effectiveness of neuromuscular electrical stimulations combined with swallowing-related muscle training to treat swallowing dysfunction after stroke.Methods:Computer retrieval performed in the 9 databases, including PubMed, Embase, Web of science, Cochrane Library, ClinicalTrials, China Biomedical Literature Database (CBM), China Knowledge Network Database (CNKI), Wanfang Database (WanFang), and China VIP Database (VIP). Taking the published literature from the establishment of the database until December 20, 2020. Literature searching is related to neuromuscular electrical stimulation randomized controlled trials on the effect of swallowing in stroke. In addition, we will do the manual search in Baidu Academic and Google Academic database as a supplementary search. The correlative randomized controlled clinical studies retrieval time range from the establishment of the database to December 20, 2020. Two investigators will screen the literature according to the inclusion and exclusion criteria independently, during that period they will evaluate the quality of the included studies and extract data from studies. The extracted data are dichotomous data will be represented by relative risk, continuous data will be represented by mean difference or standard mean deviation. If there exists heterogeneity and the final data summary analysis select random effect model. On the contrary, the fixed effect model is selected. Then, RevMan5.3 software was used when analyzing included literature. Meanwhile, the analysis results were illustrated by drawing.Results:This review will summarize available trials aimed at providing a comprehensive estimation of effectiveness of neuromuscular electrical stimulation associated with swallowing muscle training for post-stroke dysphagia.Conclusion:This review based on a comprehensive analysis of currently published randomized controlled trials on post-stroke dysphagia, that provide reliable evidence-based medicine evidence for the efficacy of neuromuscular electrical stimulation associated with swallowing rehabilitation training.Registration number:INPLASY202110009.