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Critical Reviews™ in Physical and Rehabilitation Medicine

ISSN for PRINT: 0896-2960

Institutional price:	$684.00
Issues per year:	4

2002, Volume14

82 pages

Issue price - $163.00

Neuromuscular Stimulation for Treating Shoulder Dysfunction in Hemiplegia

David Yu, M.D.
Dept.of Rehabilitation Medicine,University of Washington; Harborview Medical Center,Seattle,WA;Center for Physical Medicine and Rehabilitation,Case Western Reserve University,Dept.of Orthopedics,MetroHealth Medical Center,Cleveland,OH

John Chae, M.D.
Center for Physical Medicine and Rehabilitation, Case Western Reserve University, and Department of Physical Medicine and Rehabilitation, Rehabilitation Engineering Center, Department of Orthopedics, Metrohealth Medical Center, Cleveland, OH

ABSTRACT

This article is a critical review of neuromuscular electrical stimulation (NMES) for treating shoulder dysfunction in hemiplegia. The primary clinical benefits of NMES are reduction of shoulder subluxation and pain. The secondary clinical benefits include augmentation of motor and functional recovery. Two methods of delivering NMES to the hemiplegic shoulder have been reported. Several randomized, controlled trials of transcutaneous NMES (i.e., current delivered by surface electrodes) and one pretest-posttest trial of percutaneous, intramuscular NMES for treating shoulder dysfunction in hemiplegia are reviewed. The pathogenesis of shoulder pain in hemiplegia is not well understood. Many factors potentially contribute to the development of shoulder pain, including shoulder subluxation. However, the relation between subluxation and pain remains controversial. Potential causes of shoulder pain in hemiplegia are reviewed, including the potential role of early subluxation in the pathogenesis of other types of shoulder pathology. Further work is needed to elucidate the pathogenesis of shoulder pain in hemiplegia, to develop valid measures of clinically relevant outcomes, and to maximize the clinical benefits of NMES. NMES is a promising treatment for shoulder dysfunction in hemiplegia. Further evaluation is warranted.