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Critical Reviews™ in Physical and Rehabilitation Medicine

ISSN for PRINT: 0896-2960

Institutional price:	$684.00
Issues per year:	4

Best Paper Award Selection - Editorial Board Site

1999, Volume11

208 pages

Issue price - $326.00

Neuromuscular Stimulation for Motor Relearning in Hemiplegia

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

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

ABSTRACT

The evolving basic science and clinical evidence support the use of active repetitive movement training to maximize motor relearning after stroke. However, because of the severity of hemiplegia among many stroke survivors and the changing health care environment that emphasizes compensatory strategies active repetitive movement training remains outside the realm of standard rehabilitation interventions. A potential solution is the use of neuromuscular stimulation mediated active repetitive movement training. Randomized clinical studies support the use of surface cyclic neuromuscular stimulation to facilitate the motor recovery of acute and chronic stroke survivors. Electromyography (EMG) triggered neuromuscular stimulation may be more effective in view of the coupling of intent with muscular contraction and afferent feedback, although there are fewer clinical studies. The evolving data support the use of neuromuscular stimulation for motor recovery for stroke survivors. Unfortunately, published reports to date suffer from significant methodological deficiencies, including small sample sizes and limitation of outcomes to motor impairment. Thus, prior to the formulation of broad recommendations on the use of neuromuscular stimulation for motor relearning, large, multicenter, randomized, double-blinded, placebo-controlled studies should be carried out with short- and long-term assessments of motor impairment, physical activity, societal participation, and quality of life.