Neuromuscular Electrical Stimulation (NMES)

 Dirks et al (2014) states that injured patients are advised by doctors to take a bed rest or undergo limb immobilization. However, patients may develop disuse atrophy (a condition where muscles become weaker and decreases in size). In this condition, the functional capacity of skeletal muscle is reduced, muscle becomes weak and the rate of basal metabolic reduces (Dirks et al, 2014). The author asserts that muscle protein synthesis and the rates of breakdown are not balanced and this result to the muscle atrophy. Long term or short term period of hospitalization or rehabilitation is measured by the condition of disuse atrophy. The imbalance causes impairments and the solution to this is only to apply physical activities during muscle disuse (Dirks et al, 2014). However, it is not possible to have a physical activity in clinical situations and so the only thing to do in order to alleviate muscle disuse is to use neuromuscular electrical stimulation.

Dirks et al (2014) asserts that NMES allows muscle contraction and habitual physical activity. To demonstrate the effectiveness of NMES in increasing muscle contraction, an isotope methodology was used. Before conducting the study, it had been noticed that NMES is responsible in maintaining the rates of muscle protein synthesis in patients with tibia fracture and skeletal muscle function. The study presented in this article was conducted to investigate whether NMES alleviates the disuse atrophy.  In the study, 24 men were presented and immobilization of one-legged knee in 5 days was conducted. The overall results showed that application of NMES in the short period of muscle disuse prevented muscle atrophy and it was also found that muscle atrophy can be prevented in a long-term period if NMES is applied daily.  From the study, it is found that NMES acts as an interventional strategy in preventing muscle loss and strengthening muscle protein synthesis (Dirks et al, 2014). The study was also used to investigate whether muscle disuse which occurs in a short period can be alleviated with daily use of NMES.  Remarkably, daily application of NMES prevented disuse atrophy. Generally, disuse atrophy causes muscle weakening, reduces functional capacity. The rapid changes are as a result of neuromuscular deconditioning. NMES is effective not only in increasing muscle strength but also it plays role in myocellura mechanisms where it maintain muscle satellite cells and muscle mass (Dirks et al, 2014).

 

Nuerogenic dysphasia occurs when nervous system is damaged, and damage may cause brain tumor, brain injury and more. Patient with this disease is unable to swallow and there are serious complications. If the disease is recognized earlier and managed, the complication can be prevented (Salvatore et al, 2016). The purpose of this article is to examine whether NMES is effective in treating Nuerogenic dysphasia.  In the study, Vitalstim is examined whether it is responsible in functional recovery. Note that VitalStim is a tool is a NMES and in this case, the tool is used in functional exercise in dysphasia therapy.

 In addition, NMES has electrical stimuli and the electrodes are responsible in supporting muscle strength and prevent muscle atrophy (Salvatore et al, 2016). In the study, a managed 34 has chronic dysphasia which occurred after suffering from brain injury. To evaluate the effectiveness of NMES, the man was treated by using Vitalstim. The man had suffered from behavioral impairments for 3 months and he had taken intensive Neurorehabilitation treatment.  The condition had resulted to severe dysphasia and he used nasogastric tube in swallowing.  Before using Vitalstim device, the patient had undergone a conventional therapy but he did not improve from the condition. Then, the patient was treated using Vitalstim device and after 6-week period, there was a remarkable improvement. The patient could swallow even solid food safely and without complications (Salvatore et al, 2016).

 

 The overall results show that Traumatic Brain Injury caused Nuerogenic Dysphasia and NMES was effective in treating the problem. This means that NMES has nueroplastic changes and neurophysiologic approach. Vitalstim assisted in conventional therapy and there was no side effect. The devise had a positive effect in treating dysphasia (Salvatore et al, 2016). The neuroplastic change in NMES was effective in swallowing function by acting in peripheral effects. Noteworthy, NMES focused on cortical brain areas and offered rehabilitation protocol. An important point to note is that Vitalstim therapy is an effective treatment and it is a non-invasive and electrical stimulation which helps patients in swallowing (Salvatore et al, 2016).

 

William and Flynn (2014) assert that critical ill people are likely to face risk in life due to muscle wasting, muscle weakness and reduced physical functions. However, NMES can act as an active exercise and help the patients recover from illness. Many hospitals use Intensive care unit acquired weakness (ICU-AW) and there are risks associated with this in that patients can develop multi-organ failure, immobility, corticosteroids and so forth.  The prolonged hospitalization can also lead to muscle weakness, reduction in physical function and other psychological issues (Williams & Flynn, 2014). The effects affects life as patient cannot engage in social functioning or return to normal quality of life.

Neuromuscular electrical stimulation (NMES) is an important method which has been used in treating critically ill persons and positive results have been encountered.  It is an effective method and various studies have confirmed that NMES prevents muscle wasting, maintain skeletal muscles, restore muscle function, improve exercise tolerance and so forth (Williams & Flynn, 2014). All these evidences are an indication that NMES can also be capable in treating critically ill people. The purpose of the study in this article is to evaluation whether NMES can be effective in patients who are critically ill.

In the study, a review method on database searches was used. Searches were done from Cochraine Library, PEDro and other database. The researchers used key terms as such as electrical stimulation, critically ill and so forth. In research, researchers concentrated on evaluating whether NMES is effective in treating critically ill patients. The systematic evaluation and a narrative approach were   used to make the conclusion.  All studies in the review had different outcomes related with NMES. In the review, one study showed that NMES caused a reduction in the 3-mythel histidine excretion and reduced muscle protein. Another study reported that there was an increase in blood pressure and reperfusion rates.  Other five studies reported a change on muscle mass and muscle strength (Williams & Flynn, 2014). Generally, all studies showed that NMES is a safe procedure and it is associated with potentials benefits in patients who are critically ill. This is evidence from the several studies which reported that patients developed muscle strength and reduced mechanical ventilation. The important point to note is that though patients in ICU alleviate acute disease; there are long-term complications such as muscular weakness and more (Williams & Flynn, 2014). However, the dysfunction is treated either by using NMES or other techniques. NMES has a beneficial response and satisfactory results in critically ill patients due to its well tolerated intervention.  Some of the beneficial response includes muscle strength and functionality.

 

Reference

Dirks, M. L., Wall, B. T., Snijders, T., Ottenbros, C. P., Verdijk, L. B., & Loon, L. C. (2014). Neuromuscular

electrical stimulation prevents muscle disuse atrophy during leg immobilization in humans. Acta

Physiologica, 210(3), 628-641. doi:10.1111/apha.12200

 

Salvatore Calabrò, R., Nibali, V. C., Naro, A., Floridia, D., Pizzimenti, M., Salmeri, L., & ... Bramanti, P.

(2016). Is non-invasive neuromuscular electrical stimulation effective in severe chronic

neurogenic dysphagia? Report on a post-traumatic brain injury patient.

Neurorehabilitation, 38(1), 53-57. doi:10.3233/NRE-151295

 

Williams, N., & Flynn, M. (2014). A review of the efficacy of neuromuscular electrical stimulation in

critically ill patients. Physiotherapy Theory & Practice, 30(1), 6-11.

doi:10.3109/09593985.2013.811567