The Clinical Use of Neuromuscular Electrical Stimulation for Neuromuscular Rehabilitation: What Are We Overlooking?

Publication date: Available online 9 December 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Nicola A. Maffiuletti, Julien Gondin, Nicolas Place, Jennifer Stevens-Lapsley, Isabelle Vivodtzev, Marco A. Minetto
The clinical success of neuromuscular electrical stimulation (NMES) for neuromuscular rehabilitation is greatly compromised by the poor consideration of different physiological and methodological issues that are not always obvious for the clinicians. Therefore, the aim of this narrative review is to re-examine some of these fundamental aspects of NMES using a tripartite model perspective. First, we contend that NMES does not actually bypass the central nervous system but results in a multitude of neurally-mediated responses that contribute substantially to force generation and may engender neural adaptations. Second, we argue that too much emphasis is generally placed on externally-controllable stimulation parameters, while the major determinant of NMES effectiveness is the intrinsically-determined muscle tension generated by the current (i.e., evoked force). Third, we believe that a more systematic approach to NMES therapy is required in the clinic, and this implies a better identification of the patient-specific impairment and of the potential "responders" to NMES therapy. Based on these considerations, we suggest that the crucial steps for ensuring the clinical effectiveness of a NMES treatment should consist of: (1) identifying the neuromuscular impairment with clinical assessment; (2) implementing algorithm-based NMES therapy while (3) properly dosing the treatment with tension-controlled NMES and eventually amplifying its neural effects.



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