History of NMES
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NMES has been used to improve muscle function in the medical field for centuries. |
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Primarily used by physical therapists. |
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There is a lack of research on the efficacy of electrical stimulation for the improvement of swallowing, there is however, sufficient research supporting the efficacy of electrical stimulation to improve muscle function. |
Other terminology sometimes mistaken for NMES, (Freed, 2001)
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Electrical Muscle Stimulation (EMS) – electrical stimulation that helps improve denervated muscles in the absence of peripheral innervation. |
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Functional Electrical Stimulation (FES) – electrical stimulation used for helping with functional activities (eg. Gait) |
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Transcutaneous Electrical Nerve Stimulation (TENS) – use of electrical stimulation for pain management. |
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These terms are often used interchangeably for NMES, but they are not the same. |
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CVA, TIA |
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Neurological degenerative diseases or syndromes |
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Muscular disorders |
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Drug toxicity |
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Head injuries |
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Head/neck cancer |
Benefits of NMES
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Improves swallowing
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Improves quality of life
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Decreases health care costs (reduced amount of therapy and
hospitalization)
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Improves nutrition
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Avoid surgical placement of PEG
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Reduces risk of aspiration
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USE of NMES is Contraindicated
in patients with: (Freed, 2001)
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Cardiac pacemakers |
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Patients that are severely demented due to their inability to follow directions and constant verbalization |
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Patients with significant reflux due to a feeding tube |
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Patients with dysphagia due to drug toxicity |
Neuromuscular Treatments on
Swallowing: a Tutorial
Three main categories are reviewed: Active exercises, Passive exercises
and Physical agent modalities.
The point of Neuromuscular treatment is to strengthen and tone muscles that are weakened. The clinician must be knowledgeable of the principles of strength training and must know their patient in order to execute these exercises effectively. The article gave a good overview).
Neuromuscular electrical stimulation was addressed of the principles of strength
training and a helpful table of methods that are used effectively to target
impairment (i.e. weakness, hypertonicity, muscle spasm in this article. Freed,
Freed, Chatburn and Christian, (2001) report that NMES is different from
Neuromuscular treatment in that carryover to volitional movement may be limited.
Electrical stimulation might best be reserved for those patients who cannot
produce volitional movements. In speech or swallowing therapy, limited
information is available as to the benefits for improving strength of the
swallowing mechanism.
What are the Pros and Cons of Neuromuscular
Electrical Stimulation?
Cons-With Neuromuscular Electrical Stimulation of the functioning that was gained, carryover of that gained functioning may not be as much as compared to the carryover of active exercises.
Neuromuscular Electrical Stimulation increases an individual’s fatigue. It also is not recommended for individuals that fatigue has a negative impact on their neuromuscular condition.
Pros-When Neuromuscular Electrical Stimulation is paired with resistance training and functional activities, the outcome is positive.
Neuromuscular Electrical Stimulation has been found to be effective in the rehabilitation of individuals that have suffered spinal cord injury.
It has been shown to be effective when individuals possess a system of nerves and muscles that are not deviant, but rather intact and that due to brain injury they have lost control of their movement.
What does Research say about
Neuromuscular Electrical Stimulation?
There has been limited information concerning research of Neuromuscular Electrical Stimulation and its affect on the various oral, pharyngeal and laryngeal muscles. With this limitation of information it is difficult to determine if Neuromuscular Electrical Stimulation is beneficial for the muscles involved in speech and swallowing.
Current Research:
According to Humbert & Ludlow, research is currently being conducted by researchers in the Laryngeal and Speech Section of the National Institute of Neurological Disorders and Stroke of the National Institutes of Health to determine the "Feasibility of Neuromuscular Stimulation for Laryngeal Elevation During Swallowing" (Humbert & Ludlow, 2004). The research will also look at whether or not the laryngeal elevation will help to open the upper esophageal sphincter during swallowing.
According to Humbert & Ludlow, the outcome of this study could help with the development of a prosthesis that could be implanted and provide the needed stimulation to help with elevation of the larynx during swallowing.
Previous Research:
It has been studied that a neuromuscular prosthesis implanted into the laryngeal area is stable and is functional for 1.5 years with limited injury to the tissue (as cited in Humbert & Ludlow, 2004).
The National Institute of Neurological Disorders and Stroke, Laryngeal and Speech Section found that Neuromuscular Stimulation can be utilized for several different functions. It can be utilized to open an individual’s airway. It can be utilized in individuals with abductor spasmodic dysphonia to close the vocal folds and help with voice break reduction. It can also be utilized to help with laryngeal elevation (Humbert & Ludlow, 2004).