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Electrical Stimulation And Range Of Motion: References
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Bajd T., Kralj A., Stefancic
M., and Lavrac N. (1999) Use of functional electrical stimulation in the lower
extremities of incomplete spinal cord injured patients. Artif. Organs 23,
403-409.
Abstract: After a program of therapeutic electrical stimulation, 3 groups of
incomplete spinal cord injured (SCI) patients were identified, those in whom an
improvement of both voluntary and stimulated muscle force was observed, those
with an increase in stimulation response only, and patients in whom no effect of
electrical stimulation training could be recorded. As it is difficult to predict
the outcome of the electrical stimulation rehabilitation process, a diagnostic
procedure was developed to predict soon after accidents which incomplete SCI
patients are candidates for permanent use of a functional electrical stimulation
(FES) orthotic aid. The candidates for chronic use of FES are patients with weak
ankle dorsiflexors and sufficiently strong knee extensors. These patients are
equipped with a single channel peroneal stimulator augmenting dorsiflexion and
knee and hip flexion in a total lower limb flexion response. By applying FES to
the ankle plantar flexors, the swing phase of walking can be significantly
shortened and faster walking obtained
Bajd T., Munih M., and Kralj A.
(1999) Problems associated with FES-standing in paraplegia. Technol. Health Care
7, 301-308.
Abstract: Prolonged immobilization, such as occurs after the spinal cord injury
(SCI), results in several physiological problems. It has been demonstrated that
the standing posture can ameliorate many of these problems. Standing exercise
can be efficiently performed by the help of functional electrical stimulation
(FES). The first application of FES to a paraplegic patient was reported by
Kantrowitz in 1963. It was later shown by our group that standing for
therapeutic purposes can be achieved by a minimum of two channels of FES
delivered to both knee extensors. The properties of the stimulated knee
extensors (maximal isometric joint torque, fatiguing, and spasticity) were not
found as sufficient conditions for efficient standing exercise. According to our
studies, the ankle joint torque during standing is the only parameter which is
well correlated to the duration of FES assisted standing. For good standing low
values of the ankle joint torque are required. To minimize the ankle joint
torque the lever belonging to the vertical reaction force must be decreased.
Adequate alignment of the posture appears to be the prerequisite for efficient
FES assisted and arm supported standing exercise. Some patients are able to
assume such posture by themselves, while many must be aided by additional
measures. At present, surface stimulation of knee extensors combined with some
appropriately "compliant shoes" looks to be adequate choice
Bajuk S., Jelnikar T., and
Ortar M. (1996) Rehabilitation of patient with brachial plexus lesion and break
in axillary artery. Case study. J. Hand Ther. 9, 399-403.
Abstract: This paper describes the physiotherapy and occupational therapy used
in treating a 74-year-old woman with a left brachial plexus lesion, a break in
the axillary artery, dislocation of the acromioclavicular joint, a broken
scapula and clavicula, serial left rib fractures, and lacerations on the upper
and lower arm. After testing the patient, the following goals were set: reduce
pain, soften scar tissue, and improve joint motion, muscle strength, and
functionality of the hand. A 12- month outpatient program was used. Various
analgesics were used to reduce pain, and a special aid was made to unweight the
shoulder and elbow joints. Physiotherapy included kinesiotherapy, audiovisual
biofeedback, electrical stimulation, friction massage, and lymph drainage.
Occupational therapy included active functional exercises and re-education. As a
result of this program, the patient no longer had pain, passive range of motion
was close to normal, active motion where present was improved, swelling was
reduced, and the hand became functional again. Complex physiotherapy,
occupational therapy, and the patient's motivation resulted in the
rehabilitation of severe trauma of the hand
Baker L.L., Yeh C., Wilson D.,
and Waters R.L. (1979) Electrical stimulation of wrist and fingers for
hemiplegic patients. Phys. Ther. 59, 1495-1499.
Abstract: Passive cyclical electrical stimulation was applied during a four-week
treatment program to the wrist and finger extensors of 16 hemiplegic patients
with flexor spasticity. The study noted the effects of this treatment on the
patients' sensation; spasticity; passive range of motion of the wrist,
metacarpophalangeal, and proximal interphalangeal joints; and strength in the
wrist extensor muscles. Patients were divided into chronic and subacute groups.
Both groups received electrical stimulation for three half-hour periods a day,
seven days a week, as a substitute for all other range-of-motion techniques.
Flexion contractures were prevented in the subacute group of patients at the
wrist, metacarpophalangeal, and proximal interphalangeal joints. A statistically
and clinically significant increase in wrist extension range occurred in the
chronic group that had wrist flexion contractures before the electrical
stimulation. Increased extension was noted at the metacarpophalangeal and
proximal interphalangeal joints of patients in the chronic group. Those patients
with some voluntary wrist extension before the treatment began were able to
increase their extension strength during stimulation. No changes in skin
sensation were noted and only a general trend in decreasing spasticity was
apparent
Baker L.L., Parker K., and
Sanderson D. (1983) Neuromuscular electrical stimulation for the head-injured
patient. Phys. Ther. 63, 1967-1974.
Abstract: Recent research has shown that electrical stimulation is effective in
treatment programs designed to maintain or gain range of motion, to facilitate
voluntary motor control, and to strengthen muscles weakened by disuse. All of
these treatment goals are relevant to the head- injured patient who frequently
demonstrates profound disuse atrophy, joint contractures with excessive muscle
tone, and decreased voluntary motor capabilities. As the cognitive status of the
head-injured patient improves, electrical stimulation can be incorporated into
traditional treatment programs to enhance their effectiveness. This article
discusses using neuromuscular electrical stimulation with programs aimed at
managing contractures, reducing spasticity, and facilitating voluntary motion.
The limitations of electrical stimulation in the head- injured patient
population are addressed
Baker L.L. and Parker K. (1986)
Neuromuscular electrical stimulation of the muscles surrounding the shoulder.
Phys. Ther. 66, 1930-1937.
Abstract: Neuromuscular electrical stimulation (NMES) can be used to augment
range-of-motion, strengthening, and facilitation treatment programs of the
muscles surrounding the shoulder. The purposes of this article are 1) to
describe the uses of NMES around the shoulder joint as developed through our
clinical use and 2) to detail the effects of an NMES program on chronic shoulder
subluxation as determined by a clinical study. Because of the complexities of
this multiarticular joint, NMES is most useful in the initial phase of the ROM,
and stimulated contractions are compromised, relatively, as the humerus moves
above the 90-degree horizontal plane. The use of NMES to provide scapular
stabilization often entails unwanted alteration of the pressures on the spinal
column, occasionally making the treatment program unusable. Electrical
stimulation to prevent or correct shoulder subluxation, especially in the
neurologically involved patient, provides the therapist with a powerful new
treatment technique. In a group of stroke patients, shoulder subluxation was
reduced significantly (p less than .05) at the completion of a six-week NMES
program. Some of the problems, and possible solutions, unique to the development
of electrical stimulation programs for the shoulder muscles are discussed
Bilko T.E., Paulos L.E., Feagin
J.A., Jr., Lambert K.L., and Cunningham H.R. (1986) Current trends in repair and
rehabilitation of complete (acute) anterior cruciate ligament injuries. Analysis
of 1984 questionnaire completed by ACL Study Group. Am. J. Sports Med. 14,
143-147.
Abstract: Results of a 21 question survey, taken at the ACL Study Group meeting
in 1984, present a composite picture of current practices in ACL reconstruction
and rehabilitation. Forty-four of the 50 questionnaires were returned. Responses
represented views from knee surgeons in the United States, Canada, Australia,
Sweden, and Switzerland. These results were compared with a report of a 1980
international survey in which views of 40 knee experts from the United States,
Canada, England, France, and Sweden were summarized. Questions on the two
surveys were similar, particularly about rehabilitation. Although the time span
between the two surveys was only 4 years, we can see both consistencies and
changes. Responses about length of time between ACL repair and full range of
motion (by 6 months) were essentially the same (88% in 1980, and 86.4% in 1984).
However, changes were evident in length of immobilization (longer in 1980) and
prescribing isometric contractions of quadriceps 1st week postoperatively (more
frequently in 1980). Surgeons allowed patients to return to full activity sooner
in 1980 than in 1984. Electrical stimulation was being used more frequently in
1984, and apparently the practice of simultaneous hamstring and quadriceps
contraction has come into prominence since 1980 as it was not mentioned in the
first survey. In 1984, 50% of the respondents indicated they prescribed it.
Since standardized reporting systems are not established, we cannot do reliable
statistical analyses on large samples. At the present time, making surveys with
responses from similar groups every few years is the best available way to
capture trends in treatment of ACL injuries
Bowman B.R., Baker L.L., and
Waters R.L. (1979) Positional feedback and electrical stimulation: an automated
treatment for the hemiplegic wrist. Arch. Phys. Med. Rehabil. 60, 497-502.
Abstract: Positional feedback (PF) and electrical stimulation were combined in a
new treatment modality for facilitating wrist extension in stroke patients.
Thirty adult hemiparetic patients lacking normal voluntary wrist extension were
randomly placed in control and study groups. The control group received
conventional therapy while the study group received positional feedback
stimulation training (PFST) in addition to conventional treatment. At the end of
the 4-week program, study patients showed a 280% increase in isometric extension
torque when the wrist was positioned in 30 degrees of extension and 70% increase
when positioned in 30 degrees of flexion. Control patients showed no significant
changes in torque. Study patients made an average 200% gain in selective range
of motion over their starting levels while controls made only a 50% increase.
Treatment using automated PFST equipment allows controlled repetitive isotonic
exercise and facilitation of wrist extension without continuous one-on-one
therapist/patient supervision
Bremner L.A., Sloan K.E., Day
R.E., Scull E.R., and Ackland T. (1992) A clinical exercise system for
paraplegics using functional electrical stimulation. Paraplegia 30, 647-655.
Abstract: A low cost clinical exercise system was developed for the spinal cord
injured, based on a bicycle ergometer and electrical stimulation. A pilot
project was conducted, using the system, to examine the effects of stimulation
induced cycling in long term paraplegics. The project comprised 2 phases of
exercise, a strengthening phase involving a 12 week programme of electrical
stimulation to the quadriceps and hamstrings and a 12 week cycling phase.
Physiological, morphological and biochemical parameters were measured for each
subject, at the beginning of the programme and following each phase. Results
showed that a programme of stimulation induced lower limb exercise increased the
exercise tolerance of all patients, as determined by a progressive increase in
exercise time, cycling rate and exercise load. The enhanced exercise tolerance
was a result of increases in local muscle strength and endurance. Increases in
thigh muscle area and joint range of motion were recorded and all incomplete
subjects reported an improvement in functional capabilities and general
wellbeing
Bryden A.M., Memberg W.D., and
Crago P.E. (2000) Electrically stimulated elbow extension in persons with C5/C6
tetraplegia: a functional and physiological evaluation. Arch. Phys. Med. Rehabil.
81, 80-88.
Abstract: OBJECTIVE: To measure the effect of electrically stimulated triceps on
elbow extension strength, range of motion, and the performance of overhead
reaching tasks. SETTING: Clinical research laboratory. PARTICIPANTS: Four
individuals with spinal cord injuries at the C5 or C6 motor level.
INTERVENTIONS: The participants, who already had an implanted upper extremity
neuroprosthesis, were provided with elbow extension through functional
electrical stimulation (FES) of the triceps brachii. MAIN OUTCOME MEASURES:
Comparisons of stimulated elbow extension to voluntary elbow extension: (1)
evaluations of impairment such as range of motion and strength; (2) performance
of a set of functional overhead reaching tasks that required elbow extension;
(3) a usage survey (conducted by telephone) to examine use of triceps
stimulation in the home and community. RESULTS: All participants achieved
greater range of motion and strength of elbow extension with stimulated triceps
versus without. Overall functional task performance improved in 100% of the
tasks tested for all but one participant, who showed improvement in 60% of the
tasks. Participants reported using the triceps in at least one activity for at
least 90% of the days the neuroprosthesis was donned
Campbell J.M. and Meadows P.M.
(1992) Therapeutic FES: from rehabilitation to neural prosthetics. Assist.
Technol. 4, 4-18.
Abstract: The purpose of this paper is to review the therapeutic applications of
electrical stimulation and to focus on functional neuromuscular electrical
stimulation (FES), which is the production of useful muscle contractions for
joint stability and limb movement. The use of FES to improve patient function
during the recovery period after illness or injury and the transition to FES
neural prosthetic systems for patients who do not fully recover will be
discussed. Emphasis will be given to the maintenance of posture and the
production of purposeful movement from the perspective of technologies and
clinical strategies that are available today and from the perspective of those
technologies that have the potential for transfer to community health care in
the near future
Carmick J. (1995) Managing
equinus in children with cerebral palsy: electrical stimulation to strengthen
the triceps surae muscle. Dev. Med. Child Neurol. 37, 965-975.
Abstract: A new therapeutic proposal for the management of equinus in children
with cerebral palsy is to strengthen the calf muscles instead of weakening them
surgically. Prior research indicates that in children with cerebral palsy the
triceps surae muscle is weak and needs strengthening. Neuromuscular electrical
stimulation (NMES) was used as an adjunct to physical therapy. A portable NMES
unit with a hand-held remote switch stimulated an active muscle gait cycle.
Results are discussed for four children, who showed improved gait, balance,
posture, active and passive ankle range of motion, and foot alignment. The toe
walkers became plantigrade and the equinovalgus posture of the foot decreased.
Spasticity did not increase
Carroll S.G., Bird S.F., and
Brown D.J. (1992) Electrical stimulation of the lumbrical muscles in an
incomplete quadriplegic patient: case report. Paraplegia 30, 223-226.
Abstract: The increasing number of incomplete cervical spinal cord injuries
means that more attention needs to be focused on the rehabilitation of the
incomplete quadriplegic hand. A case study, describing the application of
electrical stimulation for strengthening the paretic lumbrical muscles, is
presented. A 2 week strengthening program resulted in a 33% increase in the
force produced by the lumbrical muscles. No loss of strength had occurred 4
weeks after cessation of the treatment. The magnitude and speed of this result
should be of interest to those clinicians who seek to maximise patient
independence in minimal time
Chantraine A., Baribeault A.,
Uebelhart D., and Gremion G. (1999) Shoulder pain and dysfunction in hemiplegia:
effects of functional electrical stimulation. Arch. Phys. Med. Rehabil. 80,
328-331.
Abstract: OBJECTIVE: To determine the influence of functional electrical
stimulation (FES) on subluxation and shoulder pain in hemiplegic patients.
DESIGN: Controlled study of 24 months' duration beginning in the first month
after onset of stroke. SUBJECTS AND SETTING: One hundred twenty hemiplegic
patients with both subluxed and painful shoulder were followed for
rehabilitation before and after discharge between 1989 and 1993. All subjects
received conventional rehabilitation based on the Bobath concept. In addition,
patients were alternately assigned to a control group or to receive additional
FES for 5 weeks on muscles surrounding their subluxed and painful shoulder. MAIN
MEASURES: Clinical examinations, including range of motion, pain assessment, and
x-rays, were performed at the start of the study, between the second and fourth
weeks after onset of stroke, and subsequently at 6, 12, and 24 months. RESULTS:
The FES group showed significantly more improvement than the control group in
both pain relief (80.7% vs. 55.1%, p<.01) and reduction of subluxation (78.9%
vs. 58.6%, p<.05). Furthermore, recovery of arm motion appeared to be
significantly improved in the FES group (77.1% vs. 60.3% in the control group,
p<.01). CONCLUSION: The FES program was significantly effective in reducing the
severity of subluxation and pain and possibly may have facilitated recovery of
the shoulder function in hemiplegic patients
Crago P.E., Memberg W.D., Usey
M.K., Keith M.W., Kirsch R.F., Chapman G.J., Katorgi M.A., and Perreault E.J.
(1998) An elbow extension neuroprosthesis for individuals with tetraplegia. IEEE
Trans. Rehabil. Eng 6, 1-6.
Abstract: Functional electrical stimulation (FES) of the triceps to restore
control of elbow extension was integrated into a portable hand grasp
neuroprosthesis for use by people with cervical level spinal cord injury. An
accelerometer mounted on the upper arm activated triceps stimulation when the
arm was raised above a predetermined threshold angle. Elbow posture was
controlled by the subjects voluntarily flexing to counteract the stimulated
elbow extension. The elbow moments created by the stimulated triceps were at
least 4 N.m, which was sufficient to extend the arm against gravity. Electrical
stimulation of the triceps increased the range of locations and orientations in
the workspace over which subjects could grasp and move objects. In addition,
object acquisition speed was increased. Thus elbow extension enhances a person's
ability to grasp and manipulate objects in an unstructured environment
Davis R., Houdayer T., Andrews
B., and Barriskill A. (1999) Paraplegia: prolonged standing using closed-loop
functional electrical stimulation and Andrews ankle-foot orthosis. Artif. Organs
23, 418-420.
Abstract: One T10 paraplegic male (CS) implanted in 1991 with a Nucleus FES-22
stimulator has been able to achieve closed-loop standing for 1 h. The knee
angles are monitored by electrogoniometers, resulting in the quadriceps
stimulation time being less than 10%. Stance stability is achieved by the
Andrews anterior ankle-foot orthosis (AFO). The use of accelerometers for trunk
inclination and vertical acceleration during controlled stand-to-sit, diminishes
slamming onto the seat. CS does one- handed tasks with objects of 2.2 kg. In
another T10 paraplegic male (FR), surface stimulation was applied over 1.5 years
to both femoral nerves at the groin for conditioning and prolonged standing.
With quadricep conditioning, 55 Nm at 45 degrees of knee flexion is produced.
With the AFO and knee monitoring, FR can stand uninterrupted for up to 70 min
and perform one-handed tasks. In August 1998, he was implanted with the
multifunctional Praxis FES 24-A stimulator for restoration of limb movements,
bladder and bowel function, and pressure sore prevention
Davis S.E., Mulcahey M.J.,
Smith B.T., and Betz R.R. (1999) Outcome of functional electrical stimulation in
the rehabilitation of a child with C-5 tetraplegia. J. Spinal Cord. Med. 22,
107-113.
Abstract: Hand function was provided for a six-year-old child with C-5 American
Spinal Injuries Association (ASIA) classification-A tetraplegia through a
percutaneous intramuscular (i.m.) functional electrical stimulation (FES)
system. In conjunction with implantation of 10 percutaneous i.m. electrodes for
provision of grasp and release of her right hand, reconstructive surgery was
performed to provide upper extremity positioning to optimize hand use. The
subject participated in FES training over a nine-week period for approximately
five hours weekly, with an additional five hours each week dedicated to exercise
and conditioning of her arm muscles. Physical and functional assessments
included range of motion (ROM), manual muscle testing (MMT), activities of daily
living (ADL) abilities and the Canadian Occupational Performance Measure (COPM),
used to evaluate the effect of stimulated hand function and surgical
reconstruction on functional ability. These were conducted prior to FES and
surgery and repeated after rehabilitation training. With rehabilitation and
training, the child was able to control her FES system. Physical assessments
revealed increased strength of both shoulders and more useful range of arm
movement. Functional assessments show that the FES system enabled her to perform
age-appropriate ADL that previously were achievable only with physical
assistance. Her overall level of independence in ADL ability increased, as did
self-rated levels of satisfaction and performance on chosen activities. Positive
gains demonstrated here suggest the need for further studies of FES systems in
young children with SCI
Draper V. and Ballard L. (1991)
Electrical stimulation versus electromyographic biofeedback in the recovery of
quadriceps femoris muscle function following anterior cruciate ligament surgery.
Phys. Ther. 71, 455-461.
Abstract: Both electrical stimulation and electromyographic biofeedback have
been shown to be more effective than voluntary isometric exercise alone in the
recovery of quadriceps femoris muscle force following anterior cruciate ligament
(ACL) reconstruction. In a comparison of these two modalities, 30 patients with
ACL reconstruction were randomly assigned to either a group receiving electrical
stimulation in conjunction with voluntary isometric exercise or a group
receiving biofeedback in conjunction with voluntary isometric exercise.
Following 6 weeks of a rehabilitative exercise protocol, the quadriceps femoris
muscle isometric peak torque in the operative limb was compared with that in the
nonoperative limb. A t test of independent samples indicated that the
biofeedback group recovered a significantly greater percentage of their
nonoperative limb's peak torque than did the electrical stimulation group.
Measurements of active knee extension were taken at weeks 1, 2, 4, and 6 of the
exercise program. A two-way analysis of variance (groups x weeks) indicated no
significant difference between the rate at which each group recovered full
active extension. The authors concluded that biofeedback is more effective than
electrical stimulation in facilitating the recovery of peak torque and that
biofeedback is comparable to electrical stimulation in the recovery of active
knee extension
Faghri P.D., Rodgers M.M.,
Glaser R.M., Bors J.G., Ho C., and Akuthota P. (1994) The effects of functional
electrical stimulation on shoulder subluxation, arm function recovery, and
shoulder pain in hemiplegic stroke patients. Arch. Phys. Med. Rehabil. 75,
73-79.
Abstract: The purpose of this study was to evaluate the effectiveness of a
functional electrical stimulation (FES) treatment program designed to prevent
glenohumeral joint stretching and subsequent subluxation and shoulder pain in
stroke patients. Twenty-six recent hemiplegic stroke patients with shoulder
muscle flaccidity were randomly assigned to either a control group (n = 13; 5
female, and 8 male) or experimental group (n = 13; 6 female, and 7 male). Both
groups received conventional physical therapy. The experimental group received
additional FES therapy where two flaccid/paralyzed shoulder muscles (supraspinatus
and posterior deltoid) were induced to contract repetitively up to 6 hours a day
for 6 weeks. Duration of both the FES session and muscle contraction/relaxation
ratio were progressively increased as performance improved. The experimental
group showed significant improvements in arm function, electromyographic
activity of the posterior deltoid, range of motion, and reduction in subluxation
(as indicated by x-ray) compared with the control group. We concluded that the
FES program was effective in reducing the severity of shoulder subluxation and
pain, and possibly facilitating recovery of arm function
Franco J.C., Perell K.L.,
Gregor R.J., and Scremin A.M. (1999) Knee kinetics during functional electrical
stimulation induced cycling in subjects with spinal cord injury: a preliminary
study. J. Rehabil. Res. Dev. 36, 207-216.
Abstract: The purpose of this preliminary study was to describe pedal
effectiveness parameters and knee-joint reaction forces generated by subjects
with chronic spinal cord injury (SCI) during functional electrical stimulation
(FES)-induced bicycling. Three male subjects (age 33-36 years old), who were
post-traumatic SCI (ASIA-modified level A, level T4-C5) and enrolled in an FES
rehabilitation program, signed informed consent forms and participated in this
study. Kinematic data and pedal forces during bicycling were collected and
effective force, knee-joint reaction forces, knee generalized muscle moments,
and knee- joint power and work were calculated. There were three critical
findings of this study: 1) pedaling effectiveness was severely compromised in
this subject population as indicated by a lack of overall positive crank work;
2) knee-joint kinetics were similar in magnitude to data reported for unimpaired
individuals pedaling at higher rates and workloads, suggesting excessive
knee-joint loading for subjects with SCI; and 3) shear reaction forces and
muscle moments were opposite in direction to data reported for unimpaired
individuals, revealing an energetically unfavorable knee stabilizing mechanism.
The critical findings of this study suggest that knee-joint kinetics may be
large enough to produce a fracture in the compromised lower limbs of individuals
with SCI
Gotlin R.S., Hershkowitz S.,
Juris P.M., Gonzalez E.G., Scott W.N., and Insall J.N. (1994) Electrical
stimulation effect on extensor lag and length of hospital stay after total knee
arthroplasty. Arch. Phys. Med. Rehabil. 75, 957-959.
Abstract: The effects of electrical stimulation in conjunction with traditional
physical therapy, on knee extensor lag and length of hospital stay among
patients recovering from total knee arthroplasty were assessed. Forty patients
who underwent total knee replacement (TKR) were randomly assigned to either an
electrical stimulation group (16 females, 5 males), or a control group (15
females, 4 males). Both groups received conventional physical therapy including
continuous passive motion (CPM) to the affected limb, ambulation training, range
of motion exercises, and activities of daily living (ADL) training. The
experimental group additionally received electrical stimulation during CPM
treatment. Experimental group subjects reduced their extensor lag from 7.5 to
5.7 degrees, whereas control group extensor lag increased from 5.3 to 8.3
degrees. These trends were significantly different (p < .01). Rehabilitation
discharge criteria were reached in 6.7 days in the experimental group and 7.4
days in the control group. These differences were also significant (p < .05).
The results of this study indicate that the application of electrical
stimulation during recovery from TKR can effectively reduce extensor lag and
decrease the length of hospital stay
Grill J.H. and Peckham P.H.
(1998) Functional neuromuscular stimulation for combined control of elbow
extension and hand grasp in C5 and C6 quadriplegics. IEEE Trans. Rehabil. Eng 6,
190-199.
Abstract: Spinal cord injury sustained at the C5/C6 level leaves an individual
without voluntary control of the muscles of the forearm, hand, or of the elbow
extensors. The objective of this research project was to integrate functional
neuromuscular stimulation (FNS) control of elbow extension with a previously
developed system that provides hand grasp in order to increase the working
volume in space in which users can perform functional tasks. Elbow extension
control was achieved by detecting the position of the arm in space and
determining the magnitude of the gravitational moment acting to oppose
extension. An accelerometer was used as the command control source, and this
sensor was placed over the ulna near the elbow joint to detect static
(gravitational) acceleration, and therefore the gravitational moment acting
about the elbow joint. This value determined the level of electrical stimulation
required to activate the triceps muscles to full extension against these forces.
Combined FNS control of elbow extension and hand grasp was implemented in two
quadriplegic subjects. Both subjects were able to reach and grasp objects at
locations in space which were unattainable without triceps activation
Handa I., Matsushita N., Ihashi
K., Yagi R., Mochizuki R., Mochizuki H., Abe Y., Shiga Y., Hoshimiya N., Itoyama
Y., and . (1995) A clinical trial of therapeutic electrical stimulation for
amyotrophic lateral sclerosis. Tohoku J. Exp. Med. 175, 123-134.
Abstract: This paper describes the effects of therapeutic electrical stimulation
(TES) on the wasting muscles in a patient with amyotrophic lateral sclerosis.
The patient is a 47-year-old male, and he has a history of progressive muscle
weakness and atrophy, affected more in the right side. Percutaneously indwelling
intramuscular electrodes were implanted to the affected muscles in the right
upper and lower extremities but no electrode in the corresponding left region.
Within a month of TES therapy, a rapid improvement of extremity motion appeared
in the TES treated side. Long-term application of TES more than 3 months
increased the strength of the muscle which had been evidently weaker than the
non- treated side. CT findings of both the upper and lower extremities with TES
therapy showed an increase in the density and a reduction in the moth-eaten
image. An increase in the thickness of the muscles was also observed in the TES
treated side while deterioration was observed in the muscles on the non-treated
side
Herbison G.J., Jaweed M.M., and
Ditunno J.F., Jr. (1983) Exercise therapies in peripheral neuropathies. Arch.
Phys. Med. Rehabil. 64, 201-205.
Abstract: The treatment of peripheral neuropathies should be aimed at
maintaining the range of motion of the joints, re-educating the patient in
skilled activities and optimizing the recovery of strength. Many techniques have
been described to substitute for, to strengthen and to improve the function of
residual innervated muscle; however, not all of these techniques are of
unquestioned value. Specifically, electrical stimulation does not appear to
enhance reinnervation of totally denervated muscle. Similarly, overstretching
weakened muscle may impair the use of paretic muscle. Because overwork may
damage partially denervated muscle, brief isometric or isotonic contractions may
be more beneficial for increasing strength than a program of habitual exhausting
activities
Keith M.W., Kilgore K.L.,
Peckham P.H., Wuolle K.S., Creasey G., and Lemay M. (1996) Tendon transfers and
functional electrical stimulation for restoration of hand function in spinal
cord injury. J. Hand Surg. [Am. ] 21, 89-99.
Abstract: Spinal cord injury at the C5 and C6 level results in loss of hand
function. Electrical stimulation of paralyzed muscles is one approach that has
demonstrated significant capacity for restoring grasp and release function. One
potential limitation of this approach is that key muscles for stimulation may
have lower motor neuron damage, rendering the muscles unexcitable. We have used
surgical modification of the biomechanics of the hand to overcome this
limitation. Tendon transfer of paralyzed but lower motor neuron intact muscles
can compensate for potential function lost owing to muscles with lower motor
neuron damage. Such procedures have been performed to provide finger extension,
thumb extension, finger flexion, and wrist extension. Additional surgical
procedures have been performed to enhance the function provided with electrical
stimulation. These are side-to-side synchronization of the finger flexor and
extensor tendons, the flexor digitorium superficialis Zancolli-lasso procedure,
and thumb interphalangeal joint arthrodesis. These procedures have been
performed in 11 patients with C5 and C6 level spinal injuries and functional
electrical stimulation neuroprostheses. In these patients, 41 different
functional electrical stimulation-related procedures were performed and 38 gave
the desired result after surgery. One procedure resulted in no increase or
decrease in function or muscle output, and two procedures resulted in a decrease
in muscle force or joint range of motion. The issues that must be considered in
performing functional electrical stimulation-related tendon transfers are
discussed
Laska T. and Hannig K. (2001)
Physical therapy for spinal accessory nerve injury complicated by adhesive
capsulitis. Phys. Ther. 81, 936-944.
Abstract: BACKGROUND AND PURPOSE: The authors found no literature describing
adhesive capsulitis as a consequence of spinal accessory nerve injury and no
exercise program or protocol for patients with spinal accessory nerve injury.
The purpose of this case report is to describe the management of a patient with
adhesive capsulitis and spinal accessory nerve injury following a carotid
endarterectomy. CASE DESCRIPTION: The patient was a 67-year-old woman referred
for physical therapy following manipulation of the left shoulder and a diagnosis
of adhesive capsulitis by her orthopedist. Spinal accessory nerve injury was
identified during the initial physical therapy examination, and a program of
neuromuscular electrical stimulation was initiated. OUTCOMES: The patient had
almost full restoration of the involved muscle function after 5 months of
physical therapy. DISCUSSION: This case report illustrates the importance of
accurate diagnosis and suggests physical therapy intervention to manage adhesive
capsulitis as a consequence of spinal accessory nerve injury
Lehmann T.R., Russell D.W.,
Spratt K.F., Colby H., Liu Y.K., Fairchild M.L., and Christensen S. (1986)
Efficacy of electroacupuncture and TENS in the rehabilitation of chronic low
back pain patients. Pain 26, 277-290.
Abstract: Fifty-four patients treated in a 3-week inpatient rehabilitation
program were randomly assigned to and accepted treatment with electroacupuncture
(n = 17), TENS (low intensity transcutaneous nerve stimulation, n = 18), and
TENS dead-battery (placebo, n = 18). Outcome measures included estimates of pain
(on a Visual Analogue Scale) and disability by both physician and patient,
physical measures of trunk strength and spine range of motion, as well as the
patient's perceptions of the relative contribution of the education, exercise
training, and the electrical stimulation. Analyses of variance were utilized to
determine effects of treatment (electroacupuncture, TENS, placebo) across time
(admission, discharge, and return) for the outcome measures. There were no
significant differences between treatment groups with respect to their overall
rehabilitation. All 3 treatment groups ranked the contribution of the education
as being greater than the electrical stimulation. However, the
electroacupuncture group consistently demonstrated greater improvement on the
outcome measures than the other treatment groups. For the visual analogue scale
measure of average pain, there was a statistical trend at the return visit
suggesting that the acupuncture group was experiencing less pain
Lieber R.L., Amiel D., Kaufman
K.R., Whitney J., and Gelberman R.H. (1996) Relationship between joint motion
and flexor tendon force in the canine forelimb. J. Hand Surg. [Am. ] 21,
957-962.
Abstract: To increase in vivo tendon force and gliding after flexor tendon
repair, a variety of modifications to the methods by which protective passive
motion is administered have been advocated. To determine the relationship
between the prime variables, wrist and digital position, muscle activation, and
in vivo tendon force, a clinically relevant canine model was developed. Force
was measured in the flexor tendon during several joint manipulation paradigms:
single-finger flexion- extension with the wrist flexed (group 1F), single-finger
flexion- extension with the wrist extended (group 1E), four-finger flexion-
extension with the wrist flexed (group 4F), four-finger flexion- extension with
the wrist extended (group 4E), and synergistic wrist and finger motion where
wrist extension and finger flexion were performed simultaneously, followed by
wrist flexion and finger extension (group SYN). In addition, tendon force was
measured during electric stimulation of the proximal flexor muscle mass. Passive
tendon force with the wrist extended (groups 1E and 4E) was two to three times
greater than that measured with the wrist flexed, independent of the number of
digits moved. With the wrist extended, peak tendon force reached 1,997 g +/- 194
g during single-digit manipulation (group 1E), compared to only 853 g +/- 104 g
with the wrist flexed during the same maneuver (group 1F). Statistical
comparison between means revealed that groups 1E and 4E were significantly
different from groups 1F, 4F, and SYN (p < .005). There were no significant
differences between groups 1E and 4E or between groups 1F, 4F, and SYN (p >
.200). Active muscle force elicited by electrical stimulation and passive force
varied dramatically as the wrist was flexed from full extension 3460 g +/- 766 g
to full flexion 427 g +/- 239 g (p < .001). Simultaneously, passive tension
decreased from 940 g +/- 143 g with wrist extended to 76 g +/- 37 g with the
wrist flexed. These data indicate that wrist position has the greatest effect on
flexor tendon force during motions that are commonly used to rehabilitate flexor
tendon repairs. Thus, if force is to be controlled during passive motion,
wrist-joint angle will have the dominant effect, while the number of digits
manipulated will have much less of an effect. If the clinical goal is to
minimize tendon force, rehabilitation could be carried out with the wrist
flexed, whereas if the goal is to increase tendon force, rehabilitation could
include exercise programs that use a greater degree of wrist extension
Milne R.J., Dawson N.J., Butler
M.J., and Lippold O.C. (1985) Intramuscular acupuncture-like electrical
stimulation inhibits stretch reflexes in contralateral finger extensor muscles.
Exp. Neurol. 90, 96-107.
Abstract: Electro-acupuncture is one of many physical measures used to relieve
musculoskeletal pain and to improve the associated restricted range of motion.
Experiments were designed to determine whether or not acupuncture-like
stimulation inhibits stretch reflexes in an arm extensor muscle in human
volunteers. Surface electromyographic recordings were made on the right extensor
digitorum communis muscle and averaging techniques were used to study the reflex
responses to brief deflection of the finger with a solenoid-driven probe. The
ratio M1:M2 of two components of the reflex was reduced during continuous
acupuncture-like stimulation of the contralateral first dorsal interosseus and
extensor digitorum communis muscles near their motor points (acupuncture points
LI 4 and LI 11). Concomitant changes in skin temperature were observed on the
forehead and in the arm in which acupuncture-like stimulation was used. In
control experiments, when the acupuncture needles were inserted subcutaneously
and stimulated with the same current parameters at distinctly uncomfortable
intensities, no change in the reflexes occurred. These findings show that
acupuncture- like stimulation exerts physiologic effects on the central nervous
system, mediated presumably by muscle afferent fibers. The effects may be
relevant to relief of muscle spasm and musculoskeletal pain, and restoration of
mobility
Mulcahey M.J., Betz R.R., Smith
B.T., Weiss A.A., and Davis S.E. (1997) Implanted functional electrical
stimulation hand system in adolescents with spinal injuries: an evaluation.
Arch. Phys. Med. Rehabil. 78, 597-607.
Abstract: OBJECTIVE: To study the utility and functional benefits of an
implanted functional electrical stimulation (FES) system for hand grasp and
release in adolescents with tetraplegia secondary to spinal cord injuries.
DESIGN: Intervention study with before-after trial measurement with each subject
as his or her own control. SETTING: Nonprofit pediatric orthopedic
rehabilitation facility specializing in spinal cord injury. PARTICIPANTS: A
convenience sample of five adolescents between 16 and 18 years of age with C5 or
C6 level tetraplegia at least 1 year after traumatic spinal cord injury. Key
muscles for palmar and lateral grasp and release were excitable by electrical
stimulation. INTERVENTIONS: A multichannel stimulator/receiver and eight
electrodes were surgically implanted to provide stimulated palmar and lateral
grasp and release. In conjunction with implantation of the FES hand system,
surgical reconstruction in the form of tendon transfers, tendon lengthenings and
releases, and joint arthrodeses was performed to augment stimulated hand
function. Rehabilitation of the tendon transfers and training in the use of the
FES hand system were provided. MAIN OUTCOME MEASURES: Measurements of pinch and
grasp force, the Grasp and Release Test (GRT), and an assessment of six
activities of daily living (ADL) were administered before implantation of the
FES hand system and at regular follow-up intervals. Results of the stimulated
response of individual muscles and surgical reconstruction were evaluated using
standard and stimulated muscle testing techniques and standard assessment of
joint range of motion. All subjects completed followup testing. RESULTS: Lateral
and palmar forces were significantly greater than baseline forces (p = .043).
Heavy objects on the GRT could only be manipulated with FES, and FES increased
the level of independence in 25 of 30 ADL comparisons (5 subjects, 6 activities)
as compared to baseline. After training, FES was preferred in 21 of 30
comparisons over the typical means of task completion. Of the 40 electrodes
implanted, 37 continue to provide excellent stimulated responses and all of the
implanted stimulators have functioned without problems. The surgical
reconstruction procedures greatly enhanced FES hand function by either expanding
the workspace in which to utilize FES (deltoid to triceps transfer), stabilizing
the wrist (brachioradialis to wrist extensor transfer), or stabilizing joints
(intrinsic tenodesis transfer, FPL split transfer). CONCLUSION: For five
adolescents with tetraplegia, the combination of FES and surgical reconstruction
provided active palmar and lateral grasp and release. Laboratory-based
assessments demonstrated that the FES system increased pinch force, improved the
manipulation of objects, and typically increased independence in six standard
ADL as compared to pre-FES hand function. The study also showed that the five
adolescents generally preferred FES for most of the ADL tested. Data on the
benefits of the implanted FES hand system outside of the laboratory are needed
to understand the full potential of FES
Pandyan A.D., Granat M.H., and
Stott D.J. (1997) Effects of electrical stimulation on flexion contractures in
the hemiplegic wrist. Clin. Rehabil. 11, 123-130.
Abstract: OBJECTIVE: To study the effects of electrical stimulation (ES) on
flexion contractures in the hemiplegic wrist. DESIGN: The investigation was
carried out following an OFF (two weeks with rehabilitation only)-- ON (two
weeks with ES treatment and rehabilitation)--OFF (two weeks rehabilitation only)
fixed protocol. SETTING: A stroke ward and an outpatient stroke service.
SUBJECTS: Eleven hemiplegic subjects with reduced range of extension and
increased resistance to passive movement at the wrist. MAIN MEASURE:
Quantitative measures of the hemiplegic posture at the wrist, passive range of
extension and resistance to passive extension of the wrist. Measurements were
taken at the start of the study and then at two-weekly intervals. Two extra
measurements were taken at the end of the ON period. RESULTS: Following two
weeks treatment with ES the posture of the wrist improved and the passive range
of extension increased. However, there were no significant changes in the
resistance to passive movement. These benefits appeared largely to be lost two
weeks after ES was discontinued. CONCLUSIONS: Short-term ES gives temporary
improvements in contractures at the wrist in poststroke hemiplegia
Popovic D., Stojanovic A.,
Pjanovic A., Radosavljevic S., Popovic M., Jovic S., and Vulovic D. (1999)
Clinical evaluation of the bionic glove. Arch. Phys. Med. Rehabil. 80, 299-304.
Abstract: OBJECTIVE: Clinical evaluation of the Bionic Glove, a prototype of a
new functional electrical stimulation device designed to improve the function of
the paralyzed hand after spinal cord injury. PATIENTS: Twelve people with spinal
cord injury at C5-C7 who had used the device 6 months or more. SETTING:
Measurements were made at the Institute "Dr Miroslav Zotovic" in Belgrade as a
part of a multicenter clinical trial. METHODS: Measures include Upper Extremity
Function Test, Functional Independence Measure, and Quadriplegia Index of
Function. RESULTS: The daily use of a Bionic Glove had two major effects: (1)
increasing the power grasp; and (2) increasing the range of movements. Active
force was significantly greater than passive tenodesis force, as shown in other
studies. Most manual tasks improved significantly with the use of the assistive
system, as judged by the time needed to complete a task or the subject's
qualitative ratings of a task difficulty. Most subjects who retained some
dexterity without the assistive system hesitated to use the assistive system to
manipulate small objects. CONCLUSION: The Bionic Glove can significantly improve
independence in people with C5-C7 spinal cord injury if their initial Functional
Independence Measure and Quadriplegia Index of
Smith L.E. (1990) Restoration
of volitional limb movement of hemiplegics following patterned functional
electrical stimulation. Percept. Mot. Skills 71, 851-861.
Abstract: 24 hemiplegic patients completed patterned functional electrical
stimulation (PFES) upon the afflicted arm and leg. The multichannel PFES program
was mathematically derived from the EMG agonist/antagonist pattern recorded from
each subject's unaffected limbs during a series of monitored, voluntary
movements. The average improvement in volitional range of motion for the group's
paralyzed limbs was 90% for the upper extremities and 69% for the lower
extremities. For partially paralyzed limbs, there was an average increase in
range of movement of 68% for the upper extremities and 26% for the lower
extremities. These findings support the relearning-based, PFES open-loop theory
which uses individualized therapeutic PFES-derived from EMG coordination
patterns modeled from specific, ballistic limb movements to rehabilitate
patients who have been immobilized after stroke
Steadman J.R. (1982)
Rehabilitation of skiing injuries. Clin. Sports Med. 1, 289-294.
Abstract: It is important to include psychological and physiologic
rehabilitation in addition to rehabilitation of the injured area. Motion that
does not stress repairs of either ligament or bone is not contraindicated.
Exercises that aggravate patellofemoral problems should be modified to avoid
areas in the range of motion that cause crepitance or pain. The use of
modalities such as electrical stimulation is an important adjunct. Exercisers
that allow speed work-out and isolate the muscle group are helpful but not
mandatory. Manual resistance can parallel each type of machine exercise.
Ligaments that have been repaired should be allowed to mature prior to allowing
subluxing stresses. Before resumption of skiing, reactive exercises should be
done
Taylor P.N., Burridge J.H.,
Dunkerley A.L., Wood D.E., Norton J.A., Singleton C., and Swain I.D. (1999)
Clinical use of the Odstock dropped foot stimulator: its effect on the speed and
effort of walking. Arch. Phys. Med. Rehabil. 80, 1577-1583.
Abstract: OBJECTIVE: To assess the clinical effectiveness of the Odstock dropped
foot stimulator by analysis of its effect on physiological cost index (PCI) and
speed of walking. This functional electrical stimulation (FES) device stimulates
the common peroneal nerve during the swing phase of gait. DESIGN: A
retrospective study of patients who had used the device for 4 1/2 months.
SUBJECTS: One hundred fifty-one patients with a dropped foot resulting from an
upper motor neuron lesion. SETTING: A medical physics and biomedical engineering
department of a district general hospital specializing in the clinical
application of FES and a neurophysiotherapy department at a separate hospital.
MAIN OUTCOME MEASURES: Changes in walking speed and effort of walking, as
measured by PCI over a 10-meter course. RESULTS: There was a 92.7% compliance
with treatment. Stroke patients showed a mean increase in walking speed of 27%
(p<.01) and reduction in PCI of 31% (p<.01) with stimulation, and changes of 14%
(p<.01) and 19% (p<.01), respectively, while not using the stimulator. Multiple
sclerosis patients gained similar orthotic benefit but no "carry-over."
CONCLUSIONS: The measured differences in walking with and without stimulation
were statistically significant in the stroke and multiple sclerosis groups. In
this study use of the stimulator improved walking. Those with stroke
demonstrated a short-term "carry-over" effect
Weingarden H.P., Kizony R.,
Nathan R., Ohry A., and Levy H. (1997) Upper limb functional electrical
stimulation for walker ambulation in hemiplegia: a case report. Am. J. Phys.
Med. Rehabil. 76, 63-67.
Abstract: Electrical stimulation has been sporadically used in the treatment of
hemiplegia. Reported benefits include decreasing spasticity, providing a
supplementary means for range of motion exercises, increasing strength, and
improving local blood flow in a paretic or paralyzed limb. Some studies have
also shown functional gains in the hemiplegic upper limb following treatment
with electrical stimulation. Nevertheless, there have been very few reports of
the use of neuromuscular stimulation to achieve new hemiplegic upper limb
activity not possible without the electrical stimulation. This is a case report
of a head injury patient who was able to begin ambulation with a walker, without
physical assistance, for the first time in the 16 yr since his injury. A new
electrical stimulation device (Handmaster) initially used therapeutically, and
then functionally, provided a reliable, strong grasp and release and was
instrumental in achieving the new level of function. The device proved to be
easy to use in the home, giving the patient microprocessor-controlled
therapeutic and patterned functional electrical stimulation
Weingarden H.P., Zeilig G.,
Heruti R., Shemesh Y., Ohry A., Dar A., Katz D., Nathan R., and Smith A. (1998)
Hybrid functional electrical stimulation orthosis system for the upper limb:
effects on spasticity in chronic stable hemiplegia. Am. J. Phys. Med. Rehabil.
77, 276-281.
Abstract: A new hybrid functional electrical stimulation orthosis system for the
upper limb has been designed to allow for ease of use in the home as a daily
treatment modality, as well as offer the opportunity for function enhancement.
In a pilot study, the system was used by ten patients with chronic stable
hemiparesis secondary to cerebral vascular accident and head injuries. The
patients were referred by their treating physicians or therapists after meeting
the inclusion criteria of good general health, being greater than one year after
head injury, or being ten months post-stroke, with no observed neurologic
changes in the prior six weeks. Each of these patients had received prolonged
physical therapy, either continuous from the initial inpatient rehabilitation
treatment or on an intermittent basis over a period of years. The baseline
status for factors related to increased muscle tone, i.e., passive range of
motion at the wrist and elbow, posture at rest, posture immediately following
activity, and spasticity were quantified before the treatment protocol with the
functional electrical stimulation orthosis. Active range of motion and tests of
functional use of the involved upper limb were also assessed. The patients were
instructed in the protocol, trained in the use of the system, and then used the
electrical orthosis at home for up to several hours per day. Follow-up
assessments were at six months. A statistically significant improvement was
noted in all muscle tone/spasticity parameters measured. A separate report will
describe the effects on voluntary motion and functional capabilities
Werner S., Arvidsson H.,
Arvidsson I., and Eriksson E. (1993) Electrical stimulation of vastus medialis
and stretching of lateral thigh muscles in patients with patello-femoral
symptoms. Knee. Surg. Sports Traumatol. Arthrosc. 1, 85-92.
Abstract: Thirty patients with unilateral patello-femoral symptoms and a
hypotrophic vastus medialis muscle were treated with transcutaneous electrical
stimulation of the vastus medialis obliquus and stretching of the lateral thigh
muscles twice daily for 10 weeks. Before and after treatment the position of the
patella at fixed knee flexion angles and the area of the vastus medialis and
vastus lateralis muscles were studied by computed tomography. Isokinetic
quadriceps torque was registered with a Cybex II Dynamometer. An evaluation with
a functional knee score was carried out. The healthy contralateral leg served as
control in all the examinations. Clinically two-thirds of the patients had
improved after 10 weeks of treatment and this improvement remained at follow-up
3.5 years later. The area of the vastus medialis and the quadriceps torque of
the treated leg increased significantly, while the area of the vastus lateralis
and the position of patella did not change. We conclude that transcutaneous
electrical muscle stimulation of the vastus medialis and stretching of the
lateral thigh muscles might be of benefit in patients with patello-femoral
symptoms and a hypotrophic vastus medialis. An improvement after 10 weeks of
treatment seems to predict a good long-term result
Winchester P., Montgomery J.,
Bowman B., and Hislop H. (1983) Effects of feedback stimulation training and
cyclical electrical stimulation on knee extension in hemiparetic patients. Phys.
Ther. 63, 1096-1103.
Abstract: Positional feedback stimulation training and cyclical electrical
stimulation were used in combination as a treatment for facilitating knee
extension in hemiparetic patients. Forty adult hemiparetic patients who
demonstrated minimal active control of their quadriceps femoris muscles were
randomly assigned to control or study groups. The control patients received a
program of physical therapy, and the study patients received the positional
feedback stimulation training in addition to their therapy program. The
stimulation training provided the patient with immediate auditory and visual
feedback of his changing joint angle while he voluntarily extended his knee.
When the patient reached a near maximal extension effort, electrical stimulation
of the quadriceps femoris muscle was automatically triggered, completing the
patient's available range of motion in extension. The stimulation training was
supplemented with two hours of cyclical electrical stimulation daily. At the end
of four weeks, analysis revealed a statistically significant increase in knee
extension torque and active synergistic range of motion in the study group. No
change was noted in their ability to extend their knees using isolated
quadriceps femoris muscle control. This study suggests that positional feedback
stimulation training is effective when used to augment a facilitation program
for improving knee extension control in hemiparetic patients
Wright P.A. and Granat M.H.
(2000) Improvement in hand function and wrist range of motion following
electrical stimulation of wrist extensor muscles in an adult with cerebral
palsy. Clin. Rehabil. 14, 244-246.
Zizic T.M., Hoffman K.C., Holt
P.A., Hungerford D.S., O'Dell J.R., Jacobs M.A., Lewis C.G., Deal C.L., Caldwell
J.R., Cholewczynski J.G., and . (1995) The treatment of osteoarthritis of the
knee with pulsed electrical stimulation. J. Rheumatol. 22, 1757-1761.
Abstract: OBJECTIVE. The safety and effectiveness of pulsed electrical
stimulation was evaluated for the treatment of osteoarthritis (OA) of the knee.
METHODS. A multicenter, double blind, randomized, placebo controlled trial that
enrolled 78 patients with OA of the knee incorporated 3 primary efficacy
variables of patients' pain, patients' function, and physician global evaluation
of patients' condition, and 6 secondary variables that included duration of
morning stiffness, range of motion, knee tenderness, joint swelling, joint
circumference, and walking time. Measurements were recorded at baseline and
during the 4 week treatment period. RESULTS. Patients treated with the active
devices showed significantly greater improvement than the placebo group for all
primary efficacy variables in comparisons of mean change from baseline to the
end of treatment (p < 0.05). Improvement of > or = 50% from baseline was
demonstrated in at least one primary efficacy variable in 50% of the active
device group, in 2 variables in 32%, and in all 3 variables in 24%. In the
placebo group improvement of > or = 50% occurred in 36% for one, 6% for 2, and
6% for 3 variables. Mean morning stiffness decreased 20 min in the active device
group and increased 2 min in the placebo group (p < 0.05). No statistically
significant differences were observed for tenderness, swelling, or walking time.
CONCLUSION. The improvements in clinical measures for pain and function found in
this study suggest that pulsed electrical stimulation is effective for treating
OA of the knee. Studies for longterm effects are warranted
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