The Electrophysical Forum aims to provide an interactive platform for questions, comments, discussion and opinion related to the use of Electro Physical modalities in therapy. It is supported by an Internationally renowned expert panel and a broad sphere of clinicians, researchers, educators and students. Active participation is welcomed.

Sign up to start posting >>>

Ask a question and get it answered by your peers and respected experts

Answer a question and be recognised, raising your international profile



Create a link to us from your website, blog or social media platform.


NMES for Chronic Hemiplegic Shoulder Subluxation

A client is a stroke survivor of about two years origin, presenting with left hemiplegia and a pronounced shoulder subluxation. He has received 13 sessions of NMES (MH6000 TENS/EMS Combo). In the last 5 sessions, the parameters were changed(Initially-Pulse width: 200us, Frequency: 80Hz, On/off: 8:6, Mode: A, Ramp of: 1, Time: 20mins, Intensity: 4-5 ; Now- 300us, 30Hz, 10:5, S, 2, 20mins, 4-5) following a publication from Physiotherapy Canada, Volume 69, Special Issue 2017. In addition, he started the use of a shoulder brace support with adjustable strap 3 weeks ago. However, I observed increase in muscle tone while performing ROM (especially elbow F/E and forearm S/P) at the recent physio session. What do you think? Is it a positive outcome? Should the treatment approach be discontinued/encouraged?

Many thanks

Ayobami

Fasuba Ayobami Debowale

2 weeks ago

Back to General Electrotherapy

Post a reply

135 views

Dr Ethne Nussbaum
Dr Ethne Nussbaum

Dear Fasuba, I am not sure why your client is developing increased tone in the forearm and whether this is related to the Estim you have been applying. I would comment however that the section on Hemiplegic shoulder in the literature article you refer to, points out that the longer the time since stroke onset the less likelihood of a good outcome. Further, the parameters of current that you used (presumably what was available in the pre-sets of your stim unit) seem not to replicate any of the protocols that we reported as being beneficial. The most beneficial protocols according to the literature used upward of 250 microsec pulse duration, low pulse repetition rate (to avoid muscle fatigue), increasingly longer ON times and decreasing OFF times applied for many hours per day, 6-7 days a week. As Cliff Eaton mentioned, placement of electrodes is also a key factor. Visible reduction of the subluxation and re-alignment of the shoulder complex is an essential sign that the electrodes are properly placed for the individual patient. Amplitude of current should be high enough to reduce the subluxation but not higher (again to avoid fatigue). By now your patient likely has significant weakness of the muscles that hold the humerus and scapula in place during shoulder/arm function - however, in the long run, the shoulder muscles require endurance properties to allow normal movement without causing impingement injury. I hope this is helpful in your consideration of whether to continue Estim or not for this client. Ethne

Cliff Eaton
Cliff Eaton

Dear Fasuba Perhaps I have not fully understood your question but I’m not sure why increased muscle tone would not be a positive outcome What most Neuro therapies look for from NMES when incorporating into patient management is centralising if the humeral head and a reduction of the sulcus sign Cliff

Cliff Eaton
Cliff Eaton

Dear Fasuba Perhaps I have not fully understood your question but I’m not sure why increased muscle tone would not be a positive outcome What most Neuro therapies look for from NMES when incorporating into patient management is centralising if the humeral head and a reduction of the sulcus sign Cliff

1-4 of 4

Reply to this discussion

You cannot edit posts or make replies: