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NMES for Peripheral Nerve Injury

I have a pediatric oncology patient with a sciatic nerve injury following a surgery involving a hemipelvectomy with THR. She has 0/5 muscle strength for dorsiflexion, plantar flexion, inversion, eversion, and any toe movements. She can actively bend and extend her both her knee and hip. Her mom reports that an EMG performed recently showed that her nerves in both legs have been injured from Vincristine, as well as the right leg being more extensively injured from surgery (I haven't been able to find the EMG report though). I've been researching the use of NMES in peripheral nerve injuries and I think it might be worth trying. I'm wondering if there are any suggestions as to which muscles I should focus on and what parameters might be best?

Carley Townsend

1 week ago

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Hi Carley, Here is a good starting point on the topic about the e-stim for denervated muscles - It is good if you find good EMG specialist to estimate the possibility for nerve regeneration. In this paper you can find some information about that - You said that the patient have EMG so try to find the report and communicate with the examiner. Finally, if you do not see/expect any improvement in the patient, please refer him/her to some good reconstructive surgeon for a nerve graft/transfer. Remember - as the time goes on, the chances for good outcome with this kind of surgery decrease. So be quick and don't hesitate. In the last year in our clinic we had two patients similar to those that you described. One was reconstructed with nerve autografts and the other was neurotized with n.obturatorius. Both have continiuing improvement. Both use e-stim as part of the postoperative program. This is good paper on the topic and in the refferences you can find even more information - I work with a lot of traumatic brachial plexus patients. I use long biphasic compensated impulses with trapezoidal and sometimes triangular or rectangular shape. Usually it is above 100-200 ms lenght and it decreases with the time. It makes their muscles to contract and it looks that somehow it helps with the recovery of the nerve function. This paper is about that: . I put the electrodes on the muscles - usually if you put one electrode on the most thick part of the muscle it brings the strongest contraction. Stimulation is 15 - 30 minutes at a time, usually daily. Many patients buy machines for home stim so they can do the stim two times a day. In any case the optimal dose for this kind of stimulation is not known. Sometimes there is recovery of the function, but it depends on many things. First - you need to be shure that the nerve continuity is not compromised. Second - sometimes there is compression from the fibrosis/scarring and in that case only careful neurolisys can help. With the biggest nerves you can check these things on sonography, but you need a good sonographer. What else? Maybe you can try LLLT - I use it sometimes with mixed results. Here is an interesting paper which can give you some ideas to try - Write me if you need some help with finding the full articles. I hope that it helped :) Kind regards, Georgi

Cliff Eaton
Cliff Eaton

Dear Carly We never know what will come through our door do we? What a sad situation NMES will not help the nerve to recover, However you can use NMES with DC and a long pulse width to activate the muscle cells directly. At the risk of promotion (there maybe others) The Chattnooga Physio NMES unit has a programme for partial Denervated and total Denervated muscles It is obviously very important to look after the integrity of the muscles until such time as, hopefully, the nerves regenerate You should consider using NMES for all of the affected muscles. A Denervated programme lasts 8 mins and with a four channel machine you could work 4 muscles at a time. IT needs to be used daily if not twice daily. So home use will be required. The parents may look to invest in one although I know in some countries they are available to rent Those muscles that are still innervated you should also consider combining NMES with any exercise prescription you may have prescribed I wish your patient all the best Cliff

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