Physiological and methodological considerations for the use of neuromuscular electrical stimulation

Abstract

The main aim of this review is to discuss some evidence-based physiological and methodological considerations for optimal use of neuromuscular electrical stimulation (NMES) in healthy and impaired skeletal muscles. After a quick overview of the main applications, interests and limits of NMES use, the first section concentrates on two crucial aspects of NMES physiology: the differences in motor unit recruitment pattern between NMES and voluntary contractions, and the involvement of the nervous system during peripheral NMES. The second section of the article focuses on the most common NMES parameters, which entail the characteristics of both the electrical current (the input) and the evoked contraction (the output).

Electrical stimulation for neuromuscular testing and training: state-of-the art and unresolved issues

“…Gondin et al (2011b) provided an overview of the main training studies in which NMES has been applied to healthy subjects or even to competitive athletes with the objective to improve muscle function. As already pointed out in a recent review published in this journal (Maffiuletti 2010), the so-called training intensity (i.e., the level of force evoked by NMES, expressed as a fraction of the MVC force) seems to be the main determinant of NMES training effectiveness. In other words, muscles should produce the greatest relative tension when stimulated by NMES in order to maximize the training-induced strength gains (Lai et al 1988;Selkowitz 1985).…”

“…Such early occurrence of fatigue represents a major limitation of NMES, and could eventually play a role in NMES-induced muscle damage (Nosaka et al 2011). In order to maximize the spatial recruitment during NMES, thus minimizing the extent of muscle fatigue, it has been recommended to implement different expedients during a treatment session such as progressive increase in current intensity, alteration in muscle length, and displacement of active electrodes (Maffiuletti 2010). In this cluster of articles, further approaches have been proposed to alleviate, at least in part, discomfort and other possible complications associated to the electrically evoked contractions (Botter et al 2011;Bergquist et al 2011;Gobbo et al 2011).…”

Effects of Eccentric Contractions Induced Electrical Stimulation Training System on Quadriceps Femoris Muscle

“…To stimulate at flexion angle from 0˚ to 30˚, we set stimulated time at 1 sec. The electrical stimulation (carrier frequency: 2500 Hz; and burst modulated frequency: 100 Hz) was delivered through a pair of 9 × 5 cm gelcoated electrodes attached to the region of the VI muscle belly following described [23].…”

Influência de parâmetros da estimulação elétrica funcional na contração concêntrica do quadríceps

“…Sistemas de FES são usados na prática clínica para o fortalecimento do músculo enfraquecido e a recuperação ou preservação da função do mesmo durante a fase de atividade reduzida ou de imobilização (Maffiuletti, 2010). Além disso, também tem sido relatada a ocorrência de adaptações neurais associadas ao uso da eletroestimulação (Braz et al, 2009), sendo um processo importante para a retomada de interação do paciente com o ambiente (Peckham e Knutson, 2005;Sinkjaer e Popovic, 2009).…”

“…Apresentam-se na literatura modelos mecânicos da variação angular, ou força resultante, da articulação do joelho devido à estimulação dos músculos quadríceps (El Makssoud et al, 2003;Ferrarin e Pedotti, 2000;Franken et al, 1993;Lynch e Popovic, 2011;Mohammed et al, 2010;Perumal et al, 2006) e também, mesmo que em menor quantidade, estudos sobre a influência de medidas antropométricas sobre os efeitos da FES (Doheny et al, 2010;Gave et al, 2011;Maffiuletti, 2010;Maffiuletti et al, 2011;Petrofsky, 2008). Contudo, não é possível medir todas as variáveis que determinam exatamente como um músculo irá responder à estimulação elétrica, de modo que as variações na resposta do músculo não têm sido padronizadas.…”