Neuromuscular
Electrical Stimulation:
A Review of the
Literature
By: Jessica Stewart B.A.
Wayne State University Graduate Student
Neuromuscular electrical stimulation
(NMES) has been used for many
decades a part of rehabilitative therapy
In the early 2000’s, the Food & Drug
Administration approved NMES for use
with dysphagia treatment
Uses
O NMES applies electrical impulses to the
nervous system to stimulate sensory and/or
motor neurons
O Common Uses
• Relaxation of muscle spasms
• Prevention or retardation of disuse atrophy
• Improvement of local blood circulation
• Re-education of the muscle
Application
Transcutaneous
O Stimulates sensory nerves under the skins
surface
O Benefits
• Non invasive
• Generally inexpensive
O Cons
•
Needs higher amplitude to reach deeper
muscles
Application
O Percutaneous
• Electrodes temporarily placed in muscle
O Surgical
• Permanent Placement
Candidates
O Ideal
• Individuals who have central nervous system
abnormalities with intact peripheral nerve
functions
O Contraindications
• Individuals with motor neuron death
• Individuals with progressive fatigue
• Individuals with pacemaker, metal implant, skin
breakdown, cancer, cardiac or seizure disorder,
impaired peripheral nerves, pregnant
Swallowing Therapy
O Speech Language Pathologists typically
administer transcutaneous applications
O One to Two sets of electrodes placed on
anterior neck
O NMES is most effective if paired with the
actual swallowing of a bolus
Studies
Permsirivanich et al. (2009)
O Participants: stroke survivors with
dysphagia
O Group 1: NMES
O Group 2: Traditional
• Postural adjustment
• Supraglottic swallowing
• Mendelsohn maneuver
• Effortful swallow
O Results: NMES greater increase in
functional oral intake
Studies
Christiaanse et al. (2011)
O Participants: pediatric patients with dysphagia
O Group 1: NMES
O Group 2: Traditional therapy
• Oral motor training
• Diet modification
O Results: MNES did lead to improvement but
not more than traditional therapy
Studies
Heijnen, Speyer, Baijens, and Bogaardt (2011)
O Participants: Parkinson's patients with
oropharyngeal dysphagia
O Group 1: Traditional Therapy
• Oral motor exercises, airway protection maneuvers,
posture adjustments
O Group 2: Traditional Therapy listed above and MNES
to suprahyoid musculature at motor level
O Group 3:Traditional Therapy listed above and MNES
to suprahyoid musculature at sensory level
O Results: all the groups demonstrated a significant
increase in health related qualities of life, however
there was no difference between the groups
Studies
Bulow, Speyer, Baijens, Woisard, and Ekberg
(2008)
O Participants: 25 individuals who received
swallowing therapy from three area hospitals
O Group 1: NMES
O Group 2: Traditional Therapy
• Diet modification
• Oral motor exercise
• Varying postures and maneuvers
O Results: Both groups demonstrated significantly
positive results; however, there was not a
statically significant difference between groups
Studies
Carnaby-Mann and Crary (2007)
O Meta Analysis of 7 transcutaneous
neuromuscular electrical stimulation studies
O Results: Significant, but small, results support
use of NMES to improve swallowing and
therapeutic effects maintain present even after
the stimulation has been removed
Biggest Challenge
O Lack of standardized and objective
outcome measurement
• All results are based on clinician’s subjective
judgment
Should I Do It?
O Review current literature
O Safety of patient
O Cost
O Client’s needs and values
Conclusion & Questions
References
Bailey, R., Fletcher, K., Gosa, M., Miller, J.L., Saavedra, J., Scarborough, D., & Miller, C.K. (2009).
Frequently asked questions regarding the use of electrical stimulation to treat feeding and
swallowing disorders in the pediatric population. Retrieved June 26, 2012, from www.asha.org.
Bulow, M., Speyer, S., Baijens, L., Woisard, V., & Ekberg, O. (2008). Neuromuscular electrical
stimulation (NMES) in stroke patients with oral and pharyngeal dysfunction. Dysphagia, 23, 302309. Doi: 10.1007/s00455-007-9145-9
Carnaby-Mann, G.D., & Crary, M.A. (2007). Examining the evidence on neuromuscular electrical
stimulation for swallowing. Arch Otolaryngol Head Neck Surgery, 133, 564-571.
Clark, H., Lazarus, C., Arvedson, J., Schooling, T., & Frymark, T. (2009). Evidence-based systematic
review: Effects of neuromuscular electrical stimulation on swallowing and neural activation.
American Journal of Speech-Language Pathology, 18, 361-375.
Christiaanse, M.E., Mabe, B., Russell, G., Long Simeone, T., Fortunato, J., & Rubin, B. (2011).
Neuromuscular electrical stimulation is no more effective than usual care for the treatment of
primary dysphagia in children. Pediatric Pulmonology, 46, 559-565.
Groher, M.E., & Crary, M.A. (2010). Dysphagia: Clinical management in adults and children. Maryland
Height, Missouri: Mosby, Inc.
Heijnen, B.J., Speyer, R., Baijens, L.W.J., & Bogaardt, B.C.A. (2011). Neuromuscular electrical
stimulation versus traditional therapy in patients with Parkinson’s disease and oropharyngeal
dysphagia: Effects on quality of life. Dysphagia, doi: 10.1007/s00455-011-9371-z
References
Huckabee, M., & Doeltgen, S. (2007). Emerging modalities in dysphagia rehabilitation: neuromuscular
electrical stimulation. The New Zealand Medical Journal, 120, (1263).
Humbert, I., & Ludlow, C.L. (March 16, 2004). Electrical stimulation aids dysphagia. The ASHA Leader.
Retrieved from www.asha.org/publications.leader/2004/040316/040316c.htm
Linkov, G., Branski, R.C., Amin, M., Chernichenko, N., Chen, C., Alon, G., Langmore, S., Wong, R.J., &
Kraus, D.H. (2011). Murine model of neuromuscular electrical stimulation on squamous cell carcinoma:
Potential implications for dysphagia therapy. Head & Neck, doi: 10.1002/hed
Ludlow, C.L. (March 4, 2008). Electrical stimulation and dysphagia: What we do and
don’t know. The ASHA Leader, 13 (3), 8-11.
www.asha.org/publications.leader/2008/080304/f080304a
Permsirivanich, W., Tipehatyotin, S., Wongchai, M., Leelamait, V., Setthawatcharawanich, S.
Sathirapanya, P., Phabphal, K., Juntawises, U., & Boonmeeprakob, A. (2009). Comparing the effects of
rehabilitation swallowing
therapy vs. neuromuscular electrical stimulation therapy among stroke patients with persistent
pharyngeal dysphagia: A randomized controlled study. Journal of the Medical Association of Thailand,
92 (2), 259-265.
Steel, C.M., Thrasher, A.T., & Popovid, M.R. (2007). Electric stimulation approaches to the restoration
and rehabilitation of swallowing: a review. Neurological Research, 29, 9-15.
United States Food and Drug Administration 510 (k) summary (June 6, 2001). Dysphagia Treatment
Device.