To Sum Up...

Over the past four weeks we have covered a lot of information on the use of NMES. So to re-cap, NMES is a form of electrical stimulation where by a high intensity short duration electrical stimulation is applied to a normally innervated but weakened muscle in order to elicit a contraction. The premise being that by forcing the 

muscle to contract, the muscle will strengthen allowing the child to function normally.

There are no recommended ‘safe’ parameters for NMES use on children; however it is common practice to start with low settings and gradually increase until the desired effect is attained without causing pain or distress. This threshold will vary between clients. The parameters must be gradually increased at the start of each application. 

When using NMES in children it is important to remember that, depending on the age of the child and the degree of disability, they may not understand what you are asking of them. NMES must be introduced slowly so that the child adjusts to the therapy in order for it to be successful. It is a good idea to apply the treatment to the parent first to eliminate any worries that they may inadvertently pass onto the child. 

There are many contraindications and precautions that you must screen for before beginning NMES treatment on any client but extra attention must be paid if treating a child. I believe that the precautions most likely to affect CP children are skin conditions, infection and, especially in this day and age, obesity.  However, the other precautions should not be disregarded.

There are contraindications regarding the placement of electrodes as well and these should be strictly adhered to. It is also important to choose the correct size electrode for the muscle being stimulated and have a reasonable distance between the electrodes (i.e. neither too far apart nor too close).

There is quite a lot of research out there on NMES and other electrotherapy modalities for treating CP children. These studies show a positive result after NMES treatment however, there seems to be a lack of control groups in these studies, so we don’t know how much of the improvement is due to the NMES or natural improvement. There is definitely a need for more study in this area however based on the current research I would not hesitate to prescribe NMES treatment to a CP child with a muscle weakness as anything we can do to improve these children’s quality of life is definitely worthwhile.