Physical Therapy Korea (한국전문물리치료학회지)

Korean Research Society of Physical Therapy (한국전문물리치료학회)
권호 표지
DOI QR코드

DOI QR Code

Immediate Effect of Neuromuscular Electrical Stimulation on Balance and Proprioception During One-leg Standing

  • Je, Jeongwoo (Injury Prevention and Biomechanics Laboratory, Department of Physical Therapy, Yonsei University) ;
  • Choi, Woochol Joseph (Injury Prevention and Biomechanics Laboratory, Department of Physical Therapy, Yonsei University)
  • Received : 2022.07.04
  • Accepted : 2022.08.04
  • Published : 2022.08.20
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Neuromuscular electrical stimulation (NMES) is a physical modality used to activate skeletal muscles for strengthening. While voluntary muscle contraction (VMC) follows the progressive recruitment of motor units in order of size from small to large, NMES-induced muscle contraction occurs in a nonselective and synchronous pattern. Therefore, the outcome of muscle strengthening training using NMES-induced versus voluntary contraction might be different, which might affect balance performance. Objects: We examined how the NMES training affected balance and proprioception. Methods: Forty-four young adults were randomly assigned to NMES and VMC group. All participants performed one-leg standing on a force plate and sat on the Biodex (Biodex R Corp.) to measure balance and ankle proprioception, respectively. All measures were conducted before and after a training session. In NMES group, electric pads were placed on the tibialis anterior, gastrocnemius, and soleus muscles for 20 minutes. In VMC group, co-contraction of the three muscles was conducted. Outcome variables included mean distance, root mean square distance, total excursion, mean velocity, 95% confidence circle area acquired from the center of pressure data, and absolute error of dorsi/plantarflexion. Results: None of outcome variables were associated with group (p > 0.35). However, all but plantarflexion error was associated with time (p < 0.02), and the area and mean velocity were 37.0% and 18.6% lower in post than pre in NMES group, respectively, and 48.9% and 16.7% lower in post than pre in VMC group, respectively. Conclusion: Despite different physiology underlying the NMES-induced versus VMC, both training methods improved balance and ankle joint proprioception.

Keywords

Acknowledgement

This study was supported by the "Brain Korea 21 FOUR Project" and the Korean Research Foundation for the Department of Physical Therapy at the Yonsei University.

References

  1. Sjolund B, Terenius L, Eriksson M. Increased cerebrospinal fluid levels of endorphins after electro-acupuncture. Acta Physiol Scand 1977;100(3):382-4. https://doi.org/10.1111/j.1748-1716.1977.tb05964.x
  2. Godfrey S. Principles and practice of electrical epilation. London: Routledge; 2007.
  3. Mendel FC, Fish DR. New perspectives in edema control via electrical stimulation. J Athl Train 1993;28(1):63-74.
  4. Reed BV. Effect of high voltage pulsed electrical stimulation on microvascular permeability to plasma proteins. A possible mechanism in minimizing edema. Phys Ther 1988;68(4):491-5. https://doi.org/10.1093/ptj/68.4.491
  5. Alon G, Levitt AF, McCarthy PA. Functional electrical stimulation enhancement of upper extremity functional recovery during stroke rehabilitation: a pilot study. Neurorehabil Neural Repair 2007;21(3):207-15. https://doi.org/10.1177/1545968306297871
  6. Kowalczewski J, Gritsenko V, Ashworth N, Ellaway P, Prochazka A. Upper-extremity functional electric stimulation-assisted exercises on a workstation in the subacute phase of stroke recovery. Arch Phys Med Rehabil 2007;88(7):833-9. https://doi.org/10.1016/j.apmr.2007.03.036
  7. Liberson WT, Holmquest HJ, Scot D, Dow M. Functional electrotherapy: stimulation of the peroneal nerve synchronized with the swing phase of the gait of hemiplegic patients. Arch Phys Med Rehabil 1961;42:101-5.
  8. Knutson JS, Hisel TZ, Harley MY, Chae J. A novel functional electrical stimulation treatment for recovery of hand function in hemiplegia: 12-week pilot study. Neurorehabil Neural Repair 2009;23(1):17-25. https://doi.org/10.1177/1545968308317577
  9. Miller BF, Gruben KG, Morgan BJ. Circulatory responses to voluntary and electrically induced muscle contractions in humans. Phys Ther 2000;80(1):53-60. https://doi.org/10.1093/ptj/80.1.53
  10. Scremin OU, Cuevas-Trisan RL, Scremin AM, Brown CV, Mandelkern MA. Functional electrical stimulation effect on skeletal muscle blood flow measured with H215O positron emission tomography. Arch Phys Med Rehabil 1998;79(6):641-6. https://doi.org/10.1016/S0003-9993(98)90037-5
  11. Sherry JE, Oehrlein KM, Hegge KS, Morgan BJ. Effect of burstmode transcutaneous electrical nerve stimulation on peripheral vascular resistance. Phys Ther 2001;81(6):1183-91. https://doi.org/10.1093/ptj/81.6.1183
  12. Gardner SE, Frantz RA, Schmidt FL. Effect of electrical stimulation on chronic wound healing: a meta-analysis. Wound Repair Regen 1999;7(6):495-503. https://doi.org/10.1046/j.1524-475x.1999.00495.x
  13. McCaig CD, Rajnicek AM, Song B, Zhao M. Controlling cell behavior electrically: current views and future potential. Physiol Rev 2005;85(3):943-78. https://doi.org/10.1152/physrev.00020.2004
  14. Nuccitelli R. A role for endogenous electric fields in wound healing. Curr Top Dev Biol 2003;58(2):1-26. https://doi.org/10.1016/S0070-2153(03)58001-2
  15. Currier DP, Mann R. Muscular strength development by electrical stimulation in healthy individuals. Phys Ther 1983;63(6):915-21. https://doi.org/10.1093/ptj/63.6.915
  16. Massey BH, Nelson RC, Sharkey BC, Comden T, Otott GC. Effects of high frequency electrical stimulation on the size and strength of skeletal muscle. J Sports Med Phys Fitness 1965;5(3):136-44.
  17. Wolf SL, Ariel GB, Saar D, Penny MA, Railey P. The effect of muscle stimulation during resistive training on performance parameters. Am J Sports Med 1986;14(1):18-23. https://doi.org/10.1177/036354658601400104
  18. Laughman RK, Youdas JW, Garrett TR, Chao EY. Strength changes in the normal quadriceps femoris muscle as a result of electrical stimulation. Phys Ther 1983;63(4):494-9. https://doi.org/10.1093/ptj/63.4.494
  19. McMiken DF, Todd-Smith M, Thompson C. Strengthening of human quadriceps muscles by cutaneous electrical stimulation. Scand J Rehabil Med 1983;15(1):25-8.
  20. American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 2009;41(3):687-708. https://doi.org/10.1249/MSS.0b013e3181915670
  21. Caggiano E, Emrey T, Shirley S, Craik RL. Effects of electrical stimulation or voluntary contraction for strengthening the quadriceps femoris muscles in an aged male population. J Orthop Sports Phys Ther 1994;20(1):22-8. https://doi.org/10.2519/jospt.1994.20.1.22
  22. Kamel DM, Yousif AM. Neuromuscular electrical stimulation and strength recovery of postnatal diastasis recti abdominis muscles. Ann Rehabil Med 2017;41(3):465-74. https://doi.org/10.5535/arm.2017.41.3.465
  23. Henneman E. Relation between size of neurons and their susceptibility to discharge. Science 1957;126(3287):1345-7. https://doi.org/10.1126/science.126.3287.1345
  24. Tokuno CD, Carpenter MG, Thorstensson A, Cresswell AG. The influence of natural body sway on neuromuscular responses to an unpredictable surface translation. Exp Brain Res 2006;174(1):19-28. https://doi.org/10.1007/s00221-006-0414-x
  25. Bickel CS, Gregory CM, Dean JC. Motor unit recruitment during neuromuscular electrical stimulation: a critical appraisal. Eur J Appl Physiol 2011;111(10):2399-407. https://doi.org/10.1007/s00421-011-2128-4
  26. Binder-Macleod SA, Halden EE, Jungles KA. Effects of stimulation intensity on the physiological responses of human motor units. Med Sci Sports Exerc 1995;27(4):556-65.
  27. Gregory CM, Bickel CS. Recruitment patterns in human skeletal muscle during electrical stimulation. Phys Ther 2005;85(4):358-64. https://doi.org/10.1093/ptj/85.4.358
  28. Knaflitz M, Merletti R, De Luca CJ. Inference of motor unit recruitment order in voluntary and electrically elicited contractions. J Appl Physiol (1985) 1990;68(4):1657-67. https://doi.org/10.1152/jappl.1990.68.4.1657
  29. Guney H, Kaya D, Citaker S, Kafa N, Yosmaoglu B, Yetkin I, et al. Is there any loss of ankle proprioception in diabetic patients without neuropathy? Isokinet Exerc Sci 2013;21(4):317-23. https://doi.org/10.3233/IES-130503
  30. Chen X, Qu X. Age-related differences in the relationships between lower-limb joint proprioception and postural balance. Hum Factors 2019;61(5):702-11. https://doi.org/10.1177/0018720818795064
  31. Coelho VK, Gomes BSQ, Lopes TJA, Correa LA, Telles GF, Nogueira LAC. Knee proprioceptive function and physical performance of patients with patellofemoral pain: a matched case-control study. Knee 2021;33:49-57. https://doi.org/10.1016/j.knee.2021.08.031
  32. Amiridis I, Arabatzi F, Violaris P, Stavropoulos E, Hatzitaki V. Static balance improvement in elderly after dorsiflexors electrostimulation training. Eur J Appl Physiol 2005;94(4):424-33. https://doi.org/10.1007/s00421-005-1326-3
  33. Mignardot JB, Deschamps T, Le Goff CG, Roumier FX, Duclay J, Martin A, et al. Neuromuscular electrical stimulation leads to physiological gains enhancing postural balance in the prefrail elderly. Physiol Rep 2015;3(7):e12471. https://doi.org/10.14814/phy2.12471
  34. Kornetti DL, Fritz SL, Chiu YP, Light KE, Velozo CA. Rating scale analysis of the Berg Balance Scale. Arch Phys Med Rehabil 2004;85(7):1128-35. https://doi.org/10.1016/j.apmr.2003.11.019
  35. Kear BM, Guck TP, McGaha AL. Timed Up and Go (TUG) test: normative reference values for ages 20 to 59 years and relationships with physical and mental health risk factors. J Prim Care Community Health 2017;8(1):9-13. https://doi.org/10.1177/2150131916659282
  36. Greve J, Alonso A, Bordini AC, Camanho GL. Correlation between body mass index and postural balance. Clinics (Sao Paulo) 2007;62(6):717-20. https://doi.org/10.1590/S1807-59322007000600010
  37. Greve JM, Cug M, Dulgeroglu D, Brech GC, Alonso AC. Relationship between anthropometric factors, gender, and balance under unstable conditions in young adults. Biomed Res Int 2013;2013:850424. https://doi.org/10.1155/2013/850424
  38. Kim S, Lim K, Choi WJ. Effect on the center of pressure of vision, floor condition, and the height of center of mass during quiet standing. Phys Ther Korea 2021;28(2):154-60. https://doi.org/10.12674/ptk.2021.28.2.154
  39. Rennie S. Electrophysical agents. Contraindications and precautions: an evidence-based approach to clinical decision making in physical therapy. Foreword. 2010;62(5):1-3.
  40. Doyle RJ, Hsiao-Wecksler ET, Ragan BG, Rosengren KS. Generalizability of center of pressure measures of quiet standing. Gait Posture 2007;25(2):166-71. https://doi.org/10.1016/j.gaitpost.2006.03.004
  41. Murray MP, Seireg AA, Sepic SB. Normal postural stability and steadiness: quantitative assessment. J Bone Joint Surg Am 1975;57(4):510-6. https://doi.org/10.2106/00004623-197557040-00012
  42. Prieto TE, Myklebust JB, Hoffmann RG, Lovett EG, Myklebust BM. Measures of postural steadiness: differences between healthy young and elderly adults. IEEE Trans Biomed Eng 1996;43(9):956-66. https://doi.org/10.1109/10.532130
  43. Acaroz Candan S, Akoglu AS, Bugusan S, Yuksel F. Effects of neuromuscular electrical stimulation of quadriceps on the quadriceps strength and functional performance in nursing home residents: a comparison of short and long stimulation periods. Geriatr Gerontol Int 2019;19(5):409-13. https://doi.org/10.1111/ggi.13633
  44. Hammami R, Behm DG, Chtara M, Ben Othman A, Chaouachi A. Comparison of static balance and the role of vision in elite athletes. J Hum Kinet 2014;41:33-41. https://doi.org/10.2478/hukin-2014-0030
  45. Luo H, Wang X, Fan M, Deng L, Jian C, Wei M, et al. The effect of visual stimuli on stability and complexity of postural control. Front Neurol 2018;9:48. https://doi.org/10.3389/fneur.2018.00048
  46. Collins AT, Blackburn JT, Olcott CW, Dirschl DR, Weinhold PS. The effects of stochastic resonance electrical stimulation and neoprene sleeve on knee proprioception. J Orthop Surg Res 2009;4:3. https://doi.org/10.1186/1749-799X-4-3
  47. Li JX, Xu DQ, Hoshizaki B. Proprioception of foot and ankle complex in young regular practitioners of ice hockey, ballet dancing and running. Res Sports Med 2009;17(4):205-16. https://doi.org/10.1080/15438620903324353