What is electrostimulation?
Electrostimulation therapy consists of providing pre-programmed stimulus impulses to nerves, muscles or joints through surface electrodes placed on the skin, with the aim of providing a therapeutic effect.
Two important aspects must be differentiated when it is proposed to carry out a treatment with electrostimulation, on the one hand the motor units to be stimulated, and on the other the type of current most suitable to achieve the therapeutic objective.
Motor units are made up of motor neurons and muscle fibers. They are classified according to the type of muscle fiber into red I, white IIA and white IIX. Most muscles are composed of approximately 50% red I fibers, 25% white IIA fibers, and the remaining 25% represented by white IIX fibers.
Depending on the therapeutic objective, current will be applied TENS or EMS
- TENS: it is applied in analgesia, vascularization and blood circulation processes.
- EMS: applied to gain sensory awareness and muscle strength. It is the most used for the rehabilitation of dysphagia.
Application and electrodes
- Positioning and type of electrodes: There are different sizes of electrodes and it is important to adjust them to the muscle to work to avoid synergies.
- Application techniques: In the area of speech therapy, the most used technique is bipolar, which consists of using electrodes of the same size placed in the treatment area with the same density and amount of stimulation.
Clinical application
In the speech therapy field, the clinical application is aimed at different conditions:
- Facial pain
- Temporomandibular dysfunction and bruxism
- Mouth breathing
- Orofacial motor skills
- drooling
- Oral expression
- Dysphagia
- Snoring/Apnoea
- Facial aesthetics
- sensitivity
What is an electrostimulation session like?
It is important that the professional who applies the therapy has knowledge in electrophysiology, anatomy and muscle physiology, as he will have to take into account the parameters of: intensity, frequency, cycles, duration as well as determine the duration and number of necessary sessions.
A Aspace Catalonia Foundation we have speech therapists trained in electrostimulation. From the speech therapy area of the neurorehabilitation services, intensive electrostimulation interventions applied to dysphagia and orofacial motor skills are being carried out.
They are performed between 15 and 20 sessions of thirty minutes with a frequency of two or three days a week, depending on the case and the professional's clinical criteria.
The therapy consists of combining electrostimulation with a resistance, strength or counter-resistance training program of the affected muscles together with functional activities (swallowing, chewing, breathing, voice, speech...)
Contraindications
The person's age and underlying pathology must be taken into account before electrostimulation treatment is indicated.
It is contraindicated in some cases such as epilepsy, heart disease, severe syndromic profiles, febrile states, wounds and dermatitis. In these cases, it will be the referring doctor who will assess whether you are a candidate to receive the intervention.
Scientific evidence
Currently, the quality of the scientific evidence and the degree of recommendation increasingly support the use of this tool as a complement to conventional therapy, especially in dysphagia.
The combination of rehabilitation exercises with electrostimulation favors an improvement in the strength, time and recovery of muscles involved in swallowing. The literature shows that optimal results are obtained when electrostimulation is combined with a program of resistance training and functional activities, such as swallowing.
BIBLIOGRAPHY
- Assoratgoon, I., Shiraishi, N., Tagaino, R., Ogawa, T., & Sasaki, K. (2023). Sensory neuromuscular electrical stimulation for dysphagia rehabilitation: A literature review. Journal of Oral Rehabilitation, 50(2), 157–164. https://doi.org/10.1111/JOOR.13391
- Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, Langdon K, Namara MM, Paton MC, Popat H, Shore B, Khamis A, Stanton E, Finemore OP, Tricks A, Te Velde A , Dark L, Morton N, Badawi N. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Curr Neurol Neurosci Rep. 2020 Feb 21;20(2):3. doi: 10.1007/s11910-020-1022-z. PMID: 32086598; PMCID: PMC7035308.
- Sun, Y., Chen, X., Qiao, J., Song, G., Xu, Y., Zhang, Y., Xu, D., Gao, W., Li, Y., & Xu, C. (2020). Effects of Transcutaneous Neuromuscular Electrical Stimulation on Swallowing Disorders: A Systematic Review and Meta-Analysis. American Journal of Physical Medicine & Rehabilitation, 99(8), 701–711. https://doi.org/10.1097/PHM.0000000000001397
- Wright, PA, Durham, S., Ewins, DJ, & Swain, ID (2012). Neuromuscular electrical stimulation for children with cerebral palsy: A review. Archives of Disease in Childhood, 97(4), 364–371. https://doi.org/10.1136/archdischild-2011-300437
- Yan, D., & Vassar, R. (2021). Neuromuscular electrical stimulation for motor recovery in pediatric neurological conditions: a scoping review. Developmental Medicine and Child Neurology, 63(12), 1394–1401. https://doi.org/10.1111/DMCN.14974
