How We Facilitate Neurological Rehabilitation, and Why:
At Absolute Physical Therapy we serve patients with a variety of neurological ailments, including cerebral palsy, stroke, traumatic brain injury, or spinal cord injury.
Depending on the nature of the diagnosis, the therapist and the patient work together to restore lost strength of the neurologically impaired muscles. This sometimes includes efforts to further strengthen surrounding muscles to compensate for areas that are unlikely to be restored.
Exercise programs include balance drills and functional training exercises, which are done with goals to restore strength and endurance of core muscles, arms, and legs. Along with these exercises, EMS is also used to facilitate recovery for neurological and functional impairment.
Strength and Conditioning
Studies show that exercise principles of overload that work for increasing fitness in normal subjects work better than traditional “physical therapy” calisthenic type exercises in patients with Parkinson’s disease. The good news is that exercise programs for patients with Parkinson’s disease don’t particularly have to be complex, and can often be maintained at fitness centers after formal physical therapy is over.
Recently published studies conclude that not only is electrical muscle stimulation (EMS) safe for treating many causes or side effects of neurological and functional impairment, but that next to exercise it appears to be the most powerful out there. Absolute Physical Therapy uses EMS, which consistently yields positive results, in order to:
- Increase sensation and decrease pain in neuropathy
- Increase muscle strength and hypertrophy
- Increase bone density
- Improve circulation
- Achieve aerobic effects
New research is being published and utilized at Absolute Physical Therapy very frequently.
EMS for Paraplegia
Classically, electrical muscle stimulation works well for upper motor neuron lesions; which are typical of cervical spinal cord injury because the sensory and motor neurons between the muscles and the spinal cord is intact. However, what is missing is input from the brain turning on, or off in the case of clonus or spasticity, muscle contractions. Because the spinal cord ends at at ~L1-2, at which point spinal nerves exit the cord forming the cauda equina, an injury here disrupts the reflex arc between the leg muscles and the spinal cord. Since electric muscle stimulation (EMS) generally works by first activating the motor nerves, which then indirectly activate their respective muscles, and those nerves are damaged with lower motor neuron injuries, EMS is generally not effective for non-spastic paraplegia.
NMES (neuromuscular electrical stimulation pays homage to the nerve-muscle distinction in it’s name. EMS seems to have won out in the terminology/popularity war. The presence of spasticity in the leg muscles, however, is an indication that those nerves are still intact and conventional EMS should then work.
EMS with complete spinal cord injury has not been shown to restore function, but benefits do include preserving muscle health, increasing cardiovascular health, increasing bone mineral density, provide some muscle cushion to lessen risk of pressure ulcers. All are good things that would be great if they could be extended to those with lower motor neuron injuries.
EMS for Aerobics
Results suggest that subtetanic NMES can elicit a consistent aerobic exercise response without undue discomfort and could be considered as an alternative exercise modality.
I read this paper maybe a year ago when I was somewhere into my year of electric stimulation instead of weights for exercise, and was able to reproduce their procedure with my equipment and obtain results of my own. Did I like it? Not really, but at lower intensities it would feel better and probably still get circulation going well enough to be helpful for those with injuries. Also I intend to try it on patients with quadriplegia as alternative the the electric stimulation bicycles, which are prohibitively expensive and very difficult to set up.
For uninjured people I think EMS for aerobics has promise, but isn’t yet worked out well enough to be practical. It’s something I want to continue to read about, work on, and experiment with but it’s tough because it’s painful. It feels considerably sharper than EMS for strengthening and my favorite strengthening protocols only run 10 minutes long. For cardio I do a 30 minute program, for which the last 10 minutes are particularly punishing, so it needs work; unfortunately that work isn’t particularly pleasant so it’s hard to stay motivated. I’ve done literally hundreds if not thousands of self treatments with EMS for strength, but for aerobics I have only done five.
EMS and Stroke
I’m only recently starting to look into the data for EMS for restoring function post stroke, and from the reviews I have read there is a lot of research that shows it works.
Chad’s latest innovations for the treatment of neuropathy take a look at diet related changes. These diet related changes show very positive influences on risk factors for neuropathy, reducing insulin and improving insulin sensitivity, and lessening atherosclerotic plaque; all of which seems to be the causal factors behind neuropathy and are now being shown to actually improve peripheral nerve survival. Similar searches have provided articles showing positive effects of diet of victims of ischemic stroke and Parkinson’s disease.
Intermittent Fasting and Stroke Recovery
I recently read a study exploring whether Intermittent fasting (IF) is neuroprotective after ischemia, which was tested on mice. Rather than using an every other day feeding form of intermittent fasting (which I expect no human would want to do for long), they set mice up in an eight hour window of eating every day, followed by a 16 hour fast, which is a type of intermittent fasting which has been termed “time restricted feeding” where you eat only during certain hours each day. This is similar to the “Fast 5” diet that I’m trying out right now, which differs only slightly in that it’s a five hour eating window rather than an eight used in this study.
When put on alternate day feeding, the latter strain of mice was almost twice as much; such that they didn’t lose weight, but still had neuroprotective benefits. This study where the mice ate every day in the eight hour window, ate less and had lesser weight in comparison the AL mice. The authors thought this type of diet would perhaps give the best of both worlds, combining the health benefits of both intermittent fasting and caloric restriction, and I think that may be an advantage for the “time restricted feeding” as compared to the “every other day” fasting schedule.