Alex Jacobs

Thanks for closing out this season of Twitter Thursdays with me! It was a great discussion #PT582 #AJ

@kolbyareed #PT582 #AJ Do you think NMES could be used past the acute stage?

#PT582 #AJ I think that nmes could be used in the acute stage and provide benefit. This review provides some guidelines for its use. ncbi.nlm.nih.gov/pmc/articles/P…

@ds_DPT #PT582 #AJ Do you think this article has a sufficient amount of research to always use NMES with stroke patients? Would there be a situation you don't want to use this tx?

This article shows that NMES can be effectively used in stroke patients to treat shoulder subluxation. #PT582 #AJ pubmed.ncbi.nlm.nih.gov/28343442/

@JacquelineTorpy #PT582 #AJ It as mentioned earlier by @bonniediamond53 that if the nerve is not intact then NMES won't work.. what level of intact does the nerve need to be for this tx to be used?

@AlexJacobs_SPT #PT582 #AJ NMES may be useful if the dislocation caused damage to the nerves of the brachial plexus and limited their ability to successfully send a contraction signal to the muscles, so NMES could help with that neuromuscular reeducation and (1/2)

Woah! It’s Twitter Thursday, can’t wait to hear what you all have to say! #PT582 #AJ

@jacquedompier #PT582 #AJ What other interventions do you think would be helpful? And in what situations would you choose them over NMES?

@AlexJacobs_SPT #AJ #PT582 2/2 arm function or pain! I think there are other interventions that would assist in the other issues that accompany a subluxation; nonetheless, it seems that there is a role for this intervention for this type of injury!

@DBlair_NAUSPT #PT582 #AJ If a patient is having so much pain they are unable to move do you think the NMES tx would also cause them pain/make them uncomfortable? Would you still continue tx?

@AlexJacobs_SPT #PT582 #AJ NMES could be more beneficial than strengthening exercises if movement causes someone so much pain they are unable to perform exercises - having some muscle stimulation over none is always preferable. Once they can perform exercises they should transition over.

@CaitieBell1 Amazing that you have seen it! Did the pt make good progress with this treatment/did you feel like it was the appropriate tx looking back?

@AlexJacobs_SPT #AJ #PT582 I've seen NMES used when the pt has instability or strength <3/5. It assists with atrophy reduction and muscle strengthening, therefore providing more stability to an unstable joint by activating muscles without necessarily having to perform an exercise.

@_Erin_Peterson @LukasBarker #PT582 #AJ Great idea! How would you ensure that the shoulder is stabilized in the water if it was already subluxed or at high risk?

@JordynMaxwell2 #PT582 #AJ Great point!! What other populations are you primarily thinking you would want to use this with?

I found a good amount of research on NMES post-stroke to treat both shoulder pain and subluxation. Most of the research I was able to find is specific to this population, but I am curious about carryover to other populations. #PT582 #AJ pubmed.ncbi.nlm.nih.gov/15129391/

@LukasBarker #PT582 #AJ I agree building strength and stability is key! Would there be another tool you would prefer using to help with the strengthening exercises or would you stick to the traditional exercise?

@McCarthyShealey #PT582 #AJ Would strength training still be as beneficial if the pt does not keep up with their exercises?

@AlexJacobs_SPT #PT582 #AJ while I think both have a place in treatment and could be used in conjunction with each other, for muscular injuries, I would say strength training would be more beneficial in the long run, because NMES is only providing relief while being delivered to the pt

@bonniediamond53 #PT582 #AJ If the pt did not have an intact nerve do you have any other ideas for treatment?

@HaydenHoekstra #PT582 #AJ Great thoughts on intensity! Would there be a time when you would want to use a higher intensity with neuro pts?

#PT582 #AJ I think I would turn to NMES once strengthening exercises do not prove to be beneficial or working. I think I would approach musculoskeletal by having higher intensity to get a good contraction but treat neurological with a lower intensity to assist it fire the muscle.

@abigail_lue #PT582 #AJ How would you determine if the pt is able to begin/complete the strengthening exercises?

(2/2) I think it would be important to begin strengthening to muscles around the shoulder to actively prevent subluxation once the pt is able to though. We don't want them to rely on modalities forever! #PT582 #AJ

(1/2) A meta-analysis by Lee et al found that NMES was effective for dec subluxation in the acute stages after a stroke. This is bc, subluxation, coupled with severe hypotonia can lead to further dec in ROM & stretching of the joint capsule #PT582 #AJ

@NathanTurley4 #PT582 #AJ If we are not reducing pain or improving function with this treatment do you think that it is still a viable option?

#PT582 #AJ In this study they found Estim can be used to prevent or reduce shoulder subluxation early after stroke. However, it should not be used to reduce pain or improve upper arm motor function after stroke. ncbi.nlm.nih.gov/pmc/articles/P…

@Karmae20 #PT582 #AJ Great insight! Do you know how long you would have to use the tx for it to be helpful? How long do strength training effects last if the pt does not continue with exercise?

#PT582 #AJ In a quick search, I saw that both are helpful in the prevention. However I did see that NMES does not tend to have lasting effects after treatment is stopped. I would use both, but strength training would be more emphasized to ensure that the training would last

@JessicaTeply #PT582 #AJ Would you use this technique with patients who have general weakness rather than difficulty with neural activation?

Shoulder NMES in combo w/ PT has been shown to have positive effects on pts. w/ post-stroke hemiplegia. A good technique for start of rehab to⬆️muscle hypertrophy & ⬇️subluxation risk in pts. who have difficulty w/ neural activation of muscles. #AJ #PT582 ncbi.nlm.nih.gov/pmc/articles/P…

@MorganDrew16 #PT582 #AJ Would it be worth using it in the short term always or would there be a point where you would always stick to the strengthening exercises for prevention?

#PT582 #AJ NMES can be used to prevent shoulder subluxation especially poststroke in the acute phases, it does not seem to support long term prevention without continued treatment. Strengthening exercises should be used in combination with this treatment for long term benefits.

@ColleenDrisSPT Great article! Would you still want to use it if you were seeing the pt more than 6 weeks post injury? Or would that rule it out? #PT582 #AJ

#AJ #PT582 I found NMES use on stroke pt to help with sublex. This review said it is more effective when used within 6 wks of injury with strength training. At the start, I think it is good but after they have the neuro control it may not be as beneficial. ncbi.nlm.nih.gov/pmc/articles/P…