Recent evidence affirms the rationale of applying NMES to paralyzed or paretic muscles in order modulate central nervous system (CNS) plasticity. NMES induces transmission of afferent inputs along sensory pathways originating from both muscular and non-contractile structures. Kimberley et al., (2004) Han et al. (2003) and Smith et al. (2003) have presented evidence of increased excitability in the contralateral hemisphere following excitation of selected peripheral nerves of both stroke survivors and healthy subjects (see Volume I, Chapters 6, 14 and 15).
A potential role for NMES in promoting recovery following damage to the brain is derived from the hypothesis of territorial competition. The hypothesis is based on evidence that the cortical representation of body segments is continuously modulated in response to activity, inactivity, and skill acquisition. As part of this ongoing adaptation process there seems to be competition among body segments for territorial representation in the sensorimotor cortex (Muellbacher et al., 2002). Artificial alteration of afferent inputs can be achieved with NMES via amplification and sustaining of afferent vollies from the more deprived distal segments, thus helping those segments compete for territorial representation. NMES treatment groups have shown at least a 50% improvement over controls in Fugl-Meyer (Chae et al., 1998) action research arm (ARA) test scores (Powell et al., 1999), and upper limb advanced distributed learning tests (Popovic et al., 2003) in various populations.
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