Over 50 clinical studies are published on the application of stimulation for modification of spasticity. Three approaches have been used. The first approach uses sensory stimulation over the spastic muscle group. The second approach elicits muscle contraction in the antagonist muscle group for strengthening and simultaneous stretch of the spastic muscles. The third, most recent approach has been to stimulate alternately both agonists and antagonists (Alon et al., 1998, 2003). All three approaches have been statistically equally beneficial. Many patients are likely to experience a long-term reduction in spasticity of about 0.7-1 notch on the 0-5 Ashworth scale, a rather modest effect that may not justify prescribing NMES for the sole purpose of spasticity management. For additional information on the mechanisms and management of spasticity, see Volume II, Chapter 17.

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