Neuroelectrical stimulation of muscles

March 23, 2009


From my last post I have had several people contact me wondering if I am saying that electrical stimulation is not helpful and am actively discouraging its use. This is intended to clarify my thoughts.


Electrical stimulation has been shown to increase muscle mass in paralyzed individuals. Thus it is likely to be able to increase mass in people with MS. But I predict that stim alone will not be enough to restore walking. It is a long slow process to restore strength. The stim should help produce more muscle mass -- but without the exercise program the gait is less likely to return -
Application of both is likely to be the most beneficial -having a base of slowly growing the muscles should allow the gradual increase of volitional exercise. Having a PT can help identify which exercises to add to get the most benefit for the effort expended.


I don't know what happens with stim alone - there would be some rationale to think the biochemistry in the brain would be improved even without exercise -- but restoring more normal walking, sitting or other muscle functions probably requires exercise and re-education of the brain - muscle pathways.

Re the food/ micronutrient/ supplement questions


I can only report my observations on my own experience. Food - will have more micronutrient content than supplements alone -- But there may be benefits from targeted augmentation with supplements in addition to food - particularly if tailored to the individual based on medical family history etc.
Your observations about the dilemma for most who are struggling to get by is unfortunately too common - and I am sure makes it frustrating for anyone who is trying to regain their health.

Food alone -- won't solve MS - because it is multifactorial - with toxic exposures, micronutrient deficiencies, food allergies, genetic differences and infection exposures and current infections all adding up to each person's unique experience with the disease. That makes providing and finding a generalizable solution so elusive. Finding out what are you own contributions to the disease state -- requires finding someone who can unpeel the onion of all these factors.

From my own experience -- very few physicians understand this -- and I am unraveling the onion slowly myself. An organization -- institute for functional medicine has international membership of physicians and other health professionals who view chronic disease including MS through this lens. Going to there web site - you can find the pages for providers and look under the international provider listings to find someone who does.

Unfortunately I don't have many answers - only questions and my personal observations/ experiences which may or may not be generalizable to others -- I wish that I did -- and I wish that we'd get the study approved so that we could begin accumulating experience with others.


March 22, 2009
Powdered Greens, Wheat Grass and Gluten Sensitivity
For two months I believed that I was experiencing a decline in my back strength and stamina despite continued exercise, NMES and intensive nutrition. I had been using KYOGREEN to provide additional green intake during the day for the prior six months.

I had presumed that wheat grass would not have significant levels of gliadin or gluten, particularly since acutely I believed the Kyogreen improved my energy while traveling.

I have since discontinued the KYOGREEN, and have made no other changes in my routines. Now after three weeks without the KYOGREEN my stamina, and strength are back on the rebound.

I’ve decided to use my Vitamix to create my own green beverages to have at work instead of using the instant greens. I’ve been rotation between blending cilantro, parsley or kale with water and ice. It’s worked well for me. I have more energy immediately following the glass of greens. And my energy levels are better off the wheat grass.

My conclusion is that the cereal grasses likely contain the same antigens as the grain. If you have food sensitivity to gluten, likely you’ll have sensitivity to the wheat and other cereal grasses as well.

I think greens are still incredibly good for us. But it is likely preferable make your own green beverage using a blender and greens leafs that you know you can tolerate. Its a great energy boost to one's day.

tw
March 20, 2009


Home exercise program is superior to electrical stimulation.

An article on the use of functional electrical stimulation in the setting of secondary progressive multiple sclerosis was recently published in Multiple Sclerosis.

A recent study demonstrates that a physiotherapy home exercise program provides statistically more improvement to walking ability than the use of functional electrical stimulation or FES in patients with secondary progressive MS.


A randomized trial comparing the use of functional electrical stimulation (FES) to home exercise therapy for individuals with secondary progressive MS and foot drop was recently published in Multiple Sclerosis. Twenty individuals received FES to flex ankle during the swing phase of walking. Twenty four received a home exercise program. At the end of 18 weeks the home exercise group had a statistically significantly greater level of gait improvement as compared to the group using FES.



The way I interpret these findings is that exercise is a very important component of the rehabilitation of gait. FES maybe beneficial as an intervention that is equivalent to an ankle foot orthosis (AFO), but greater levels of gait rehabilitation can be achieved by using a home exercise program. NMES is the stimulation of muscles directly and is to be coupled with volitional contraction during the electrical contraction. It is also intended to be coupled with an exercise program to re-educate the muscle firing patterns to improve functional use of the muscles. While the hypertrophy of muscles may be achieved without an exercise program, re-education of the muscles important to the rehabilitation of gait

http://msj.sagepub.com/cgi/content/abstract/1352458508101320v1March 7, 2009
First published on March 12, 20090
Multiple Sclerosis


A randomized trial to investigate the effects of functional electrical stimulation and therapeutic exercise on walking performance for people with multiple sclerosis
CL Barrett, GE Mann, PN Taylor*, and P Strike

The National Clinical FES Centre, Department of Clinical Sciences and Biomedical Engineering, Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ, UK

A randomized trial comparing the use of functional electrical stimulation to
http://msj.sagepub.com/cgi/content/abstract/1352458508101320v1March 7, 2009
First published on March 12, 2009
Multiple Sclerosis March 2009

doi:10.1177/1352458508101320
* To whom correspondence should be addressed.




Background

Functional electrical stimulation (FES), is a means of producing a contraction in a paralyzed or weak muscle to enable function through electrical excitation of the innervating nerve.

Objective

This two-group randomized trial assessed the effects of single channel common peroneal nerve stimulation on objective aspects of gait relative to exercise therapy for people with secondary progressive multiple sclerosis (SPMS).

Methods

Forty-four people with a diagnosis of SPMS and unilateral dropped foot completed the trial. Twenty patients were randomly allocated to a group receiving FES and the remaining 24 to a group receiving a physiotherapy home exercise program for a period of 18 weeks.

Results

The exercise group showed a statistically significant increase in 10 m walking speed and distance walked in 3 min, relative to the FES group who showed no significant change in walking performance without stimulation. At each stage of the trial, the FES group performed to a significantly higher level with FES than without for the same outcome measures.

Conclusion

Exercise may provide a greater training effect on walking speed and endurance than FES for people with SPMS. FES may provide an orthotic benefit when outcome is measured using the same parameters. More research is required to investigate the combined therapeutic effects of FES and exercise for this patient group.
t