Neuromuscular electrical stimulation in elderly fallers
Falls in the elderly represent a major health and economic burden leading to fractures, immobility and mortality. The age-related decline in muscle mass (sarcopenia), balance deficits and altered gait parameters have been strongly linked with falling in elderly population. Physiotherapy programs targeting these parameters are effective in improving muscle power, balance and reducing falls rates.
However, there are geographical, economic and logistical barriers in many countries which prevent elders from participating in such programs. The use of home based neuromuscular electrical stimulation (NMES) has been previously shown to be effective at increasing muscle power in several groups, but high level evidence assessing the impact of NMES on elders falls risk is currently lacking.
A recently conducted systematic review addressed this issue by collating evidence from 10 studies assessing the effects of NMES on function as related to falls risk in elderly. A vast heterogeneity of dosage, program length and methods was present in the reviewed articles with 2 methods of training being prominent; NMES alone, and NMES with concurrent voluntary muscle contraction (NMES+). Further to this, the majority of studies focused on NMES training of the knee extensors or ankle dorsiflexors. The results of the review show improvement, but not always statistically/ clinically significant, in Timed Get Up and Go, Gait speed, Berg Balance Scale and muscle power in both NMES and NMES+ intervention groups, with a slight trend to increased muscle power improvements in the NMES+ populations.
This study provides the first high quality evidence that home based NMES may be a viable treatment option for reducing falls risk in the elderly. It should however, be viewed in context and with caution as it does not provide data regarding actual fall rates and demonstrates very modest improvements in associated risk factors. Other home based interventions which focus on exercise, such as the Otago program, have significantly better evidence to support their efficacy for falls reduction in this population.
In line with the current conventional wisdom, this study supports the paradigm that active movement produces greater reduction in falls risk and that passive treatments should be reserved for those who are unable to complete traditional falls reduction programs. This study also indirectly raises the interesting possible avenue of research that NMES may be a useful adjunct to traditional falls reduction programs.
> From: Langeard et al., Exp Geront 91 (2017) 88-98. All rights reserved to Elsevier Ltd. Click here for the online summary.