tangular wave form, indirect application, maximally
tolerated intensity) as the only mode of
treatment is a useful tool in the treatment of
chondromalacia patellae, where significant
quadriceps atrophy exists. The degree of
strength improvement ranged from 25-200%
and was observed to be directly dependent on
the intensity of the electrical stimulation tolerated
and the severity of the patient's condition. Furthermore,
thigh girth increased slightly (5.1%)
and the majority of patients reported a decrease
in pain. This study did not utilize other exercise
or treatment groups, or a control group for comparison,
so generalization must be made with
caution.
Williams and Streetz5 reported that electrical
stimulation in combination with active exercises
was the most successful technique in restoring
the function of the quadriceps muscles. However,
this clinical report utilized electrical stimulation
primarily as a kinesthetic reeducation
technique for the vastus medialis muscle in patients
who lacked normal voluntary control. Electrical
stimulation alone was said not to be as
effective as when combined with exercises. Description
of the exercises used in conjunction
with the electrical stimulation was not provided.
The specific current format and application technique
were described as follows: faradic, 2.8-
3.8-second rest between pulses, and surged
current intensity as tolerated by the patient. The
duration of contractions and current frequency
were unspecified. Quadriceps strength scores
were not reported; however, a mean thigh girth
increase of 0.4 inch was observed after a mean
of 12 treatments.
Millardqg found electrical stimulation to be of
little value in the restoration of quadriceps
strength and thigh girth, and in the reduction of
knee effusion following immobilization postknee
trauma. Although the electrical stimulation only
group (faradic, 30-50 cycles per second, rectangular
wave form, 1 -millisecond duration
pulses) demonstrated slightly greater thigh girth
than did the voluntary exercise group, no differences
in strength or effusion remission were
observed between the two groups. However, in
this study the electrical stimulation delivered was
only of sufficient intensity to raise the heel during
knee extension. The low strength training stimulus
may have accounted for the low strength
scores.
Curwin et reported that 1 year's clinical
use of an electrical stimulator, which claims to
Frequently, researchers working in the area of
electrical stimulation have not made it clear exactly
what they have done or how. The specifics
of current format and its application technique
are often missing in published articles. Recognition
has not been given to the fact that the
possible combinations of electrical stimulation
current format and application techniques for
each are very numerous. Whether similar
strength improvements would be observed with
different combinations has not been a consideration
in the available literature.
In view of the implications associated with the
potential use of electrical stimulation as a
strength improvement technique and the publicity
being given this procedure, it is imperative
that sound scientific evaluation be undertaken.
Unless studies possess a sound scientific basis,
normal and injured individuals may undergo uncomfortable
and unnecessary electrical stimulation
treatments, which may be no more effective
than traditional simple voluntary exercise programs.
However, electrical stimulation could revolutionize
the approach to muscular strength
development in patients, normal individuals, and
athletes.
Despite the fact that the technique of high
intensity electrical stimulation may not be a viable
technique for all rehabilitation patients, it is
the responsibility of rehabilitation personnel to
know what the most effective techniques are and
to make such treatment available. Such knowledge
can only be gained through scientific and
comparative investigation.
At the present time, the available literature
does not support claims made for the Russian
technique of electrical stimulation. However, insufficient
scientific
duplicate the Russian current format, has not
demonstrated results similar to those reported
by Kots in either abnormal or normal muscle.
Although skin sensory discomfort was minimal,
considerable muscle discomfort, similar to muscle
cramp, was reported. Furthermore, maximally
tolerated electrical stimulation contractions
did not produce as much force as did
voluntary isometric contractions of the same
muscle group, which is again contrary to informatior!
reported by Kots.I4 Although strength
scores were not reported, Curwin et al.4 concll~ded
that electrical stimulation is of value in
limiting the extent of biochemical changes associated
with atrophy accompanying immobilization,
but it is not as effective or as pain-free as
claimed.
The rehabilitation electrical stimulation studies
cited have utilized different treatment technlques,
different current formats, and different
patient populations, due to having different levels
of severity in different conditions. Generalization
in these multivariate situations must be made
with caution. That electrical stimulation can be
utilized as an effective means of improving
strength of weakened muscle is generally agreed
upon. However, disagreement is apparent as to
how effective electrical stimulation is in relation
to voluntary exercise programs and in relation to
total strength gain. Whether electrical stimulation
should be utilized until normal strength levels
have been achieved has not been examined.
Furthermore, the question of whether the ultimate
benefit is great enough to warrant use of
electrical stimulation, in place of, or in combination
with, traditional exercise, has not been