PubMed · 12230652
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Gregory Rubin. 2002. Constipation.. https://pubmed.ncbi.nlm.nih.gov/12230652/
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Neuromuscular electrical stimulation may have an important role in improving the motor function of stroke survivors. Active, repetitive movement training mediated by transcutaneous cyclic and EMG-triggered NMES may facilitate the motor recovery of stroke survivors. Multicenter, double-blinded, randomized clinical trials should be pursued to confirm the motor-relearning effects of transcutaneous NMES and to define appropriate prescriptive specifications. Intramuscular EMG-controlled NMES may be superior to transcutaneous systems and is presently undergoing preliminary randomized clinical trials. Neuroprostheses systems may provided the highest level of goal-oriented activity and cognitive investments, which may lead to significant motor relearning. Implementation of clinically viable neuroprosthesis systems, however, will probably require additional technical developments including more reliable control paradigms and methods for blocking undesirable muscle contractions. In view of the dynamic nature of the present health care environment, the future of NMES technology is difficult to predict. By necessity, scientists and clinicians must continue to explore new ideas and to improve on the present systems. Components will be smaller, more durable, and more reliable. Control issues will remain critical for both motor relearning and neuroprosthetic applications, and the implementation of cortical control is likely to dictate the nature of future generations of NMES systems. Finally, consumers will direct future developments. In the present health care environment, where cost has become an overwhelming factor in the development and implementation of new technology, the consumer will become one of technology's greatest advocates. The usual drive toward greater complexity will be tempered by the practical issues of clinical implementation, where patient acceptance is often a function of a tenuous balance between the burden or cost associated with using a system and the system's impact on the user's life.
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Many of the techniques and skills the average front-line practitioner possesses (such as intake, psychological testing, cognitive behavior therapy, and relaxation therapy) can be readily and effectively applied to a chronic-pain population. More specialized techniques for pain reduction, such as biofeedback training, can be easily learned by the generalist clinician with a minimum of additional training. In this article, four general steps to assess and reduce chronic pain are reviewed. Through careful use of the available research literature, and by consulting with a colleague who has expertise in chronic pain, most psychologists can straightforwardly begin to help individuals suffering from chronic pain.