title: Neuromuscular electrical stimulation and exercise for reducing trapezius muscle dysfunction in survivors of head and neck cancer: a case-series report.
abstract: OBJECTIVE
  Damage to the spinal accessory nerve (SAN) can result in denervation of the trapezius muscle in patients undergoing surgery for head and neck cancer. Trapezius denervation leads to muscle weakness and dysfunction that, for some patients, persists despite the return of conduction along the SAN. This prospective case series describes an intervention involving a combination of a novel type of neuromuscular electrical stimulation (NMES) with bilateral exercise.
  
  
  METHODS
  Three survivors of head and neck cancer participated in the 6-week program. NMES was applied over the region of the SAN on the affected side while subjects performed bilateral voluntary scapular retraction and elevation exercises against resistance. The NMES was delivered using relatively wide pulse widths and high frequencies to enhance the electrically evoked sensory volley and was triggered by the onset of trapezius muscle activity on the non-affected side. Shoulder range of motion (ROM) assessments and patient-rated outcomes were administered at baseline and 6 weeks.
  
  
  RESULTS
  All patients showed improvements in shoulder flexion and abduction ROM and reported reductions in pain and disability.
  
  
  CONCLUSIONS
  This combination of NMES and bilateral exercise may prove to be an effective component of a comprehensive shoulder rehabilitation program for patients with persistent trapezius muscle dysfunction as a result of SAN damage.
authors.affiliation: Hospital Side Physical Therapy.
authors.forename: Evan R L
authors.initials: ER
authors.lastname: Baldwin
authors.forename: Terri D
authors.initials: TD
authors.lastname: Baldwin
authors.forename: Josh S
authors.initials: JS
authors.lastname: Lancaster
authors.forename: Margaret L
authors.initials: ML
authors.lastname: McNeely
authors.forename: David F
authors.initials: DF
authors.lastname: Collins
keywords: electric stimulation; head and neck neoplasms; muscle contraction; muscular atrophy; rehabilitation