cjhs Kapadokya Sağlık Bilimleri Dergisi 2979-9880 Cappadocia University Press Physical Medicine and Rehabilitation Fiziksel Tıp ve Rehabilitasyon Elekromiyostimülasyon Tarihçesi, Etki Mekanizmaları ve Kullanım Alanları https://orcid.org/0000-0003-3860-8444 Özden Selin KIRKLARELİ ÜNİVERSİTESİ https://orcid.org/0000-0001-6661-5540 Aközcan Pehlivanoğlu Serpil KIRKLARELİ ÜNİVERSİTESİ 04 30 2025 3 2 499 521 04 06 2025 04 21 2025

Elektromiyostimülasyon (EMS), fizik tedavide ve sporcular tarafından antrenman amaçlı kullanılan düşük frekanslı elektroterapi uygulamasıdır. EMS, doğrudan iskelet kaslarının uyarılmasını amaçlayan, nöromüsküler eğitim ve farklı patolojilerin rehabilitasyon sürecini kolaylaştırmak için tasarlanan etkili bir yöntemdir. EMS uygulamalarında bireye elektrotlar yoluyla farklı seviyelerde akım uygulanarak kas ve sinir dokularına elektrik sinyalleri gönderilmektedir. EMS’nin farklı amaçlara yönelik kullanımlarında çeşitli parametreler kullanılmaktadır. Parametrelerin değiştirilmesi sonucunda, kaslar farklı şekillerde uyarılarak çeşitli amaçlara yönelik tedaviler mümkün olabilmektedir. Rehabilitasyon ortamında genellikle zayıf kaslarda, yaralanma sonrasında veya farklı hastalıklarda kas fonksiyonunun iyileştirilmesi amacıyla tercih edilmektedir. Özellikle sağlıklı bireylerde kas kütlesinin yeniden oluşturulması ve geleneksel egzersiz eğitim programlarını uygulayamayan hastalarda yaygın olarak uygulanmaktadır. EMS, antrenmanlara destek sağlamak amacıyla sporcuların kas gücü hedeflerine zaman açısından verimli bir şekilde ulaşmasına yardımcı olmaktadır. Tüm vücut elektromiyostimülasyonu (WB-EMS) uygulaması da tüm büyük kasları aktive edici özelliği sayesinde son yıllarda popülerlik kazanmıştır. Bu çalışmanın amacı, EMS uygulamasını tanımlamak, tarihi gelişimi, etki mekanizmaları ve uygulamaları hakkında genel bir bakış açısı sunmaktır.

 Elektroterapi Elektriksel uyarım Elektromiyostimülasyon Elektriksel Kas Stimülasyonu Aldayel, A. A. (2010). Comparison of acute physiological effects between alternating current and pulsed current electrical muscle stimulation. Edith Cowan University. Amirova, L., Avdeeva, M., Shishkin, N., Gudkova, A., Guekht, A., & Tomilovskaya, E. (2022). Effect of Modulated Electromyostimulation on the Motor System of Elderly Neurological Patients. Pilot Study of Russian Currents Also Known as Kotz Currents. Frontiers in Physiology, 13, 921434. https://doi.org/10.3389/fphys.2022.921434 Arenja, N., Mueller, C., Tomilovskaya, E., Koryak, Y., Poltavskaya, M., & Saner, H. (2021). Real-world experience of feasibility and efficacy of electrical muscle stimulation in elderly patients with acute heart failure: a randomized controlled study. International journal of cardiology, 344, 113-119. https://doi.org/10.1016/j.ijcard.2021.09.062 Arija-Blázquez, A., Ceruelo-Abajo, S., Díaz-Merino, M. S., Godino-Durán, J. A., Martínez-Dhier, L., Martin, J. L., & Florensa-Vila, J. (2014). Effects of electromyostimulation on muscle and bone in men with acute traumatic spinal cord injury: A randomized clinical trial. The journal of spinal cord medicine, 37(3), 299-309. https://doi.org/10.1179/2045772313Y.0000000142 Azman, M. F., & Azman, A. W. (2017). The effect of electrical stimulation in improving muscle tone (clinical). In IOP Conference Series: Materials Science and Engineering, IOP Publishing, 260 (1), 012020. https://doi.org/10.1088/1757-899X/260/1/012020 Baker, C., Wederich, D., McNeal, C., Newsam, R., & Waters, R. (2000). Guidelines for adjustment of stimulation parameters.Neuromuscular Electrical Stimulation: A Practical Guide. 4th edition. Downey, CA: Los Amigos Research & Education Institute. Balke, M., Teschler, M., Schäfer, H., Pape, P., Mooren, F. C., & Schmitz, B. (2022). Therapeutic potential of electromyostimulation (EMS) in critically ill patients—a systematic review. Frontiers in physiology, 13, 865437. https://doi.org/10.3389/fphys.2022.865437 Berger, J., Ludwig, O., Becker, S., Backfisch, M., Kemmler, W., & Fröhlich, M. (2020). Effects of an impulse frequency dependent 10-week whole-body electromyostimulation training program on specific sport performance parameters. Journal of sports science &medicine, 19(2), 271. Bijak, M., Rakos, M., Hofer, C., Mayr, W., Strohhofer, M., Raschka, D., & Kern, H. (2005). Stimulation parameter optimization for FES supported standing up and walking in SCI patients. Artificial organs, 29(3), 220-223. https://doi.org/10.1111/j.1525-1594.2005.29039.x Bolz, A., & Bolz, L. O. (2022). Technical aspects and future approaches in transcutaneous vagus nerve stimulation (tVNS). Autonomic Neuroscience, 239, 102956. https://doi.org/10.1016/j.autneu.2022.102956 Bresadola, M. (1998). Medicine and science in the life of Luigi Galvani (1737–1798).Brain research bulletin, 46(5), 367-380. https://doi.org/10.1016/S0361-9230(98)00023-9 Casagrande, S. M., Biondo-Simões, M. D. L. P., Ioshii, S., Robes, R. R., Biondo-Simões, R., & Boeno, B. R. D. O. (2021). Histological evaluation of the effect of low-frequency electric stimulation on healing Achilles tendons in rats. Acta Cirúrgica Brasileira, 36(1), e360103. https://doi.org/10.1590/ACB360103 Chopra, S., Tripathy, A. K., Alphonso, A., Carvalho, M., & Sancia, C. (2017, January). Brain computer interface and electro stimulation of muscles to assist paralyzed patients in limited movement of hands. In 2017 International Conference on Nascent Technologies in Engineering (ICNTE) (pp. 1-6). IEEE. https://doi.org/10.1109/ICNTE.2017.7947950 Collu, R., Earley, E. J., Barbaro, M., & Ortiz-Catalan, M. (2023). Non-rectangular neurostimulation waveforms elicit varied sensation quality and perceptive fields on the hand.Scientific Reports,13(1), 1588. https://doi.org/10.1038/s41598-023-28594-0 Da Cunha, M. G., Franchin, M., Galvão, L., de Ruiz, A., de Carvalho, J. E., Ikegaki, M., de Alencar, S. M., Koo, H., Rosalen, P. L. (2013). Antimicrobial and antiproliferative activities of stingless bee Melipona scutellaris geopropolis. BMC Complementary and Alternative Medicine, 13, 1-9. https://doi.org/10.1186/1472-6882-13-23 Daroff, R. B., & Aminoff, M. J. (2014). Encyclopedia of the neurological sciences. Academic press.DeBord, K., Ding, P., Harrington, M., Duggal, R., Genther, D. J., Ciolek, P. J., & Byrne, P. J. (2023). Clinical application of physical therapy in facial paralysis treatment: a review. Journal of Plastic, Reconstructive & Aesthetic Surgery, 87, 217-223. https://doi.org/10.1016/j.bjps.2023.10.076 Delitto, A., Brown, M., Strube, M. J., Rose, S. J., & Lehman, R. C. (1989). Electrical stimulation of quadriceps femoris in an elite weight lifter: a single subject experiment. International journal of sports medicine, 10(03), 187-191. https://doi.org/10.1016/10.1055/s-2007-1024898 Demidas, A. (2021). Electrical stimulation: then and now. Applications and limitations. Physiotherapy Quarterly,29(4), 81-86. https://doi.org/10.5114/pq.2021.11098 Doucet, B. M., Lam, A., & Griffin, L. (2012). Neuromuscular electrical stimulation for skeletal muscle function. The Yale journal of biology and medicine,85(2), 201. Ellul, C., Formosa, C., Gatt, A., Hamadani, A. A., & Armstrong, D. G. (2017). The effectiveness of calf muscle electrostimulation on vascular perfusion and walking capacity in patients living with type 2 diabetes mellitus and peripheral artery disease. TheInternational Journal of Lower Extremity Wounds, 16(2), 122-128. https://doi.org/10.1177/1534734617705253 Evangelista, A.L., Alonso, A.C., Ritti-Dias, R.M., Barros, B.M., Souza, C.R.D., Braz, T.V., Bocalini, D.S. and Greve, J.M.D.A., (2021). Effects of whole body electrostimulation associated with body weight training on functional capacity and body composition in inactive older people. Frontiers in physiology, 12, 638936. https://doi.org/10.3389/fphys.2021.638936 Finkelstein, G. (2006). Emil du Bois-Reymond vs Ludimar Hermann. Comptes rendus. Biologies, https://doi.org/10.1016/j.crvi.2006.03.005 Fitzgerald, G. K., Piva, S. R., & Irrgang, J. J. (2003). A modified neuromuscular electrical stimulation protocol for quadriceps strength training following anterior cruciate ligament reconstruction.Journal of Orthopaedic & Sports Physical Therapy,33(9), 492-501. https://doi.org/10.2519/jospt.2003.33.9.492 Flodin, J., Juthberg, R., & Ackermann, P. W. (2022). Effects of electrode size and placement on comfort and efficiency during low-intensity neuromuscular electrical stimulation of quadriceps, hamstrings and gluteal muscles. BMC Sports Science, Medicine and Rehabilitation,14(1), 11. https://doi.org/10.1186/s13102-022-00403-7 Flodin, J., Reitzner, S. M., Emanuelsson, E. B., Sundberg, C. J., & Ackermann, P. (2024). The effect of neuromuscular electrical stimulation on the human skeletal muscle transcriptome. Acta physiologica,240(5), e14129. https://doi.org/10.1111/apha.14129 Fritzsche, D., Fruend, A., Schenk, S., Mellwig, K. P., Kleinöder, H., Gummert, J., & Horstkotte, D. (2010). Electromyostimulation (EMS) in Cardiac Patients. Will EMS Training Be Helpful in Secondary Prevention? Wird das EMS-Training bedeutsam für die Sekundärprävention?.Herz,35, 34-40. https://doi.org/10.1007/s00059-010-3268-8 Fuentes, J. P., Armijo Olivo, S., Magee, D. J., & Gross, D. P. (2010). Effectiveness of interferential current therapy in the management of musculoskeletal pain: a systematic review and meta-analysis. Physical therapy, 90(9), 1219-1238. https://doi.org/10.2522/ptj.20090335 Fuglevand, A. J., & Keen, D. A. (2003). Re‐evaluation of muscle wisdom in the human adductor pollicis using physiological rates of stimulation.The Journal of physiology,549(3), 865-875. https://doi.org/10.1113/jphysiol.2003.038836 Glaviano, N. R., & Saliba, S. (2016). Can the use of neuromuscular electrical stimulation be improved to optimize quadriceps strengthening?.Sports health,8(1), 79-85. https://doi.org/10.1177/1941738115618174 Ghannadi, S., Halabchi, F., Maleklou, F., Tavakol, Z., Rajabian Tabesh, M., Bala, D., & Alizadeh, Z. (2022). The effect of 6 weeks electrical muscle stimulation training and aerobic exercise on body composition of overweight women: a randomized controlled study. Sport Sciences for Health, 18(4), 1387-1395. https://doi.org/10.1007/s11332-022-00910-7 Gibson, W., Wand, B. M., Meads, C., Catley, M. J., & O'Connell, N. E. (2019). Transcutaneous electrical nerve stimulation (TENS) for chronic pain‐an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews, (4). https://doi.org/10.1002/14651858.CD011890.pub3 Gracanin, F., & Trnkoczy, A. (1975). Optimal stimulus parameters for minimum pain in the chronic stimulation of innervated muscle. Archives of physical medicine and rehabilitation,56(6), 243-249. Graczyk, E. L., Christie, B. P., He, Q., Tyler, D. J., & Bensmaia, S. J. (2022). Frequency shapes the quality of tactile percepts evoked through electrical stimulation of the nerves.Journal of Neuroscience,42(10), 2052-2064. https://doi.org/10.1523/JNEUROSCI.1494-21.2021 Grill, W. M., & Mortimer, J. T. (2002). Stimulus waveforms for selective neural stimulation.IEEE Engineering in Medicine and Biology Magazine,14(4), 375-385. https://doi.org/10.1109/51.395310 Gondin, J., Cozzone, P. J., & Bendahan, D. (2011). Is high-frequency neuromuscular electrical stimulation a suitable tool for muscle performance improvement in both healthy humans and athletes?. European journal of applied physiology,111, 2473-2487. https://doi.org/10.1007/s00421-011-2101-2 Heijnen, B. J., Speyer, R., Baijens, L. W. J., & Bogaardt, H. C. A. (2012). Neuromuscular electrical stimulation versus traditional therapy in patients with Parkinson’s disease and oropharyngeal dysphagia: effects on quality of life. Dysphagia,27, 336-345. https://doi.org/10.1007/s00455-011-9371-z Hoshiai M, Ochiai K, Tamura Y, Tsurumi T, Terashima M, Tamiya H, Maeno E, Mizuguchi S, Tomoe T, Kawabe A, Uema A., Ueno, A., Sugiyama, T Horie, Y., Sugimura, H., Koike, R., Yasu, T. (2021). Effects of whole-body neuromuscular electrical stimulation device on hemodynamics, arrhythmia, and sublingual microcirculation. Heart and Vessels, 36, 844-852. https://doi.org/10.1007/s00380-020-01755-1 Jee, Y. S. (2018). The efficacy and safety of whole-body electromyostimulation in applying to human body: based from graded exercise test.Journal of exercise rehabilitation,14(1), 49. https://doi.org/10.12965/jer.1836022.011 Jerez-Roig, J., Souza, D. L. B., Espelt, A., Costa-Marín, M., & Belda-Molina, A. M. (2013). Pelvic floor electrostimulation in women with urinary incontinence and/or overactive bladder syndrome: a systematic review. Actas Urológicas Españolas (English Edition), 37(7), 429-444. https://doi.org/10.1016/j.acuroe.2012.08.015 Kaçoğlu, C., & Kale, M. (2015). Elektromyostimülasyon ile İlgili Elektriksel Akım Parametreleri ve Metodolojisi. CBÜ Beden Eğitimi ve Spor Bilimleri Dergisi, 10(2), 34-47. Kashyap, N., Baranwal, V. K., Basumatary, B., Bansal, R., & Sahani, A. (2023). A systematic review on muscle stimulation techniques. IETE Technical Review, 40(1), 76-89. https://doi.org/10.1080/02564602.2022.2030815 Kast, S., Kemmler, W., Roemer, F.W., Kohl, M., Culvenor, A.G., Mobasheri, A., Uder, M. and von Stengel, S. (2024). Effectiveness of whole-body electromyostimulation on knee pain and physical function in knee osteoarthritis: a randomized controlled trial. Scientific Reports,14(1), 20804. https://doi.org/10.1038/s41598-024-71552-7 Kemmler, W., Bebenek, M., Engelke, K., & von Stengel, S. (2014). Impact of whole-body electromyostimulation on body composition in elderly women at risk for sarcopenia: the Training and ElectroStimulation Trial (TEST-III). Age, 36, 395-406. https://doi.org/10.1007/s11357-013-9575-2 Kemmler, W., Fröhlich, M., & Eifler, C. (2024). Whole-body electromyostimulation: Effects, limitations, perspectives of an innovative training Method. Springer Nature. Kemmler, W., Grimm, A., Bebenek, M., Kohl, M., & von Stengel, S. (2018). Effects of combined whole-body electromyostimulation and protein supplementation on local and overall muscle/fat distribution in older men with sarcopenic obesity: the randomized controlled franconia sarcopenic obesity (FranSO) study.Calcified tissue international,103, 266-277. https://doi.org/10.1007/s00223-018-0424-2 Kemmler, W., Teschler, M., Weissenfels, A., Willert, S., Bebenek, M., & von Stengel, S. (2017). Whole-body EMS to fight sarcopenic obesity–a review with emphasis on body fat.Deutsche Zeitschrift für Sportmedizin,68(7-8), 170-177. Kızıltan, E., & Dalkılıç, N. (2021). Elektrofizyolojinin Tarihsel Serüveni: Galvani Öncesi Dönem.Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi,11(3), 429-440. https://doi.org/10.31020/mutftd.966437 Knight, K., Knight, K. L., & Draper, D. O. (2012). Therapeutic modalities: the art and science. Lippincott Williams & Wilkins. Kots, Y. M. (1977). Electrostimulation. InCanadian-Soviet exchange symposium on electrostimulation of skeletal muscles. Montreal. Canada, 6-15. Lewek, M., Stevens, J., & Snyder-Mackler, L. (2001). The use of electrical stimulation to increase quadriceps femoris muscle force in an elderly patient following a total knee arthroplasty.Physical therapy,81(9), 1565-1571. https://doi.org/10.1093/ptj/81.9.1565 Levine, D., & Bockstahler, B. (2014). Electrical stimulation. Canine rehabilitation and physical therapy, 2, 342-58.Ludwig, A. (2008). Results of electromyostimulation therapy in obstructive sleep apnea. Artificial Organs,32(8), 655-658. https://doi.org/10.1111/j.1525-1594.2008.00618.x Lyons, G. M., Leane, G. E., Clarke-Moloney, M., O’brien, J. V., & Grace, P. A. (2004). An investigation of the effect of electrode size and electrode location on comfort during stimulation of the gastrocnemius muscle.Medical engineering & physics,26(10), 873-878. https://doi.org/10.1016/j.medengphy.2004.08.003 Maffiuletti, N. A. (2010). Physiological and methodological considerations for the use of neuromuscular electrical stimulation.European journal of applied physiology,110, 223-234. https://doi.org/10.1007/s00421-010-1502-y McNeal, D. R., & Baker, L. L. (1988). Effects of joint angle, electrodes and waveform on electrical stimulation of the quadriceps and hamstrings. Annals of biomedical engineering,16, 299-310. https://doi.org/10.1007/BF02368005 Mintken PE, Carpenter KJ, Eckhoff D, et al. (2007). Early neuromuscular electrical stimulation to optimize quadriceps muscle function following total knee arthroplasty: a case report. J Orthop Sports Phys Ther, 37 (7): 364–71. https://www.jospt.org/doi/10.2519/jospt.2007.2541 Moon, S. H., Choi, J. H., & Park, S. E. (2017). The effects of functional electrical stimulation on muscle tone and stiffness of stroke patients. Journal of physical therapy science, 29(2), 238-241. https://doi.org/10.1589/jpts.29.238 Moran, F., Leonard, T., Hawthorne, S., Hughes, C. M., McCrum-Gardner, E., Johnson, M. I., Rakel, B. A., Sluka K. A., Walsh, D. M. (2011). Hypoalgesia in response to transcutaneous electrical nerve stimulation (TENS) depends on stimulation intensity. The Journal of Pain, 12(8), 929-935. https://doi.org/10.1016/j.jpain.2011.02.352 Mukherjee, S., Fok, J. R., & van Mechelen, W. (2023). Electrical stimulation and muscle strength gains in healthy adults: a systematic review. The Journal of Strength & Conditioning Research, 37(4), 938-950. https://doi.org/10.1519/JSC.0000000000004359 Nishida, M. M., Tsuboyama, T., Moritani, T., & Arai, H. (2016). Review of the evidence on the use of electrical muscle stimulation to treat sarcopenia.European Geriatric Medicine,7(3), 267-271. https://doi.org/10.1016/j.eurger.2015.11.010 Paillard, T. (2008). Combined application of neuromuscular electrical stimulation and voluntary muscular contractions. Sports medicine,38, 161-177. https://doi.org/10.2165/00007256-200838020-00005 Pano-Rodriguez, A., Beltran-Garrido, J. V., Hernández-González, V., & Reverter-Masia, J. (2019). Effects of whole-body electromyostimulation on health and performance: A systematic review.BMC complementary and alternative medicine,19, 1-14. https://doi.org/10.1186/s12906-019-2485-9 Pantaleão, M. A., Laurino, M. F., Gallego, N. L., Cabral, C. M., Rakel, B., Vance, C., Sluka, K.A., Walsh, D.M., Liebano, R.E., (2011). Adjusting pulse amplitude during transcutaneous electrical nerve stimulation (TENS) application produces greater hypoalgesia. The Journal of Pain, 12(5), 581-590 https://doi.org/10.1016/j.jpain.2010.11.001 Parent, A. (2005). Duchenne de Boulogne (1806–1875).Parkinsonism & Related Disorders,11(7), 411-412. https://doi.org/10.1016/j.parkreldis.2005.04.004 Park, H. K., Na, S. M., Choi, S. L., Seon, J. K., & Do, W. H. (2021). Physiological effect of exercise training with whole body electric muscle stimulation suit on strength and balance in young women: a randomized controlled trial. Chonnam medical journal,57(1), 76. https://doi.org/10.4068/cmj.2021.57.1.76 Park, K. S. (2023). Electrical Stimulation of Nerves and Muscles. In Humans and Electricity: Understanding Body Electricity and Applications (pp. 351-376). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-031-20784-6_15 Park, J. S., Oh, D. H., Hwang, N. K., & Lee, J. H. (2018). Effects of neuromuscular electrical stimulation in patients with Parkinson’s disease and dysphagia: a randomized, single-blind, placebo-controlled trial.NeuroRehabilitation,42(4), 457-463. https://doi.org/10.3233/NRE-172306 Park, S., Min, S., Park, S.-H., Yoo, J. & Jee, Y.-S., (2021). Influence of isometric exercise combined with electromyostimulation on inflammatory cytokine levels, muscle strength, and knee joint function in elderly women with early knee osteoarthritis.Front. Physiol.12, 688260. https://doi.org/10.3389/fphys.2021.688260 Parry, S. M., Berney, S., Granger, C. L., Koopman, R., El-Ansary, D., & Denehy, L. (2013). Electrical muscle stimulation in the intensive care setting: a systematic review. Critical care medicine,41(10), 2406-2418. https://doi.org/10.1097/CCM.0b013e3182923642 Patel, P., Green, M., Tram, J., Wang, E., Murphy, M., Abd-Elsayed, A. A., & Chakravarthy, K. (2025). Latest Advancements in Transcutaneous Electrical Nerve Stimulation (TENS) and Electronic Muscle Stimulation (EMS): Revisiting an Established Therapy with New Possibilities. Journal of Pain Research, 137-153. https://doi.org/10.2147/JPR.S493162 Paternostro-Sluga, T., Fialka, C., Alacamliogliu, Y., Saradeth, T., & Fialka-Moser, V. (1999). Neuromuscular electrical stimulation after anterior cruciate ligament surgery.Clinical Orthopaedics and Related Research,368, 166-175. Patterson, R. P., & Lockwood, J. S. (1991). The current requirements and the pain response for various sizes of surface stimulation electrodes. InProceedings of the 13th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (pp. 1809-1810). Publ by IEEE. Pelegrini, A. C. A., Gasoto, E., Bussolaro, J. M., Segatti, G., de Albuquerque, C. E., & Bertolini, G. R. F. (2019). The analgesic action of Aussie current in women with non-specific chronic lumbar pain. International Journal of Therapy And Rehabilitation,26(7), 1-10. https://doi.org/10.12968/ijtr.2018.0063 Petrofsky, J., Laymon, M., Prowse, M., Gunda, S., & Batt, J. (2009). The transfer of current through skin and muscle during electrical stimulation with sine, square, Russian and interferential waveforms. Journal of medical engineering & technology, 33(2), 170-181. https://doi.org/10.1080/03091900802054580 Petterson, S., & Snyder-Mackler, L. (2006). The use of neuromuscular electrical stimulation to improve activation deficits in a patient with chronic quadriceps strength impairments following total knee arthroplasty. Journal of Orthopaedic & Sports Physical Therapy,36(9), 678-685. https://www.jospt.org/doi/10.2519/jospt.2006.2305 Porcari, J. P., McLean, K. P., Foster, C., Kernozek, T., Crenshaw, B., & Swenson, C. (2002). Effects of electrical muscle stimulation on body composition, muscle strength, and physical appearance. The Journal of Strength & Conditioning Research, 16(2), 165-172. Rattay, F. (1988). Modeling the excitation of fibers under surface electrodes. IEEE transactions on biomedical engineering, 35(3), 199-202. https://doi.org/10.1109/10.1362 Rebai, H., Barra, V., Laborde, A., Bonny, J. M., Poumarat, G., & Coudert, J. (2002). Effects of two electrical stimulation frequencies in thigh muscle after knee surgery.International journal of sports medicine,23(08), 604-609. https://doi.org/10.1055/s-2002-35525 Reilly, J. P., & Diamant, A. M. (2011). Electrostimulation: theory, applications, and computational model. Artech House.Sbruzzi, G., & Plentz, R. D. M. (2015). Effects of Electrical Stimulation in Spastic Muscles After Stroke. Stroke, 46, 2197-2205. https://doi.org/10.1161/STROKEAHA.115.009633 Schink, K., Herrmann, H. J., Schwappacher, R., Meyer, J., Orlemann, T., Waldmann, E., Wullich, B., Kahlmeyer, A., Fietkau, R., Lubgan, D., Beckmann, M. W., Hack, C., Kemmler, W., Siebler, J., Neurath, F. M., & Zopf, Y. (2018). Effects of whole-body electromyostimulation combined with individualized nutritional support on body composition in patients with advanced cancer: a controlled pilot trial.BMC cancer,18, 1-17. https://doi.org/10.1186/s12885-018-4790-y Stevens, J. E., Mizner, R. L., & Snyder-Mackler, L. (2004). Neuromuscular electrical stimulation for quadriceps muscle strengthening after bilateral total knee arthroplasty: a case series.Journal of Orthopaedic & Sports Physical Therapy,34(1), 21-29. https://www.jospt.org/doi/10.2519/jospt.2004.34.1.21 Takeda, K., Tanino, G., & Miyasaka, H. (2017). Review of devices used in neuromuscular electrical stimulation for stroke rehabilitation. Medical Devices: Evidence and Research, 207-213. https://doi.org/10.2147/MDER.S123464 Tanaka, R., Shigemori, Y., & Moriguchi, T. (2024). Non-Invasive Muscle Metabolism Assessment with Near-Infrared Spectroscopy and Electrical Muscle Stimulation.BioMed,4(4), 419-429. https://doi.org/10.3390/biomed4040033 Tatu, L., & Péréon, Y. (2025). The origins of neuromuscular electrodiagnosis. 1800–1950: a crucial period. European Neurology. https://doi.org/10.1159/000544957Tuna, N. (2001). Elektroterapi. İstanbul: Nobel Tıp Kitap Evi, 2, 129-135. Ud-Din, S., & Bayat, A. (2014). Electrical stimulation and cutaneous wound healing: a review of clinical evidence. Healthcare, 2(4), 445-467. https://doi.org/10.3390/healthcare2040445 Vance, C. G., Dailey, D. L., Rakel, B. A., & Sluka, K. A. (2014). Using TENS for pain control: the state of the evidence. Pain management, 4(3), 197-209. https://doi.org/10.2217/pmt.14.13 Veliev, G. O., Weissman, Y. D., Patchenskaya, I. V., & Poltavskaya, M. G. (2021). Comparison of different intensity modes of neuromuscular electrical stimulation in the rehabilitation of elderly patients with decompensated chronic heart failure.Kardiologiia,61(3), 23-29. https://doi.org/10.18087/cardio.2021.3.n1457 Von Stengel, S., Bebenek, M., Engelke, K., & Kemmler, W. (2015). Whole‐body electromyostimulation to fight osteopenia in elderly females: the randomized controlled training and electrostimulation trial (TEST‐III). Journal of osteoporosis,2015(1), 643520. https://doi.org/10.1155/2015/643520 Ward, A. R., & Shkuratova, N. (2002). Russian electrical stimulation: the early experiments. Physical therapy,82(10), 1019-1030. https://doi.org/10.1093/ptj/82.10.1019 Weissenfels, A., Teschler, M., Willert, S., Hettchen, M., Fröhlich, M., Kleinöder, H., Kohl, M., Stengel V.S., Kemmler, W. (2018). Effects of whole-body electromyostimulation on chronic nonspecific low back pain in adults: a randomized controlled study. Journal of pain research, 1949-1957. https://doi.org/10.2147/JPR.S164904 Watanabe, K., Yoshida, T., Ishikawa, T., Kawade, S., & Moritani, T. (2019). Effect of the combination of whole-body neuromuscular electrical stimulation and voluntary exercise on metabolic responses in human. Frontiers in Physiology,10, 291. https://doi.org/10.3389/fphys.2019.00291 Weissenfels, A., Wirtz, N., Dörmann, U., Kleinöder, H., Donath, L., Kohl, M., Fröhlich, M., von Stengel, S., Kemmler, W., (2019). Comparison of Whole‐Body Electromyostimulation versus Recognized Back‐Strengthening Exercise Training on Chronic Nonspecific Low Back Pain: A Randomized Controlled Study.BioMed research international,2019(1), 5745409. https://doi.org/10.1155/2019/5745409 Wessale, J. L., Geddes, L. A., Ayers, G. M., & Foster, K. S. (1992). Comparison of rectangular and exponential current pulses for evoking sensation.Annals of biomedical engineering,20, 237-244. https://doi.org/10.1007/BF02368523 Wigerstad-Lossing, I., Grimby, G., Jonsson, T., Morelli, B., Peterson, L. & Renström, P. (1988). Effects of electrical muscle stimulation combined with voluntary contractions after knee ligament surgery. Medicine and science in sports and exercise,20(1), 93-98. Williams, K. J., Moore, H. M., Ellis, M., & Davies, A. H. (2021). Pilot trial of neuromuscular stimulation in human subjects with chronic venous disease.Vascular Health and Risk Management, 771-778. https://doi.org/10.2147/VHRM.S320883 Wolfe, D., Rosenstein, B., & Fortin, M. (2024). The effect of EMS, IFC, and TENS on patient-reported outcome measures for chronic low back pain: a systematic review and meta-analysis. Frontiers in Pain Research, 5, 1346694. https://doi.org/10.3389/fpain.2024.1346694 Yu, X., Shen, Y., Cui, J., Ding, Y., Morsi, Y., Sun, B., Mo, X., Gu, H. (2025). The potential application of electrical stimulation in tendon repair: a review.Med-X,3(1), 7. https://doi.org/10.1007/s44258-025-00051-9 Zhou, S., & Segawa, N. (2024). Electrical Muscle Stimulation-Based Approach for Enhancing Hand-eye Coordination Training. In Extended Abstracts of the CHI Conference on Human Factors in Computing Systems, 1-6. https://doi.org/10.1145/3613905.3650939 Zhou, Z., Zheng, J., Meng, X., & Wang, F. (2023). Effects of electrical stimulation on articular cartilage regeneration with a focus on piezoelectric biomaterials for articular cartilage tissue repair and engineering.International Journal of Molecular Sciences,24(3), 1836. https://doi.org/10.3390/ijms24031836