Electrical Stimulation in Stroke Rehab -

Electrical Stimulation in Stroke Rehab

There are a few different types of electrical stimulation devices used in stroke rehab, so let’s start with some definitions:

Transcutaneous Electrical Nerve Stimulation TENS –

typically does not use a waveform or an intensity level that is adequate to cause any muscles to contract. Provides a sensory stimulation that is thought to block pain signals going to the brain, and thereby decreases the perception of pain (this method of decreasing pain is called the “gate control theory” of pain modulation). These devices are generally lower in cost, but do NOT promote recovery of function, or neural rewiring. Generally used only for pain control.

TENS unit available at www.LGMedsupply.com

another TENS model available at www.LGMedsupply.com

You can even look on amazon to find one that is much more affordable than going through a medical device company. Many units combine TENS with NMES (read below)

NeuroMuscular Electrical Stimulation NMES –

a device that uses electrical stimulation to cause a muscle or muscles to contract. There are at least three main types of NMES.

cyclic NMES – the most basic type; use a preset duration of contraction and relaxation cycles. All you have to do is turn it on and let it work.
EMG/biofeedback – uses input from your own brain’s effort to cause the device to kick-in and contract your muscles. This is great for those of you who don’t have enough muscle control to actually move your arm, hand, foot, etc…but you can generate at least a tiny amount of muscle twitching (and it might not take as much ability on your part as you expect….so ask your Dr, PT, or OT) This type of NMES requires you to use more concentration and effort than cyclic NMES, and therefore may be more productive in promoting neural rewiring and increased function.
FES – Functional Electrical Stimulation (also called neuroprostheses): this term refers to using an NMES device to perform a functional task, such a walking, lifting a cup with your hand, or other daily activities. There are devices that use transcutaneous electrodes (the stimulation comes from a device placed on the surface of the skin), and devices that use intramuscular stimulation (the device is implanted in the arm or leg).

Currently the available devices for a paretic hand have been shown to “allow stroke survivors to complete a limited number of selected functional tasks,” such as very basic gripping activities(1). In other words, a device that assists you in making a wide variety of precise hand motions is not currently available, to my knowledge. However, the technology available for the leg is currently more promising. Studies seem to show that the use of an FES device to lift your foot and toes to prevent you from dragging your foot while you walk can be as effective as an ankle-foot orthosis in improving gait (1)(2)

Here are a few examples of NMES devices used for FES (transcutaneous):