Patients with neurological conditions have impairments and functional limitations that may be addressed through the use of electrical stimulation. For example, a person who has sustained a stroke may have multiple impairments, such as decreased strength, motor control, and passive range of motion (ROM); compromised balance; and spasticity. These impairments contribute to functional limitations and disability. Mobility is compromised, so an important component of rehabilitation is to improve mobility to allow for greater independence. Neuromuscular electrical stimulation (NMES) and functional electrical stimulation (FES) may be used clinically to address some of these areas. For patients with neurological impairments, NMES is defined as the use of electrical stimulation (ES) to activate muscles through stimulation of intact peripheral motor nerves, and FES is the use of NMES to promote functional activities.1
A thorough examination must be performed to determine the patient's appropriateness for receiving ES (Box 14-1). Table 14-1 identifies items that should be considered when determining if a patient with a neurological condition is suitable for ES. This table is not all-inclusive. Other pertinent examination items specific to the patient should be included.
Box 14-1 Concerns Specific to Diagnosis
Spinal Cord Injury
History of spontaneous fractures (osteoporosis)
History of autonomic dysreflexia
Preexisting medical issues
History of seizures
Pediatric Onset Conditions
TABLE 14-1.Examination and Rationale for the Use of Electrical Stimulation in Populations With Neurological Conditions |Favorite Table|Download (.pdf) TABLE 14-1. Examination and Rationale for the Use of Electrical Stimulation in Populations With Neurological Conditions
|Tests of: ||Question ||Reason |
|Muscle innervation ||If a neurological condition is present, are muscles capable of being stimulated? ||Electrical stimulation applications typically require innervation of the muscle (an upper motor neuron injury). |
|Strength ||What is current strength (manual muscle test or muscle torque)? ||To determine muscles to treat and effect of treatment. |
|Range of motion ||Are any ROM limitations present? ||Decreased ROM may impact functional outcomes. Electrical stimulation may increase ROM. |
|Sensation ||Is sensation present, absent, or diminished? ||More frequent monitoring is needed with insensate skin. |
|Pain ||Is pain present at rest or with activity? How severe? ||To determine any positive or negative effects on pain. |
|Spasticity ||Is spasticity present? ||Spasticity can impact the choice of stimulation parameters. Spasticity may be positively or negatively impacted by electrical stimulation. |
|Function ||Are any functional limitations present? ||To determine effect of treatment on function. |
|Cognitive status ||Is cognitive status sufficient to provide feedback? ||Safety of use. |
|Caregiver assistance ||Does patient require caregiver assistance to use electrical stimulation at home if needed? ||Determine availability of assistance. |
|Other treatments ||Are any other treatments being used ...|
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