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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


  • Cognitive status

  • Preexisting medical issues

  • Spasticity

  • Blood pressure

Spinal Cord Injury

  • History of spontaneous fractures (osteoporosis)

  • History of autonomic dysreflexia

  • Sensation

  • Orthopedic concerns

  • Respiratory demands

  • Spasticity

  • Pressure sores

  • Preexisting medical issues

Cerebral Palsy

  • Orthopedic issues

  • History of seizures

  • Implanted devices

  • Cognitive status

Multiple Sclerosis

  • Spasticity

  • Fatigue

  • Cognitive status

  • Preexisting medical issues

Pediatric Onset Conditions

  • Scoliosis

  • Hip subluxation

  • Torsional deformities of bones

  • Osteoporosis

TABLE 14-1.Examination and Rationale for the Use of Electrical Stimulation in Populations With Neurological Conditions

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