Excerpted from the article, "A Rehab Revolution," Stroke Connection Magazine, September/October 2004. (Last science update March 2013)
Functional electrical stimulation (FES) delivers a shock to the survivor’s muscle. The shock activates nerves and makes the muscle move. Theoretically, the brain may be able to recapture and relearn this movement without the stimulation. “We don’t know exactly why electrical stimulation works, just that it does,” says Dr. Harvey.
Electrodes can be placed on the wrist extensor muscles of the forearm, for example. The patient relaxes the hand, then contracts the wrist extensor muscle to cause movement. This movement triggers an electric shock to the wrist extensor muscle, which causes greater movement of the hand than the patient could make. Electrical stimulation can be used on all parts of the body, including the shoulders and legs.
After a stroke affected his left side in January 1985, Chuck Reisling, 23, of Reynoldsburg, Ohio, learned to walk again during two months of therapy. Even though he walked out of the hospital in March that year, he still could only close his left hand, not open it. “I could use my hand for little more than a paperweight,” says Chuck.
While he was surfing the Web for stroke support groups in July 1999, he learned about a type of functional electrical stimulation unit that you can operate at home.
Chuck used electrical stimulation two-to-three times a day for about 30 minutes each time. As he improved, he started to use it four times a day for 30 minutes. Now he has returned to work, so he only uses it once every few months.
The electric shock “can range from a mild tingling sensation to almost a burning sensation depending on the intensity I set on the unit,” says Chuck.
“My spasticity dramatically reduced almost immediately after using electrical stimulation,” Chuck says. He could open his left hand. “I could hold a jar with my left hand. I could program the microwave. I could do simple things like wash my hands. The list continues to grow. My progress using electrical stimulation also helped my recurring depression by giving me hope of a fuller recovery.”
“The benefits are improved movement and enhanced motor control,” says Dr. Harvey. “The drawback is some survivors can’t tolerate the sensation.”
The electrical stimulation unit Chuck used cost $5,000. An electrical stimulation session at a rehabilitation center is billed like an ordinary physical therapy session and is reimbursable through Medicare.
In 2004, we reported on Neuromove and their functional electrical stimulation (FES) product for the upper arm. Neuromove is still marketing its FES device and is currently involved in a placebo-controlled study to test its effectiveness.
Since 2004, FES is increasingly common. In the July/August 2006 issue of Stroke Connection, we discuss two FES devices for drop foot that are currently on the market – the Odstock Drop Foot Stimulator and the WalkAide. Both devices use surface electrodes to electrically stimulate the peroneal nerve, which controls the movement of the ankle and foot, to raise the foot at the right time.
FES using implanted electrodes is still in the research phase. Implanted electrodes record electrical activity in weak or paralyzed muscles, amplify it and return it to the muscles where it may cause the affected muscle to fire and produce functional movement. The first research program involving implanted electrodes in stroke survivors is just beginning at Case Western Reserve University School of Medicine.