Electrical Stimulation

Posted by Nurse Linda in Life After Paralysis on October 06, 2021 # Health

Doctor holding a stethoscope In electrical stimulation, the brain can be sent messages of motor nerves by its body function. In this process, a series of chemical impulses or reactions send a message to the muscle to move from the brain. Sometimes, the impulse is for the muscle to move for a slight adjustment or internal function, neither of which are really thought about in our conscious mind. However, at other times we want to do something, like scratch an itch, feed ourselves or walk around. This takes some conscious input from our minds, but it is so automatic that we do not think of every step of the process. We just do it.

The activity of movement is due to a series of chemical processes. The nervous system has been described in terms of electrical current. It is explained as the brain is the control center, and the nerves are like wires that transmit impulses. The nerves do transmit impulses but using a chemical process that has a charge. That is what confuses nerves running on electricity like in your house. It is a chemical response with an electrical charge.

Nerves are everywhere, brain and spinal cord (central nerves) and throughout the body (peripheral nerves). A message is sent from the brain through the motor nerves as a response to the input of the sensory nerves of the body. The movement message originates in the brain, makes connections through the nerves in circuits called neural pathways. Nerve cells do not touch each other but align closely through synapses. Nerve cells transmit chemical messages through positive and negative ions.

After spinal cord injury, this process is disrupted. The message cannot get through from the brain at the level of the injury. However, the nerves below the level of injury still work. They are just not getting the signal to do their job.

Injuries to the upper motor neurons are reflexive, meaning the nerves can be stimulated. This occurs with individuals who have spinal cord injury or other neurological injuries in the cervical and thoracic areas of the spine. You will often see tone or spasticity in these levels of injury. Lower motor neuron injuries in the lumbar and sacral areas are reflexive, not stimulating the body nerves. Individuals with lower motor neuron injury rely on the manual movement of the body for stimulation. However, implants have been devised to help with nerve stimulation through central and peripheral nerves. Stimulation of neurological injury from diseases depends on the location sites of the injury.

This is where electrical stimulation comes in for reflexive types of injury. The nerves below the level of injury are waiting for (and craving) stimulation from the brain. However, there is only silence as no messages can get through the level of injury. Electrical stimulation can provide that to those nerves below the injury. The same is true for peripheral nerves.

There are several types of electrical stimulation. It is a good idea to become familiar with them. If you have the opportunity to take part in electrical stimulation therapy, you want to be sure you are getting the type of stimulation you need. Some electrical stimulation causes muscles to contract, which may or may not also stimulate the nerve. Other processes are for nerve stimulation that also contracts the muscles.

Transcutaneous electrical nerve stimulation (TENS) is used for pain. Electrodes are placed on the skin near the site of pain. The nerve is stimulated, which blocks the pain signal to the brain. TENS works on motor and sensory nerve fibers.

A stronger electrical current is obtained from electrical muscle stimulation (EMS). Also, using electrodes placed on the skin, muscles are contracted and relaxed in a pattern. This is used to build muscle strength.

The development of electrical stimulation has vastly expanded over the last two decades. As a result, there are more uses for electrical stimulation, some beneficial to individuals, especially with paralysis and wound conditions. These are a few of the applications:

Interferential current (IFC) stimulates nerves to reduce pain and increase blood circulation to the area. IFC can be used to treat some cases of tone (spasms) or for edema reduction. In addition, it might be used to treat overused muscles at the transition zone, where functional muscles make up the work for muscles below the injury level. It also has been used in treating migraine headaches. This is a non-invasive therapy where electrodes are applied to the skin over the area of concern. IFC works with peripheral nerves.

Spinal cord stimulation (SCS) are implanted devices that can be used for enhancing movement but also to reduce pain.

Neuromuscular electrical stimulation (NMES) stimulates the muscles and nerves as a therapy to improve strength to weak muscles, restore function, prevent muscle atrophy, and reduce muscle spasms. This is a strong stimulation provided through electrodes on the skin's surface over the area of treatment. NMES can be used on single muscles or as functional electrical stimulation (FES).

Functional electrical stimulation (FES) is the sequential, rhythmic contraction and relaxation of muscles and nerves for functional activity. This can be for hand control, arm function, leg movement, or bowel, bladder, and sexual function. The list is growing rapidly. Many more body activities can be affected. FES began and still is offered by the application of temporary electrodes on the skin. It now can include implants that are contained within the body. Some applications are for specific functions such as bowel, bladder, and sexual function, while others have more global actions. When placed on peripheral nerves, FES implants can aid in walking, bowel, bladder, and sexual function for individuals with lower motor neuron injury. Internal FES implants can assist with these activities and more. FES spinal devices are being evaluated through research studies, and some are approved.

Wound treatment can be improved by the use of electrical stimulation for tissue repair (ESTR). This helps speed stage III and IV pressure injury wound healing by increasing circulation and reduce swelling. Some medications can be delivered through iontophoresis to tissue for wound healing.

If you are interested in finding out if electrical stimulation is right for you, it is best, to begin with, your healthcare professional. An assessment of your health will be necessary. Some issues that can affect participation with electrical stimulation therapy are orthostatic hypotension (OA), autonomic dysreflexia (AD), bone density, blood clots, tone (spasms), skin wounds, contractures, and joint displacement. However, before starting stimulation therapy, these issues can be controlled or corrected.

Benefits of electrical stimulation can include increased function, stronger muscles and bones, increases in respiratory and cardiac function, all of which can improve your mental wellbeing. The process of electrical stimulation continues to develop and be refined. The clinical trials of implanted stimulation will be concluded in the near future. Preliminary reports are favorable for significant improvement.

A trial of electrical stimulation is necessary to see how your body responds. Instruction and direction from a physical therapist that is experienced in the therapy are critical. Begin slowly. You may not feel the effects of movement, but your body will respond to movement, especially if it has not had this input for a while or if your body is deconditioned.

Payment is, unfortunately, required to fund this type of therapy varies. Perhaps you would like and would benefit from extensive therapy or even an implant. Keep appealing to your payor. Until the payor gives a final decision, you can keep the appeal process open. Some individuals have received the therapy this way. Most will start with a smaller, local device which may only stimulate one muscle at a time. That is a helpful way to begin. As you progress with a local device, you are building evidence for your success with larger devices and more inclusive stimulation therapies. Electrical stimulation is the horizon for the treatment of paralysis.

Now is the time to educate yourself about this therapy, as it will soon be upon us. You want your body to be ready if you decide it is the thing for you. It is an effective way to reap benefits as well as to keep your body in shape and reduce complications. Nurse Linda

Pediatric Consideration:

Electrical stimulation is available to children. You will need to have your child evaluated by their healthcare professional to see if this therapy is right for them and have the health to do it. Locate a competent therapist to deliver the treatment as not all have been educated in the process.

Since children's bones and neurological systems are still developing, this type of therapy effectively stimulates neuroplasticity or the nervous system's ability to heal and organize itself for increased function.

It is as difficult to find resources for this type of therapy for children as it is for adults. Keep working at appeals. You will need to begin slowly, so a local device is a good place to start if that is approved by your child's healthcare professional. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.