Thoughts about Electrical Stimulation

Posted by Nurse Linda in Life After Paralysis on April 20, 2021 # Health

brain and stethoscopeThe brain controls all body functions by sending messages for the body through the spinal cord to do something as well as responding to stimulus from the body. This can be that the brain initiates activity or responds to impulses of information sent by the body. All these message communications happen in an instant. Sometimes, we are aware of messages such as moving an arm or scratching an itch. At other times, messages are sent that we are unaware such as breathing, for our heart to beat, to initiate a response to an infection. This is a delicate cycle that keeps our bodies functioning. After a spinal cord injury or paralysis of any cause, nerve input to and from the brain may be miscommunicated. This means that nerves are not transmitting messages correctly.

When there is an interruption in the central nervous system (brain, spinal cord) or peripheral nerves (all other nerves in the body), messages may not reach the intended body part. Additionally, the body part that is requesting a response from the brain may not transmit the message. At times, the messages may not be transmitted entirely or, at other times, partially.

Body messengering occurs through a vast internal system of nerves. Nerves have a main body with a series of small branches called dendrites. There is one long branch called an axon that has nerve terminals at the other end. All of this is encased in myelin which acts as an insulator.

Messages are sent through the system of nerves to and from the brain. This is done through an electrochemical reaction at the nerve terminals. Because the reactions involve positive and negative electrons, the chemical reaction has an internal electrical charge as the transmissions occur.

Messages from the brain to the body are sent through motor nerves. Messages from the body to the brain are sent through sensory nerves. Some nerves are mixed, both sensory and motor. Transmission of messages can be interrupted in any part of this intricate system. The brain can miscommunicate messages due to injury or disease. The interruption can be at any level of the spinal cord nerves. An individual nerve in the body can be damaged or just part of the nerve structure, such as an issue with the myelin coating as in multiple sclerosis.

When nerves are not functioning to their potential, electrochemical reactions do not occur. This creates a 'silence' in the body where the nerve is not communicating. The body runs on nerves communicating, so lack of message transmission is always being sought. Sometimes this seeking of nerve input results in tone or spasticity, autonomic dysreflexia, or results in flaccid muscles without tone.

You can provide nerve impulses through different therapies. One is to provide movement to your body by physically moving the body parts that are not receiving some or all the nerve function messages. This can be done through a range of motion exercises, stretching, passive movement, vibration, or other physical exercises. Range of motion exercise and stretching is moving your body either by using your arms to move your legs or moving your body for you. This should be done several times a day, moving every joint. There are other ways to add movement to your body through activities, including rolling in bed, pressure releases, and tilting your powerchair. The vibration of muscles can be done using a massager or use of a vibration plate.

These activities require time to be done but should be done every day as with many exercise programs. They require a minimal amount of expense. Always check with your healthcare professional prior to starting any movement program to ensure your body is able and ready for it.

Another way to get movement into your body is to consider electrical stimulation. Nerves of individuals with cervical and thoracic injuries stimulate well. Those with lumbar or sacral injuries may not stimulate as readily, but there are options. There are two ways to accomplish this goal, externally on the skin and internally with implants.

Electrical stimulation of muscles through the skin is done for a number of conditions. It is used to break pain cycles, wound healing, tone (spasms), edema and to improve function. When electrical stimulation is used as a treatment to improve function, it is termed functional electrical stimulation (FES).

To improve function, electrodes are placed on the skin over muscle targets within the body. A low energy signal to the muscle stimulates the nerve. The body will attempt to send a message to the central nervous system that the nerve is stimulated as the muscle contracts.

The use of skin surface electrical stimulation has many positive benefits, including muscle exercise and re-education, improvements in grasping, reaching, standing, walking, and bowel, bladder and sexual function in males is possible. Some individuals, especially those who have had a stroke, use this therapy consistently to improve foot drop.

Christopher Reeve used skin surface functional electrical stimulation to gain movement in every part of his body as well as increased sensation. His recovery was limited by gravity and balance, which he was still actively working to achieve. Many individuals with incomplete and complete injuries have had success or major functional improvement with this type of therapy.

Clinical application and research have propelled this therapy further into use. At the University of Washington in Seattle, a study was done placing electrodes at the base of the neck over the spinal cord, instead of at the target muscle. Using electrical stimulation, individuals with spinal cord injury have made significant functional gains in hand and arm use in weeks and months. Use this report to see if you might be able to adapt and benefit from this therapy in your local rehabilitation setting.

Many rehabilitation centers are working with functional electrical stimulation. If you would like to try this therapy, ask your healthcare professional for a referral. You may be able to use your yearly two weeks of therapy to begin a program that can be continued at home. The two-week or ten-day time period does not always need to be consecutive. It can be spread over time with breaks in between treatment days. Check with your payor source or have your healthcare professional or therapy center obtain preapproval so you will have appropriate coverage.

Another way electrical stimulation is helping individuals with paralysis is with electrodes surgically implanted. Implantable electrical stimulation consists of electrodes that are surgically put into the body, typically attached on or close to nerves. The controller may also be implanted within the body or maybe outside of the body.

Some implants are currently available for a variety of issues, especially when nerve control issues are within the peripheral nervous system (not in the brain or spinal cord) as those who have a lumbar and sacral injury resulting in flaccid muscles. One of these includes an implant for bowel, bladder and sexual function in males with injury to the cauda equina or lower end of the spinal cord. This implant attaches to the nerves just outside of the spinal cord to create an electrical impulse that opens and closes the rectal and bladder sphincters. There is an optional third connection for erectile function in males.

A diaphragmatic pacemaker for individuals that replaces mechanical ventilation for breathing is available. This can be implanted through open surgery, which can be a risk for individuals with spinal cord injury and other neurological disorders. Dr. Raymond Onders, a specialist in Ohio, has pioneered minimally invasive surgery for a diaphragmatic pacemaker implant, which recently received FDA approval. This technique will soon have increased availability.

Research for clinical application into implantable electrical stimulation is undergoing now. Preliminary indications report remarkable progress with increased independence in functional activities but also in sensation, cardiac and bowel and bladder function.

Some companies are nearing the marketplace for distribution. If you would like to follow the progress of this type of study, stay tuned to the Christopher & Dana Reeve Paralysis Foundation, which is a sponsor of a major trial of implanted electrical stimulation study. You can read more about electrical stimulation studies or any topic of interest by searching on the Government's Clinical Trials website. Even if you are not ready for a clinical trial or it is not available in your area, you can gather information for the future or adapt the study outcomes as a part of your rehabilitation. Nurse Linda

Pediatric Consideration: Waiting for adult research translation to pediatrics can take time. Fortunately, some centers are working on functional improvements for children with paralysis. Use the clinical trials website to help you locate studies as well. Pediatric research is less in number, but it is there.

You might not be able to travel to a study site or perhaps are not ready to become involved in a study. That is fine. Use the information on the site as a starting point to discuss treatment options with your healthcare provider. It might be recommended to follow along as the study progresses, or you might be able to use some of the newly gained information in the treatment plan for your child.

Electrical stimulation is an approved treatment in children with paralysis under certain conditions. Children respond quickly to the treatment. It can maintain the body for future advancements in care. Ask if it is appropriate for your child. 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.

This project was supported, in part, by grant number 90PRRC0002, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.