Electrical stimulation for stroke patients offers a wide range of benefits. From improving motor skills to preventing atrophy, electrical stimulation (E-stim) can help you overcome many secondary effects of stroke.
If your physical or occupational therapist has recommended electrical stimulation, you might be wondering how it works. This article will explain everything.
Before getting started, it’s important to note that there are some things to be aware of and contraindications to the use of electrical stimulation, which are as follows:
- Anyone with a pacemaker or other implanted electrical device should never use electrical stimulation
- Anyone with numbness/decreased sensation should use e-stim with extreme caution and under the direct supervision of a therapist or other health professional
- E-stim should never be used over wounds or malignant tissue
- Pregnant women and individuals with epilepsy should consult with a physician before using e-stim
Most importantly, always consult with your therapist before starting any e-stim program.
With that said, let’s discuss the mechanisms and benefits of e-stim for stroke recovery.
How Does Electrical Stimulation for Stroke Patients Work?
To understand how electrical stimulation works, it will help to understand how stroke affects your muscles. The brain uses chemical and electrical signals to tell your muscles when to move. When a stroke occurs, the damaged parts of the brain can no longer send these signals properly. As a result, it can become difficult, if not impossible, to move your affected muscles. This is where electrical stimulation can help.
Electrical stimulation works by placing non-invasive electrodes on your skin. Once activated, these electrodes send mild electrical impulses to your muscles, causing them to contract.
Electrical stimulation for stroke patients can help to activate the damaged portions of the brain by providing intense stimulation. In turn, this stimulation engages neuroplasticity, the process the brain uses to rewire itself and heal from injuries like stroke.
Neuroplasticity allows healthy areas of the brain to take over functions from damaged ones. It does this by forming new neural pathways in response to stimulation. Therefore, e-stim, by providing extra stimulation, can boost neuroplasticity and potentially speed up stroke recovery.
How to Gain the Most Benefits from E-stim for Stroke Rehabilitation
According to research from the American Heart Association, combining electrical stimulation with physical therapy is more effective for stroke patients than just exercise alone.
While some forms of electrical stimulation are passive (involving no participation on your behalf), e-stim for stroke patients should be active. This means you should try to engage your muscles yourself when you feel the electrical current activate.
When patients are engaged in therapy exercises during e-stim, it helps to further engage the brain-muscle connection. This will in turn increase the amount of motor control you can gain back.
Exercise without electrical stimulation can still activate neuroplasticity and help stroke patients regain movement. For maximum benefit, though, the science is clear: combining e-stim with exercise is the best way to go.
It’s important to work alongside a therapist when starting with electrical stimulation. Physical therapists will often use e-stim for rehabilitation of the lower extremities, while occupational therapists will use it for the arms. These specialists know the best places to place the electrodes and which exercises are most helpful. If e-stim works well for you, ask your therapist to recommend a home e-stim device along with exercises you can practice at home.
E-stim is sometimes uncomfortable, but it should never be painful. If you experience pain, ask your therapist to adjust your settings.
Types of Electrical Stimulation
There are multiple types of electrical stimulation available for use in stroke rehabilitation.
The following are the most common types of e-stim used by therapists:
- Neuromuscular electrical stimulation (NMES). This is used for muscle strengthening and motor recovery of paralyzed or weakened limbs.
- Functional electrical stimulation (FES). This is a type of NMES that is commonly used in stroke rehabilitation. It helps patients regain functional use of their muscles, such as improving hand strength to grasp utensils.
- Transcutaneous electrical neuromuscular stimulation (TENS). This type is often used to treat and manage post-stroke pain. Instead of sending impulses to the muscles, TENS sends them across the surface of the skin. This prevents pain signals from reaching the brain
- Interferential current. Electrodes are used in a criss-cross pattern to “interfere” with each other, allowing for higher intensity. This type is typically used on patients with spasticity.
By combining these types of e-stim, therapists can treat a wide range of stroke symptoms.
Benefits of Electrical Stimulation for Stroke Patients
E-stim has a number of uses besides strengthening muscles. Below are the major effects of a stroke that e-stim has been proven to help with:
1. Hemiplegia (Post-Stroke Paralysis) and Muscle Weakness
Electrical stimulation may help introduce movement into paralyzed muscles after stroke (hemiplegia). When electrical stimulation activates the paralyzed muscles, you can capitalize on the opportunity and practice paralysis recovery exercises to help rewire the brain.
Ideally, through massed practice, this can help stroke patients with paralysis slowly regain movement. Stimulating your muscles regularly will also help prevent muscle atrophy, a common side effect of stroke paralysis.
If you struggle with weakness after a stroke, but not paralysis, e-stim can also help. As discussed above, by combining electrical stimulation with physical and/or occupational therapy exercises, you can maximize your gains.
2. Spasticity and Gait (Walking)
In addition, e-stim has been shown to help reduce spasticity in stroke patients, even after a massive stroke. It works by restoring communication between the brain and the spastic muscles, which helps the muscles relax and lengthen.
Stroke patients that wish to improve their balance and gait can also benefit from electrical stimulation. First, the electrodes should be applied to the lower extremities with the help of a physical therapist. Then, by practicing proper gait techniques, you can boost neuroplasticity and regain proper movement.
Some therapists might also combine electrical stimulation with specialized equipment such as an assistive treadmill. This treadmill comes with a harness that holds you up in a standing position. A team of therapists will then help you move your feet in a walking motion as the treadmill runs.
3. Shoulder Subluxation
Some stroke patients struggle with a shoulder issue called shoulder subluxation where the arm becomes dislocated from the shoulder socket. This condition is often painful.
Studies have found that functional electrical stimulation can help reduce the severity of shoulder subluxation and pain. It can also help improve arm function, too.
4. Edema (Swollen Limbs)
Besides sensory issues, electrical stimulation can help reduce edema after stroke. Edema refers to the buildup of excess fluid in tissue cavities and is especially common in stroke patients with mobility impairments.
When muscles are inactive for too long, they cannot move fluid through the lymphatic system. As a result, fluid can collect in the limbs, causing pain and stiffness.
Electrical stimulation, by contracting the muscles, helps move the fluid through the body. This prevents edema from occurring and restores more functional movements in the limbs.
5. Swallowing Problems (Dysphagia)
Finally, with the help of a highly trained therapist, you can use electrical stimulation to improve swallowing problems after stroke.
It’s critical to work with a therapist here. Do not attempt to do this yourself because e-stim on the neck can be dangerous. Only a skilled therapist knows where to safely place the electrodes.
Risks of Electrical Stimulation
While electrical stimulation offers many benefits, it is not appropriate for all stroke patients. For example, it is dangerous for patients with implanted electrical devices such as a pacemaker or defibrillator.
Work with your medical team to make sure e-stim is a safe option for you. They can determine if you should work alongside a therapist or if you can learn to use it on your own at home.
In addition, some of the potential risks of e-stim include muscle tears and skin irritations and burns. If the intensity is too high, these adverse effects may occur.
Finally, avoid placing electrodes in inappropriate places such as over the:
- Reproductive organs
- Exposed metal such as pins or staples
Depending on the body part you are working on, either a trained physical or occupational therapist can help you place the electrodes during therapy, or train you to apply them to approved locations yourself.
As you can see, working with a trained therapist is critical, especially in the beginning.
Making a Decision
Electrical stimulation offers promising benefits such as improved mobility, improved sensation, and reduced pain. It also boosts neuroplasticity in the brain, which can potentially reduce stroke recovery time.
In addition, combining electrical stimulation with therapy exercise is critical for achieving maximum results.
Finally, it is critical to work alongside a therapist who can either control the treatment or train you on how to safely use e-stim at home. This will prevent any accidental injuries that can occur with improper use.
We hope this guide to e-stim helps you on the road to recovery.