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Arm Function

Functional Electrical Stimulation (FES) for the upper limb

FES treatment is provided for upper limb neurological problems resulting from stroke, brain injury, spinal cord injury or cerebral palsy.  There a three main categories of upper limb treatment:

Subluxation of the shoulder

Shoulder subluxation is a condition where the ligaments around the shoulder stretch causing the humerus bone of the arm to drop from the shoulder socket.  Shoulder subluxation is frequently painful and the range of shoulder movement and function are reduced. It is a common condition following stroke but can also result from other neurological conditions.  

The Microstim 2v2 device has been specifically designed to be used to exercise the muscles around the shoulder.  By providing overlapping stimulation from two separate channels, the first channel can be used to stimulate muscles that lift the humerus into the socket while the second channel takes over to maintain it in that position.  Our clinical experience is that electrical stimulation is very effective at reducing the pain associated with shoulder subluxation and where there is some voluntary movement, it can result in an overall improvement in arm function

  • The main aim is to reduce pain associated with shoulder subluxation
  • The three compartments of the deltoid muscle plus the supraspinatus muscle are stimulated causing the humerus to elevate into the glenoid -humeral socket
  • The treatment may need to be continued long-term to maintain reduction of pain

FES Exercise to improve hand and arm function

Stroke, Cerebral Palsy and Head Injury

Where there is some functional movement the treatment aim is to improve the hand and arm function.

  • Patients should have some functional ability, typically being able to produce a grip but may not be able to release, or reduced ability to extend the elbow
  • Main treatment aim is to increase the strength of the extensor muscles while reducing the spasticity in the flexor muscles
  • Repetition of exercises may lead to neuroplastic changes (learning) resulting in improved function
  • Patients may be asked to practice practical tasks while exercising with electrical stimulation.  By combining voluntary activity with exercise there may be a greater training effect, leading to movements being relearned.

FES Exercise to improve hand and arm function

Spinal cord injury

The treatment aim is to strengthen existing voluntary movements to maximise functional ability.

  • Patients should have some functional ability, typically a weak tenodesis grasp in C6 tetraplegia or general weakness in incomplete C5/6/7 tetraplegia
  • The main treatment aim is to increase the strength and therefore function of the affected muscles
  • Specific aims can be improvement of tenodesis grip, strengthening of elbow or wrist extension or retraining of muscles used for tendon transfer surgery.

Non functional group

In most cases, if there is little voluntary function, it is unlikely that there can be significant improvement in function after using electrical stimulation.  However, electrical stimulation can still have beneficial effects.

  • FES can be used to relieve spasticity with the aim of loosening an over tight grip or elbow flexion
  • The main treatment aim is to reduce pain associated with spasticity, increase range of motion to assist with hygiene by enabling better washing or assist other activities of daily living such as dressing

Clinical Procedure for Upper limb FES

The referral and assessment process is the same as for lower limb applications.

In most cases upper limb treatment is limited to a 6 month period.  In that time the patient will be seen for five, 1 hour appointments.  At the first appointment an electrical stimulation exercise programme for the patient to perform at home will be devised. Where appropriate, additional physiotherapy exercises may also be given.  Follow up is provided at 2, 8, 16 and 24 weeks.  At each session, the exercises are reviewed and progressed.  Where appropriate, functional measures will be made to record progress.

In some cases it is beneficial to continue treatment over a longer period.  This is reviewed at the week 24 appointment and a recommendation made to the referring clinician.   

Microstim 2V2 Kit

Clinic referral criteria