Update to NICE Guidelines for Stroke Rehabilitation in Adults
In October 2023, NICE updated their guidance [NG236] relating to Stroke Rehabilitation in Adults over the age of sixteen. This guidance has updated recommendations for the use of FES/NMES in post stroke upper limb management, including strengthening for those who are unable to move their limb against gravity. The role of FES/NMES is also recognised in the management of hemiplegic shoulder pain and as an adjunct to focal spasticity management. FES continues to be recommended for those with foot drop post stroke.
A major theme of the guidelines is that the total amount of rehabilitation therapy should be significantly increased, with the previous daily target of 40 minutes being increased to 3 hours. FES is a tool that can help provide this increase in therapy time.
The full guideline can be found here: Overview | Stroke rehabilitation in adults | Guidance | NICE
Listed below are the relevant sections regarding FES / NMES:
Electrical stimulation therapy for the upper limb
1.13.15 Consider a trial of electrical stimulation therapy as part of a comprehensive rehabilitation programme for people who have evidence of muscle contraction after stroke but cannot move their arm against resistance. [2013]
1.13.16 Continue electrical stimulation therapy if the person’s strength and their ability to practise functional tasks (for example, maintaining range of movement, or improving grasp and release) is found to be improving. [2013]
1.13.17 If a trial of electrical stimulation therapy is appropriate, ensure the treatment is guided by a qualified rehabilitation professional. [2013]
Electrical stimulation for the lower limb
1.13.29 Follow NICE’s interventional procedures guidance on functional electrical stimulation for drop foot of central neurological origin. [2013]
This guidance is NICE [IPG278] published in 2009
1.1 Current evidence on the safety and efficacy (in terms of improving gait) of functional electrical stimulation (FES) for drop foot of central neurological origin appears adequate to support the use of this procedure provided that normal arrangements are in place for clinical governance, consent and audit.
Managing shoulder pain
1.14.4 Consider 1 or more of the following options for managing shoulder pain: includes neuromuscular electrical stimulation (NMES) [2023]
Spasticity
1.15.6 Consider a trial of NMES, functional electrical stimulation (FES) or transcutaneous electrical nerve stimulation (TENS) for people after stroke with focal spasticity. [2023]
There are recommendations for further research looking at the role of stimulation in swallowing for people with oropharyngeal and oesophageal dysphagia. It is also suggested that further research is needed investigating the clinical and cost effectiveness of neuromuscular electrical stimulation (NMES), transcutaneous electrical stimulation (TENS) and functional electrical stimulation (FES) compared to usual care for people who have spasticity after a stroke.