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Patients with neurological diagnoses often have impairments of body functions/structure and limitations in activity and participation that may be addressed through the use of electrical stimulation (ES). For example, a person who has sustained a stroke may have decreased strength, motor control, and passive range of motion (PROM); compromised balance; and spasticity, which then contribute to limitations in walking and participating in community activities. Mobility and activities of daily living (ADLs) are often compromised, so important components of rehabilitation are to improve these important activities and allow for greater independence and participation. Neuromuscular electrical stimulation (NMES) and functional electrical stimulation (FES) may be used clinically to address some of these areas. NMES is defined as the use of ES to activate muscles through stimulation of intact peripheral motor nerves, and FES is the use of NMES to promote functional activities.1


A thorough examination must be performed to determine the patient’s appropriateness for receiving ES (Box 14–1). Table 14-1 identifies items that should be considered when determining whether a patient with a neurological diagnosis is suitable for ES. This table is not all-inclusive. Other pertinent examination items specific to the patient should be included.

Box 14-1 Concerns Specific to Diagnosis


  • Cognitive status

  • Pre-existing medical issues

  • Spasticity

  • Blood pressure

Spinal Cord Injury

  • History of spontaneous fractures (osteoporosis)

  • History of autonomic dysreflexia

  • Sensation

  • Orthopedic concerns

  • Respiratory demands

  • Spasticity

  • Pressure sores

  • Pre-existing medical issues

Cerebral Palsy

  • Orthopedic issues

  • History of seizures

  • Implanted devices

  • Cognitive status

Multiple Sclerosis

  • Spasticity

  • Fatigue

  • Cognitive status

  • Pre-existing medical issues

Pediatric Onset Diagnoses

  • Scoliosis

  • Hip subluxation

  • Torsional deformities of bones

  • Osteoporosis

TABLE 14–1Examination and Rationale for the Use of Electrical Stimulation in Populations With Neurological Diagnoses

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