E-Stim, Again

Following up on the E-Stim Exoskeleton post from Feb. 16, about electrical stimulation (e-stim).  What is it and how does it work?

In rehabilitation, Electric Muscle Stimulation (EMS) is a way to urge muscle response.  Patches with wires are put directly on targeted muscles.  Electrical impulses are then sent from a machine in order to make those muscles contract.  E-stim can be a way to effectively build or maintain muscle tone.  There is another type of electrical stimulation called Transcutaneous Electrical Nerve Stimulation (TENS), primarily used for treating chronic pain.  Functional Electrical Stimulation (FES) is the therapeutic application of e-stim.  Some people use FES bicycles at home after a SCI.

The ability to use e-stim depends on precisely how and where an injury to the nervous system occurs.  Damage to lower motor neurons (LMN, as opposed to upper motor neurons) compromises muscle innervation, meaning that e-stim isn't necessarily an option for muscle rebuilding or maintenance.  With LMN trauma, again depending on the cause and type, voluntary muscle movement and reflexes are lost.  E-stim may not cause any muscle contraction if LMN damage is a factor.  (This has been the case for me so far.  One therapist said it was a 50/50 chance that e-stim would work after a SCI.  But keep reading.)

I've read in passing that e-stim must be begun very early on after the injury, and that if it is not utilized at all within the first two weeks or so, then those particular peripheral nerves quit firing in response.  Whether that's true I can't say.  In my limited experience, when they say it can't be done, it's still worth the try!  Studies on the use of FES for spinal cord injury rehabilitation are ongoing.