Whether it’s a spinal cord injury, multiple sclerosis, stroke or Parkinson’s disease, there are different possibilities of electrical stimulation for neuronal disorders and impairments available today for example, for the adjustment and modification of symptoms by movement disorders and pain control.
My repertoire includes selected modern electrical stimulation methods and covers all common indications and topics – whether it is deep brain stimulation, epidural spinal cord stimulation, peripheral nerve stimulation, neuromuscular stimulation or functional electrical stimulation of individual nerves and muscles in the movement process.
The goal is usually to reach a modification of brain, spinal cord and nerve functions, for example to achieve a reduction in pain or to reduce involuntary movements, cramps or tremors and thereby support functional movements such as walking or grasping.
On the following pages you can learn more about the possibilities of electrical stimulation and its effect and application.
Neuromuscular stimulation (NMS) involves the use of surface electrodes to directly stimulate a muscle, or several muscles, in order to induce contraction of the intended muscle or muscle group(s).
In central paralyses – such as stroke, multiple sclerosis, spinal cord lesions, etc. – neuromuscular stimulation may be applied to stabilize and build up shoulder muscles, to activate movement of the arms or hands, or to strengthen muscles used in lifting the foot during walking.
A key advantage of neuromuscular stimulation is that patients may use it as a self-treatment at home.
Functional electrical stimulation (FES) is a treatment that uses electrical current to stimulate a muscle or muscle group(s), or to stimulate motor nerves, in order to either directly or indirectly induce the contraction of muscles used in movement sequences – as in lifting the foot during the “swing phase” of walking. In the latter case, a heel switch detects initiation of the lifting motion and supports it by triggering electrical stimulation.
FES is frequently used to treat a drop foot condition – in this case it is also possible to position a ring electrode directly over the nerves requiring stimulation. This form of therapy may be indicated for stroke, multiple sclerosis, brain injuries and spinal cord injuries.
A key advantage of functional electrical stimulation is that patients may use it as a self-treatment at home.
Transcutaneous electrical nerve stimulation (TENS) is a form of electrical stimulation therapy (using surface electrodes) for treating pain caused by a variety of conditions. Patients may use TENS as a self-treatment at home. The aim of this therapy is to reduce or eliminate pain by modulating the pain fibers (afferent nerve pathways). TENS activates the body’s natural pain inhibitors in the spinal cord, which in turn leads to the increased release of endogenous morphine (endorphins).
Die subkutane Nervenstimulation (SNS) modifiziert Schmerzen und ist eine Alternative zur transkutanen elektrischen Stimulation – wenn diese auf Dauer über mehrere Stunden täglich verwendet wird. Im subkutanen Bindegewebe der Haut wird eine mehrpolige Elektrode über dem Schmerzareal gelegt und nach einer Testphase mit einem Nervenstimulator, implantiert unter der Haut, verbunden. Der Eingriff ist minimal invasiv. Ziel der SNS ist die Verminderung bzw. Unterdrückung von Schmerzen durch Modulation der Schmerzfasern. Mit einem Handprogrammierer hat man jederzeit die Möglichkeit die Stimulation den klinischen Notwendigkeiten anzupassen.
Dorsal column stimulation – often referred to as spinal cord stimulation (SCS) – is a minimally invasive therapeutic method for treating spasticity (excessive muscle tone brought on by stroke, cerebral hemorrhage, multiple sclerosis, spinal cord injury, etc.) and chronic pain (back pain, polyneuropathic pain, neuralgia, etc.).
To perform the treatment, the dorsal (posterior) columns of the spinal cord are stimulated with electrical pulses using multi-contact electrodes.
The aim of dorsal column stimulation is to reduce muscle tone (spasticity) as well as pain. A handheld programming device enables the patient to self-adjust the stimulation parameters within the range established by the treating physician, thus optimizing the effectiveness of the treatment.
Deep brain stimulation (DBS) is a surgical procedure to influence movement disorders, such as those occurring with Parkinson’s disease, dystonias and essential tremor. The indications for deep brain stimulation are determined by the patient’s neurologist together with the operating neurosurgeon. If the clinical conditions for surgery are met, a 4-lead electrode is implanted in the basal ganglia to modulate “abnormal brain signals” (using a type of “brain pacemaker”) and thus positively change or suppress the movement disorder.
The aim of deep brain stimulation is to suppress stiffness, immobility and trembling in Parkinson’s syndrome, or cramps and involuntary movement in dystonias. A handheld programming device enables the patient to self-adjust the stimulation parameters within the range established by the treating physician, thus optimizing the effectiveness of the treatment.