Electro Stimulation Therapy Producing Remarkable Results

It used to be that no more improvement was expected two years after a stroke. While it is still vital to get treatment and rehabilitation as early as possible after a stroke, sometimes it takes the brain a while to recover and patients can still benefit from “second chance” treatment.

“For the most part even after two years, people who get second chance rehab do regain some functional mobility,” said Lauren Ford, a physical therapist assistant with Chenal Heights Nursing and Rehab in Little Rock. “That makes their activities of daily living easier for them and their caregivers.”

Second chance treatment can be for people who went through treatment right after their stroke, and reached a point at which progress was slowing down or maybe plateaued at the time. They went home, had a decline, and then came back to try rehab again.

“For the most part, they improve after second chance rehab,” Ford said. “With strokes and other neurological disorders, it takes a while. You have to be patient. It isn’t going to happen overnight. We let patients know it will get better, but it is going to take more than a day or two. It is a constant challenge.”

Factors that can contribute to the success of stroke rehab are the severity of the stroke and the patient’s support system of family and friends. Depression after being disabled can cause reluctance to rehab.

Physical therapists are using more tools to achieve better results.

Electrical stimulation (ESTIM) therapy tools are available in many varieties, and they can be both useful and controversial. Many feel that they are best used in later stroke rehabilitation after normal pattern movement and regeneration have been naturally facilitated. Regardless, biomechanical advances in neurosciences are advancing steadily, and they are expected to revolutionize the field of neuromuscular rehabilitation.

Ford has often seen amazing results with ESTIM.

“There are several makes and models on the market and are all good for neuro re-education,” Ford said. “I have not seen every type of ESTIM, so I am certain there are several out there that are great, but I have seen great return with systems such as Bioness and ACP PENS units.”

Ford has seen that people who receive ESTIM tend to show progress quicker than those who do not.

“I always try to use it,” she said. “If I had to pick one tool out of everything we can use with stroke patients, if there are no contraindications, I would use ESTIM. I think it is very important. I’ve seen wonderful results.”

Ford finds it very rewarding when a patient is able to do something for the first time since their stroke.

“When they can see they are getting better, they are ready to try even harder,” she said. “It is very rewarding for us and them, of course.”

Another type of electrotherapy useful in treating dysphagia (difficulty swallowing) in stroke patients is VitalStim Therapy. 

“VitalStim Therapy uses electrodes placed at selected points on the neck while an electrical current stimulates motor nerves in the throat,” said Lindsey Vestal, MS, CCC-SLP, a speech-language pathologist with Northridge Health and Rehabilitation in North Little Rock. “The patient practices swallowing exercises that cause the swallowing muscles to contract while electrodes are in place. It’s more effective than just swallowing exercises alone since it is able to stimulate nerves at a much deeper level. VitalStim Therapy is very similar to the e-stim treatment used by physical therapists.” 

Constance Williams, an occupational therapist with Chenal Heights Nursing and Rehab in Little Rock, said a treatment approach she has found to be effective is the use of neuromuscular electrical stimulation (NMES) in promoting motor return to an affected extremity.

In terms of supported research for facilitating motor return to an affected extremity, Williams said evidence-based articles are shifting toward use of functional treatment approaches to promote motor learning and neuroplasticity. “There is also evidence on constraint-induced movement, where patients are somewhat ‘forced’ to utilize their affected extremity during daily activities,” she said. “However, this approach is usually done in a very controlled setting with an established protocol.”

Other approaches that have been utilized over the years include use of weight-bearing activities, neurodevelopmental treatment (NDT), and proprioceptive neuromuscular facilitation (PNF) that aim to facilitate normal movement patterns and proper postural alignment through the use of handling and practice of motor movements. Williams said these approaches do not have as much evidence or research behind their approaches; however, they are still used by many therapists and are effective.”

The role of occupational therapy in stroke rehabilitation centers around improving functional independence during daily activities with use of various therapeutic interventions. The occupational therapist’s role is to problem-solve and task-analyze in order to determine why a patient is unable to perform a certain task.

“So it’s important for us to look at all aspects of the individual (physical, cognitive, environmental, etc.) to help promote function,” Williams said.

“The field of occupational therapy and research has really made a shift toward participation in functional and goal-related activities in order to enhance function. By that, I mean that occupational therapists are focusing their treatment around participation in daily activities-‘occupations’ that they do each day.”

Williams said typically what they see with stroke patients is someone who presents with hemiparesis to one side of the body or loss of motor function to one of their upper extremities. That loss can be severe (flaccid with no palpable muscle contraction) or minimal (increased weakness to one side).

“We may provide adaptive techniques or strategies during those tasks if patients have severe loss of motor function,” she said. “If there is motor return to the affected extremity, the occupational therapist may practice the motor patterns required to perform those tasks or incorporate the extremity into the activity to act as a functional assist.”

Stroke rehabilitation is one of the most challenging areas for any therapist. While there are different treatment protocols used for rehabilitating strokes, most deliberate protocols share similar traits. Integrating motor control, visual perceptual function, and coordination across midline (the center of the body), as well as stimulating normal postural mechanisms are critical to recovery.

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