Electrical stimulation in lower motoneuron lesions, from scientific evidence to clinical practice: a successful transition

Eur J Transl Myol, 2023 · DOI: 10.4081/ejtm.2023.11230 · Published: January 1, 2023

Simple Explanation

Long pulse electricalstimulation and its beneficial effect on lower motoneuron (LMN) damage have long been underestimated in daily rehabilitation practice in Switzerland and worldwide. The lesion might directly occur in the anterior horn, as it is the case in spinal cord injury (SCI), or it might result from peripheral nerve injuries, which can affect upper or lower extremities as a result of cuts, fractures or disc herniations. The aim of the present observational study was to extract the number of patients, the type of LMN lesion and form of applied stimulation from data collected in SPC during 2022 and consequently to substantiate these with the scientific evidence for the clinically expected stimulation effect.

Study Duration

Not specified

Participants

n=128 patients

Evidence Level

Not specified

Key Findings

1
From the 128 new patient cases, having been evaluated in 2022, 38% showed an upper motor neuron lesion, 49% a LMN lesion and 13% a combined lesion
2
In 57% the lower limbs and in 43% the upper limbs were affected, respectively
3
Changes in the degenerated musculature can still be expected even in long-standing chronic state (more than 20 years after denervation).

Research Summary

Long pulse stimulation in its application in everyday clinical practice still represents a challenge for many therapists and clinicians. A retrospective data analysis of n=128 patients, seen at the Swiss Paraplegic Centre (SPC) in 2022, shows a broad variability in manifestation of lower motoneuron damage. Treatment examples based on different causes of lower motoneuron damage are shown and corresponding stimulation programmes are assigned, as well as the expected results in terms of stimulation duration, volume and configuration.

Practical Implications

Early treatment option

Long pulse stimulation of denervated muscles is an early treatment option in temporary and potentially chronic peripheral denervation.

Preserving reinnervation target

In cases with perspective of recovery of nerve supply, the method is capable of preserving the reinnervation target in near-normal state.

Maintaining muscle tissue

If denervation is permanent, long pulse stimulation of denervated muscle is the only option to maintain muscle tissue and metabolic functioning in the anatomical region.

Study Limitations

1
The spectrum of available stimulators is still limited.
2
A limitation of most available stimulators is in low deliverable maximum amplitude and minimum of inter-pulse pauses being limited to longer than the pulse itself.
3
What remains critical, is handling and placement of electrodes.

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