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Looking for suggestions on NMES application in a gentleman with MS

I have been looking at evidence for the use of NMES in Multiple Sclerosis and am seeking some advice on parameters and sites of application. If anyone could speak to this it would be much appreciated! The patient is ambulatory with a cane though has significant limitations. He is able to get up from the floor with ++ effort. The right side is much weaker than the left. Balance is significantly affected.

Caitlin DuBiel

1 week ago

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Prof Richard Liebano
Prof Richard Liebano

Hi Caitlin,

Please see below a few more references on NMES and MS. I hope this helps.

A feasibility study to investigate the effect of functional electrical stimulation and physiotherapy exercise on the quality of gait of people with multiple sclerosis. Neuromodulation. 2014 Jan;17(1):75-84; discussion 84. doi: 10.1111/ner.12048. Epub 2013 Apr 19.

Pilot randomized trial of progressive resistance exercise augmented by neuromuscular electrical stimulation for people with multiple sclerosis who use walking aids. Arch Phys Med Rehabil. 2015 Feb;96(2):197-204. doi: 10.1016/j.apmr.2014.09.021. Epub 2014 Oct 13.

Pulse Width Does Not Influence the Gains Achieved With Neuromuscular Electrical Stimulation in People With Multiple Sclerosis: Double-Blind, Randomized Trial. Neurorehabil Neural Repair. 2018 Jan;32(1):84-93. doi: 10.1177/1545968317753681. Epub 2018 Jan 24.

Management of the symptoms of multiple sclerosis using functional electrical stimulation and exercise. Neurodegener Dis Manag. 2017 Aug;7(4):253-259. doi: 10.2217/nmt-2017-0010. Epub 2017 Aug 30.

Effects of functional electrical stimulation on gait in people with multiple sclerosis - A systematic review. Mult Scler Relat Disord. 2017 Apr;13:4-12. doi: 10.1016/j.msard.2017.01.010. Epub 2017 Jan 18.

caitlin.dubiel199
caitlin.dubiel199

Thanks Dr. Rennie. This looks like a fabulous resource.

Dr Sandy Rennie
Dr Sandy Rennie

Hello Caitlin. My colleagues and I recently published a large paper on neuromuscular electrical stimulation (Nussbaum EN et al: Neuromuscular Electrical Stimulation for treatment of muscle impairment: critical review and recommendations for clinical practice. Physiotherapy Canada 2017;69(5); 1-76). While we did not discuss MS per se, on page 18 there is a table and information on where to place electrodes and other parameters for treating foot drop and for gait improvement, which may be of some assistance for you.

In addition, Gervasoni et al (PM & R 2017;9(4);339-347) published a paper on using FES for MS. However they used the Bioness L300 Foot Drop device, not a portable muscle stimulator. I hope this information is helpful.

Kind regards, Sandy

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