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Is chronic myeloid leukemia a contraindication for e-stim? Is there any research to support use of estim with client with CML?

I am working on a SCI inpatient rehab program. I have a question about using FES with a 72 year old client with T12 AIS C SCI and who has multiple co-morbidities.
Client generally has grade 1-2’s for muscle strength in LE and I would like to use FES over quads, hamstrings, tib ant, gastroc for strengthening.
Client’s co-morbidities include chronic myeloid leukemia diagnosed over 15 years ago, which she is receiving medication treatment for. She also has osteoporosis, congestive heart failure and a history of recurrent PE (no PE currently and on anti-coagulation indefinitely). She has history of multiple fractures at T3, T11, L1, L2, L3 and L5 as well as a sternal fracture, sacrococcygeal #, left rib # and left wrist #. These occurred when she fell from a ladder about 8 weeks ago. She is currently using a power w/c. We are working on transfers bed <-> w/c +1pSBA and bed mobility. She is using tilt table at 70 deg x 15 minutes, rest, then x 10 min. We are completing strengthening and ROM for 4E and trunk. She is also practicing sitting balance exercises. She is making improvements with sitting balance, bed mobility and transfers.

I was reviewing the CPA document for electrophysical agents: Contraindications and precautions. On CPA document, it says E-stim (all forms) should not be applied to:

  • Regions of known or suspected malignancy. My question: Is chronic myeloid leukemia a contraindication for e-stim?
    I asked attending physician she was unsure about this question. Leukemia is a blood borne cancer and client’s chronic cancer has been stable with medication treatment. I asked an assistant professor at U of T and she indicated that "Cancer is considered an absolute contraindication for electrical stimulation due to its ability to stimulate cell division. Estim also has an effect on circulation. So based on the info you provided, I would not use electrical stimulation with this patient."

Also on CPA document, it says NMES should not be applied to

  • Any area unstable due to recent surgery, bone fracture or osteoporosis. In this case she has no fractures to LE where I would be applying estim, but she does have osteoporosis. I spoke with attending physician and she suggested to start low and go slow regarding osteoporosis, which I feel comfortable proceeding with in this regard.

Jonathan Russell

11 months ago

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Prof Tim Watson
Prof Tim Watson

Jonathan Thanks for your query and sorry that you have not received a reply in the last month - we are having some problems with members of the panel not being notified when a new query comes through To some extent, the answer depends on where (geographically) you are working - appreciate that this should not be the case - but that is the reality of life I am afraid In some countries the use of FES or E Stim would be considered to be a contraindication in the case that you describe - whilst in other countries it would be OK - though should be delivered with caution. This is a bit crazy - given that we are all (nominally) looking at the same evidence base . . . . I would not (personal opinion) consider the chronic myeloid leukaemia to be an absolute contraindication. The listing of 'cancer' or 'tumour' on the CI lists is a bit of a catch all - and probably over conservative. In the most part, it applies to 'solid' tumours or cancerous masses rather than the diffuse nature of what you are describing BUT that having been said, if you are practicing in Canada, and the published guidance in that country says not to do it, then you would be at odds with your professional body (potentially) and that might not be a place that you want to go. I will try and nudge a couple of my Canadian colleagues to log in and chip into the conversation. If you are not practicing in Canada, but just citing their docs, please let us know where you are based (don't need a street address - just a country!!!) Regards


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