Direct Muscle Stimulation

Therapy takes place primarily at the structural level.

If the neuromuscular access to a muscle is temporarily or permanently interrupted due to a spinal cord injury (SCI), direct muscle stimulation can ensure that the muscle can still be maintained and even rebuilt.

A denervated (complete or partial interruption of neural pathways) muscle atrophies and dystrophies - the muscle mass regresses dramatically and is replaced by fat and connective tissue. These degenerative processes are prevented by the special type of electrical stimulation and can even be reversed with regular use. The parameters and application protocols used differ fundamentally from neuromuscular stimulation (NMES) [1] - Basically, it can be said that with direct muscle stimulation, the amount of energy with which the muscle is to be stimulated and thus made to contract must be significantly higher than with neuromuscular stimulation. For direct muscle stimulation, as mentioned, high amounts of energy, but also high pulse widths are necessary to contract the muscle - this requires powerful electrical stimulation devices, which differ from pure or combined NEMS/TENS devices.

Application

e.g. the pure build-up or preservation of muscle tissue, e.g. to prevent pressure sores on the buttocks
building up other denervated or partially denervated muscles

You can find possible devices here:

Stimulette RISE Stimulator

NEUBIE Electrical Stimulation device

If you have severely atrophied muscles, contact your current or former rehabilitation center - it may be possible to obtain such a device through your insurance company if the need for it can be proven.

It is strongly advisable to start maintenance training in the early phase after denervation (complete or partial interruption of nerve pathways) and to use it regularly. [1]

Rule of thumb for direct muscle stimulation training:

min. 3x direct muscle stimulation training 30-45 min per week for muscle maintenance
5x or more muscle stimulation training 30-45 min per week for tissue remodeling with subsequent muscle development

Preferably sponge electrodes are used, which must be moistened before being applied to the muscle to be trained - Important: Only train according to the stimulation device's operating instructions and in consultation with a therapist who is familiar with direct muscle stimulation. The large amounts of energy can lead to burns or other physiological effects if used incorrectly. If used correctly, however, the therapy is absolutely safe.

The aim of training can be to maintain the health of the muscles in anticipation of a hoped-for or foreseeable reinnervation (the restoration of the nerve supply (innervation) after denervation has taken place) or a comprehensive tissue preservation as decubitus prophylaxis, which should be applied regularly. [2]

Useful links

To continue reading this topic, please follow the link below:

Trans Spinal Stimulation

Citation Source Information

[1] Funktionelle Elektrostimulation in der Neurorehabilitation, Thomas Schick, 2021.

[2] Carraro et. al 2005

[3] Webseite, https://schuhfriedmed.at/wp-content/uploads/2024/01/Neurologie_Rehab_Maerz2023.pdf