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6.3.37.2.4 NMES for Walking in Clients with Spinal Cord Injury (SCI)
The type of NMES that is used to enhance the ability to walk of SCI clients is commonly referred to as functional electrical stimulation (FES). These devices are surface units that use electrical impulses to activate paralyzed or weak muscles in precise sequence.
The use of NMES/FES is limited to SCI clients for walking, who have completed a training program which consists of at least 32 physical therapy sessions with the device over a period of three months.
The trial period of physical therapy will enable the physician treating the client for his or her spinal cord injury to properly evaluate the person's ability to use NMES/FES devices frequently and for the long term.
Physical therapy necessary to perform this training must be directly performed by the physical therapist as part of a one-on-one training program. The goal of physical therapy must be to train SCI clients on the use of NMES/FES devices to achieve walking, not to reverse or retard muscle atrophy.
NMES/FES used for walking is a benefit for SCI clients with all of the following characteristics:
• Clients with intact lower motor unit (L1 and below) (both muscle and peripheral nerve).
•Clients with muscle and joint stability for weight bearing at upper and lower extremities that can demonstrate balance and control to maintain an upright support posture independently.
•Clients that demonstrate brisk muscle contraction to NMES and have sensory perception electrical stimulation sufficient for muscle contraction.
•Clients who possess high motivation, commitment and cognitive ability to use such devices for walking.
•Clients that can transfer independently and can demonstrate independent standing tolerance for at least 3 minutes.
•Clients that can demonstrate hand and finger function to manipulate controls.
•Clients with at least 6-month post recovery spinal cord injury and restorative surgery.
•Clients with hip and knee degenerative disease and no history of long bone fracture secondary to osteoporosis.
•Clients who have demonstrated a willingness to use the device long-term.
NMES/FES used for walking is not a benefit in SCI clients with any of the following:
•Cardiac pacemakers
•Severe scoliosis or severe osteoporosis
•Skin disease or cancer at area of stimulation
•Irreversible contracture
•Autonomic dysflexia
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