Upper extremity applications of functional neuromuscular stimulation.

Functional electrical stimulation (FES) has been used for increasing muscle strength, decreasing spasticity, and controlling movement of limbs for many years. Most of this work, however, has been done in a research setting. Over the past decade, FES has moved slowly from the laboratory to the clinical world through feasibility studies in groups of patients with spinal cord injuries and strokes. Electrical stimulation has been shown to decrease spastic tone both during and after the stimulation, allowing for better limb positioning, decrease in contracture formation, and in some cases, improvement of voluntary movement. Electrical stimulation as a motor prosthesis is now being provided to small groups of spinal cord-injured patients (primarily C4, C5 and C6 levels) to assist with hand positioning and to produce hand grasp. In these settings, patients have attained greater independence in activities of daily living and in work-related tasks. Distribution of this technology to multiple centers is continuing through a technology transfer program.