Electrical Stimulation (ES) has been proven to help in upper limb recovery after stroke. Its benefits include strengthening weak muscles, increasing range of motion, reducing spasticity, and etc. However, its benefits are limited in actual application due to lack of knowledge and experience in many patients. In this sharing session, Ms. Yvonne will share practical recommendations with the clinical support evidence that can help to translate into actual practice and application for hand recovery of stroke patients. It is suitable for stroke patients, caregivers, physiotherapists, occupational therapists, doctors, nurses, and etc.

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Yvonne Khor
● Ms. Yvonne is a senior physiotherapist
and the founder of YK Natural Physio
& Academy Centre.
● She has a Master in Rehabilitation
Technology and Bachelor of
Physiotherapy
● Accumulated 8 years of experiences in
physiotherapist field including
musculoskeletal, stroke and sports
injuries.
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What is Electrical Stimulation？
● Electrical stimulation is a technique used to activate a muscle
contraction using electrical impulses.(Transcutaneous Electrical Nerve
Stimulation In stroke rehabilitation)
● Electrodes, controlled by a unit, are placed on the skin over a
predetermined area.
● Electrical current is then sent from the unit to the electrodes and
delivered into the muscle causing a contraction.
https://www.saebo.com/electrical-stimulation/
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Criterias of Electrical Stimulation in Stroke?
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● Muscle weakness
● Joint or muscle pain
● No movement
● Muscle spasticity

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Types of Common Electrical Stimulation (ES)
Types Neuromuscular Electrical Stimulation
(NMES)
Transcutaneous Electrical Nerve
Stimulation
(TENS)
Benefits ● Activate muscle
● Movement education
● Strengthen muscle
● Reduce muscles stiffness
● Increase blood circulation
● Reduce pain (joint pain, tendon
pain)
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Recommended Electrode Location
for Upper Limb in Stroke
1. To Reduce Pain
2. To Reduce Spasticity
3. To Reduce Swelling
4. To Increase Muscle Strength
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1. Reduce Pain : Shoulder and Wrist
Electrode Placement for Shoulder Pain
Electrical Stimulation Type : TENS
Duration : ~15mins (<30mins)
Electrode Placement for Wrist Pain
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Intensive reviews recommended that TENS
should be considered as a treatment option
for acute and chronic pain.
Clinical Research

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2. Reduce Spasticity
Electrical Stimulation Type : EMS/NEMS
Duration : ~15mins (<30mins)
Electrode Placement for Elbow Electrode Placement for Wrist
Elbow spasticity
Wrist spasticity
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2. Reduce Spasticity
Other stretching and strengthen exercise can be combined for better spasticity reduction
Wrist and Elbow Stretching Wrist Strengthening
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Clinical Research
Reviews showed NMES combined with other
intervention modalities can be considered as a
treatment option that provides improvements in
spasticity and range of motion in patients after stroke.

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Electrode Placement for Elbow Swelling
Electrical Stimulation Type : TENS
Duration : ~15mins (<30mins)
Electrode Placement for Hand Swelling
3. Reduce Swelling
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3. Reduce Swelling
Other exercise can be combined for better outcome
Hand Massage
Cold therapy Forearm Elevation
Robot air massage therapy
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Systematic reviews found Neuromuscular
electrical stimulation is effective in a
number of rehabilitation settings and patient
groups, for treatment of both upper and
lower limb oedema
Clinical Evidences

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4. Increase Muscle Strength
For Shoulder Flexion
For Elbow Extension
For Shoulder Extension
For Elbow Flexion
For Finger Extension
For Finger Flexion
Electrical Stimulation Type : EMS/NEMS
Duration : ~15mins (<30mins)
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4. Increase Muscle Strength
Other strengthening and functional exercise can be combined for better outcome
Finger Strengthening Wrist Strengthening Weight bearing/
joint proprioception
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Hand Robot Strengthening
Functional Movement Hand Robot Functional Movement

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Clinical Evidences

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Clinical Evidences
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Comparison of the training effectiveness of an NMES robot and a pure robot, both were effective
in improving long-term functional recovery in distal joints of the upper limb, where the robotic
sysem with NMES achieved more released muscle spasticity and more improvement in
voluntary motor effort and muscle coordination.

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Electrical Stimulation Frequency
● 90 - 130Hz pain gate mechanism : Pain reduction
● 2 - 5Hz opioid mechanisms : Pain reduction
● At least or more than 100Hz : Muscle stimulation/ Learning
Reference : https://pubmed.ncbi.nlm.nih.gov/20430713/ 19

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Contraindication
Electrical Stimulation is not suitable for patient with following person :
● Pacemaker
● Pregnancy
● Neoplastic tissue
● Active infection
● Uncontrolled epilepsy
● Uncontrolled hyper/hypotension
● Open wound
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Note : Kindly seeks for your health professional advices before using electrical stimulation

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Quick Demonstration
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Q&A
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