Managing Spasticity with NMES: A Closer Look at Physical Strategies
Spasticity remains one of the most complex challenges in upper limb neurorehabilitation. It not only limits functional ability but can also result in secondary complications like pain, muscle stiffness, and contractures. Effective physical management requires a combination of interventions tailored to each individual's needs. Among these, Neuromuscular Electrical Stimulation (NMES) has gained increasing recognition for its role in supporting recovery and improving muscle function.
Spasticity in Upper Limb, Source: Science Direct
A Multifaceted Approach to Physical Management
Physical management strategies for individuals with upper limb impairments after neurological injury often include a range of interventions that address muscle strength, joint mobility, positioning, and functional engagement.
Each element plays a unique role in supporting motor control and reducing complications associated with inactivity or abnormal tone.
Where Does NMES Fit In?
Spasticity in Upper Limb (Stroke & Cerebral Palsy Patients), using eir bands -our NMES devices.
NMES activates muscles using controlled electrical impulses. For patients with limited voluntary movement or muscle activation, NMES can support muscle re-education, reduce spasticity, and potentially delay muscle atrophy.
In the context of spasticity, NMES is particularly valuable due to its ability to:
Evidence-Based Insights
A key resource guiding the use of NMES in clinical settings is the review by Nussbaum et al. [1], published in Physiotherapy Canada. The paper provides a critical evaluation of NMES for treating muscle impairment, including its applications in spasticity management.
Here are some of the key insights:
Functional Integration is Key
Rather than treating NMES as a passive modality, the review strongly recommends integrating NMES with functional activity. For example:
Stimulating wrist or finger extensors during reaching or grasping
Combining NMES with task-specific training or sensory re-education
This approach supports motor learning and neuroplasticity, especially in individuals with stroke and spinal cord injury.
Stimulation Parameters Matter
The review emphasises that pulse duration, frequency, and intensity significantly affect both the comfort and effectiveness of NMES. For spasticity management, optimal parameters include:
Pulse duration: Typically 200–350 μs for large muscles
Frequency: Between 20–50 Hz without excessive fatigue
Intensity: Should be enough to produce a visible, functional muscle contraction
Proper parameter selection helps optimise motor unit recruitment while minimising fatigue and discomfort.
Treatment Duration and Frequency
According to the authors, session length and repetition influence outcomes significantly. Suggested guidelines include:
20–30 minutes per session
At least 3–5 times per week
Duration of intervention: at least 3–6 weeks for measurable functional change
However, the review acknowledges that protocols should be tailored to individual goals and patient tolerance.
The review concludes that NMES is most effective when it is:
Functionally applied
Individually tailored
Combined with active rehabilitation approaches
Effective spasticity management requires layering various interventions in a coordinated, responsive way. NMES can support this strategy by activating dormant pathways, enhancing control, and offering patients more opportunities to engage in meaningful movement.