Trophic Electrical Stimulation for Chronic Stroke Patients: A Fact Sheet

A stroke is a haemorrhage into the brain caused by the rupturing of blood vessels. Typically affecting one side of the body and the resulting paralysis is called hemiplegia.

Following a stroke you will have a period of intensive physiotherapy which is designed to get your arms and legs moving again as quickly as possible or to get you mobile again. You will when discharged from hospital have exercises to perform daily at home and reviews with your physiotherapist. The physiotherapy sessions may themselves tail off or end at this point.

Is this as good as you are going to get?

No

What is Trophic Electrical Stimulation?

Electrical Stimulation has been widely used over the years and is known to help certain nerve muscle problems. The stimulation techniques in the past were always focused on making the muscle move with the electrical impulses hoping that this would promote recovery (Faradism). Whilst this approach was initially useful in increasing our knowledge of the relationship between nerve and muscle, with new advances in technology, it is now possible to embark on a more specific conditioning of the system involved.

The word ‘trophic’ is about good health and systems that thrive. TES basically copies the underlying signals which nerves in normally functioning systems feed to the muscle to keep it in good health. The repeated signal is the impetus for the muscle to rebuild itself and it will do this according to exact specifications. By copying the healthy nerve signals and playing them back into a system that is dysfunctional we can gently guide it back to good health. Though the dose of TES may seem rather weak in nature as a copy of the nerve signals it is really rather like a homeopathic dose of medicine. Coming in this way it has no side effects but because it is so accurate it is in fact very potent.

TES is applied to the muscle with the specific purpose of influencing the metabolic pathway aiding the nutritional development and the growth of muscle. It takes time however for the muscle to reinstate its supply of fresh blood through the capillary beds and to redesign the building blocks of the protein to healthy blueprints. The use of TES can compliment many of the conventional physiotherapy techniques.

Why is it different from the physiotherapy I have already had?

The nervous system is constantly improving itself and the intensive treatment used 7 days a week enables you to tap into the changes. The physiotherapy treatments to date have been too short to maximise your potential.

What does it involve?

Trophic Electrical Stimulation is designed as a home based treatment. The patient uses a small unit daily at home. The physiotherapists will teach you how to apply the unit, programmes last 1 –3 hours and the unit can be worn in bed, alternatively you can wear it whilst moving around the house. Assessments are once every 2- 3 months at the discretion of the physiotherapist. Much like the recovery you have had changes are slow and progressive building to better movement and function in the future.

What changes can I expect?

With a stroke the recovery is largely influenced by the amount of damaged initially sustained. However, nerves can eventually regrow into areas only to find that the muscles have wasted with disuse so they have nothing to work with to get movement. Strengthening the red muscle and giving the nerves a wake up call can restart the recovery process.
If you have a subluxed shoulder i.e. the shoulder is hanging forward and down it may be impossible to use the arm and difficult to clear the arm from the body for dressing. Building up the red muscle around the shoulder joint allows the shoulder to be
brought back into position and allowing movement of the arm from the shoulder.
Treatment can then progress down the arm even helping with the hand sensory loss.

Likewise you may be walking but you may have problems with your foot dragging on the floor, again problems with gait can be addressed.

Initially the centre treated only facial palsy and we have had great success with facial problems following stroke. Weakness around the mouth for example can make speech slurred, this can be improved giving better lip seal to prevent dribble and tone in the cheek to improve appearance.

Where can I see a physiotherapist about the use of TES?

The Lindens Clinic has a physiotherapist specialising in the use of TES for rehabilitation following a stroke. She has seen patients a few months after the stroke or even years later. We also have a couple of experts in the treatment of facial paralysis depending upon your needs. We use electromyographic testing, an electronic way of listening to the conversation between the nerves and the muscles allowing us to isolated which out of a group of muscles is causing a problem and target the treatment more effectively.
Alternatively try asking your physiotherapist about it.

What do I do now?

Ring the clinic for an appointment. If you have private health cover they will pay the physiotherapy fees, ring them to get a preauthorisation number and to check if there is any loading or excess on your policy. You will have to pay the machine hire costs.

Produced by
Diana Farragher OBE FCSP MSc Grad Dip Phys Dip TP