Electrical stimulation can be applied both centrally and peripherally. Central non-invasive (electromagnetic) neurostimulation, also known as non-invasive brain stimulation (NIBS), includes transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), the latter of which is delivered using a coil (rTMS).

In peripheral electrical stimulation, surface electrodes are placed directly on the skin to either stimulate superficial muscles (neuromuscular (electrical)-stimulation, NM(E)S or NMS) or activate somatosensory skin afferents (transcutaneous (electro-)neuronal stimulation, T(E)NS).

Unlike peripheral stimulation techniques, central stimulation methods are currently only used experimentally in the Netherlands and are not part of any standard rehabilitation services for adults with spinal or cerebral spasticity. As a result, this module focuses exclusively on peripheral electrical stimulation techniques, including (T(E)NS and NM(E)S).

Additionally, this module covers functional electrical stimulation (FES) which involves transcutaneous stimulation of a peripheral nerve to control muscle movement during activities such as cycling on an ergometer or walking. In cases of spasticity, FES can also influence muscle tone, making it a relevant component of this module.

The primary goals of NM(E)S/FES and T(E)NS in spasticity treatment are to reduce muscle tone non-invasively, increase range of motion (ROM) and functionality, prevent contractures, alleviate pain and improve posture and positioning for functional or cosmetic reasons. Peripheral electrical stimulation can be applied in various ways, including:

• Stimulating spastic-paretic agonists to enhance their strength.
• Stimulating antagonists to inhibit the (over)activity of spastic-paretic agonists (NM(E)S).
• Transcutaneous stimulation of sensory afferents linked to spastic muscles (T(E)NS).
• Combining multiple stimulation techniques for a comprehensive approach.

Structure of this chapter

In this chapter the effects of NM(E)S, T(E)NS and (FES) on spasticity are discussed for A. stroke, B. multiple sclerosis (MS) and C. spinal cord injury. In these paragraphs only the effects on spasticity, ROM, clonus, pain and muscle cramps and related effects on activity will be presented.