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Contraindications for FES

Jill Seale, PT, PhD, NCS

June 9, 2015

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Question

What are the contraindications for using functional electrical stimulation?

Answer

First, it is necessary to go back and remind ourselves of the contraindications for electrical stimulation in general.  We certainly have to keep these in mind.  There is some debate still about the idea of whether electrical stimulation can be used when a person has a pacemaker or implantable defibrillator.  The bottom line is to not use it until you speak with their cardiologist.  Most textbooks and most literature will say it is okay to use FES or any type of electrical stimulation as long as you are not putting the electrodes on the trunk or somewhere around the heart region of the trunk.  As long as you are avoiding that, then most sources will say it is okay to do.  However, I would always want to consult the cardiologist first and touch base with them about what you would like to do and why you want to do it. For most of us, when we are thinking about doing something at the shoulder, it is a little bit closer to the heart and may be an issue.  Most of the literature says that FES is safe during pregnancy as long as you are not using it over the abdominal region, the pelvic region, the lumbar low back area, or the hip region.  That is a big part of the body, but again we are mostly talking about things related to the upper extremity or the distal lower extremity potentially.  The literature is also clear though that if a woman has had a history of miscarriage or complicated pregnancies you should forgo doing any kind of electrical stimulus no matter where it is.  This is something you would want to consult with a doctor, but most all of the literature shows it is safe for using on the extremities, staying away from the central region of the body. Over the carotid bodies is also contraindicated.  Other contraindications are over any implantable electrical devices, like phrenic nerve stimulators, urinary bladder stimulators, pain pumps, ITB pumps, etc.  If there is an area known peripheral vascular disease, thrombophlebitis, a known DVT or suspected DVT, you want to avoid Estim in that area.  You will also want to avoid the obvious places like over the phrenic nerve, the gonads, the eyes, over areas of active osteomyelitis, and areas of hemorrhage. 

 


jill seale

Jill Seale, PT, PhD, NCS

Jill has been a licensed physical therapist for 24 years. She received Board Certification in the area of Neurologic Physical Therapy from the American Physical Therapy Board of Clinical Specialties in 2004 and recertification in 2014. She has practiced almost exclusively in the field of Brain Injury and Stroke rehabilitation.  She has a variety of teaching experiences, in physical therapy academia as well as in the health care community at large. She is currently faculty in the DPT program at South College. In addition, she teaches in several online and onsite continuing education programs across the nation. She has taught and presented in the areas of neurological pathology, rehabilitation, gait, orthotics, mentoring, and research, and is currently involved in clinical research in stroke rehabilitation, orthotic management, and gait analysis/rehabilitation.


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