I have spent over fifty years working with electrical stimulation. The history is fascinating, the results can be spectacular, and despite the field's long history, I still believe we are just scratching the surface of what can be achieved. For a long time, though, using electrical stimulation for denervated muscle was uncharted territory for me, and I suspect for many others too.
In the 1970s, I was told that electrical stimulation would not work for denervated muscle. Worse, if you did manage to apply it, you might burn the skin. That all changed with the publication of the RISE study, a landmark European research programme that features heavily in this book.
I had another experience in 2010 that changed my thinking. A client in a UK Spinal Injury Unit asked me to test his muscles because he wanted to use FES cycling. His therapists had told him it was a waste of time because of his level of injury. When I tested him, I had to agree: using standard equipment, I could not produce a muscle contraction. The denervation resulting from his injury meant that conventional electrical stimulation simply would not work.
But the client was not willing to accept this. He persuaded me to lend him a specialist stimulator, and we created a daily stimulation programme for his leg muscles. After three months, he called to tell me he was now getting clear muscle contractions in both legs. It appeared that rather than the complete denervation he had been told about, he had a mixed presentation in which some nerve function was still present.
That event changed my thinking and led me to look much more closely at this field. In part, the result is this book.
This book is written for you: someone living with denervation, whether from a spinal cord injury, a peripheral nerve injury, or another cause. It is designed to help you understand your condition and make informed decisions about your treatment.
The chapters are grouped into four Parts.
Part 1, Understanding Your Condition, explains what has happened to your muscles, how nerve injury and recovery work, and provides a brief history of electrical stimulation in this field.
Part 2, The Evidence and What It Means for You, explains how electrical stimulation works, what the research shows, and provides honest answers to common concerns.
Part 3, Your Treatment, walks you through what to expect from assessment, the equipment you will use, how to manage a home programme, and how to track your progress.
Part 4, Specific Conditions and Practical Matters, covers spinal cord injury, facial palsy, post-surgical denervation, pressure ulcers, combining treatments, and why specialist equipment costs what it does.
Each chapter was originally written independently and then edited to provide a coherent whole. This means there is some overlap in content. We recommend you read the book from start to finish, as later chapters build on ideas introduced earlier. In each chapter, we point to related content in other chapters so you can find the depth you need.
The single most important message in this book is this: a denervated muscle is not beyond help. It requires a different approach to electrical stimulation than a normal muscle, but with the right equipment, the right guidance, and your commitment, meaningful improvements are possible. The science is sound, the evidence is real, and the treatment works.