We utilize E-stim in many different waveforms to increase strength, increase self-awareness, decrease spasticity. Two of these E-stim modalities we utilize at Revive are somatosensory evoked potential (SSEP) and the ReBuilder.
Somatosensory Evoked Potential (SSEP)
SSEP utilizes a non-invasive electrical current that, when applied directly to certain nerves in the face and body, can stimulate and upregulate areas of the brain affected by traumatic brain injury, stroke, neuropathy, or neurodegenerative disease. Based on each patient’s extensive diagnostic testing, Revive‘s doctors create a treatment plan that targets the exact nerves that will activate the lobes and systems in the brain affected by the patient’s condition. Some cranial nerves that are often stimulated by SSEP are the hypoglossal nerve (Cranial Nerve XII) and the trigeminal nerve (Cranial Nerve V) for neurological conditions. For many of our stroke and TBI patients learning to walk again, we utilize our gait protocol. Our gait protocol stimulates the saphenous nerve and tibial nerve in various places in the leg(s) affected by the stroke, priming the neural pathways with electrical stimulation in order to increase communication to and from the brain, optimizing our patients’ ability to re-develop these damaged neural pathways.
AL-TENS is a form of hyperstimulation described by Sjölund and colleagues in the 1970s. It can be used if patients do not respond to conventional TENS (5). IASP defines the characteristics of AL-TENS as “Low-frequency (2–4Hz), higher intensity (to tolerance threshold), longer pulse width (100–400μs)” (4). Low-frequency trains or bursts (2–4Hz) of high-frequency pulses (100–200pps) are often used in clinical practice. The intention of AL-TENS is to stimulate small diameter, high threshold peripheral afferents (A-delta) in order to activate extrasegmental descending pain inhibitory pathways. Non-painful muscle twitches occur during stimulation causing activity in small diameter muscle afferents (Fig 2b). Electrodes are positioned over myotomes, trigger points, and acupuncture points. The term AL-TENS is used loosely in literature making the synthesis of research findings difficult.
In effect, the ReBuilder acts like a pacemaker works for your heart’s electrical signals. If the pacemaker does not send exactly the right signal, then the four chambers of the heart may not pump in the right order and if the signal is too fast or too slow, the heart stops. So, too, the ReBuilder’s precisely controlled waveform coaxes your nerves to transmit their signals in the proper order. Although designated as a TENS relative to the FDA’s regulations, the ReBuilder’s signals are vastly more controlled and precise.
The ReBuilder is typically used on patients as a neurological intervention to help with cortical remapping. If the brain is unsure of where the feet are in space after a stroke or other biomechanical event, the Rebuilder can help strengthen those signaling pathways. Additionally, vagal stimulation or gait protocols may be used for similar reasons.