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Functional Electrical Stimulation (FES) and Multiple Sclerosis


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Functional electrical stimulation (FES)

Multiple sclerosis damages nerves, which prevents muscles from receiving the correct message from the central nervous system. This can lead to muscle weakness, fatigue, sensory problems, and difficulties moving the legs, feet or hands. Functional electrical stimulation (FES) is a treatment that involves the use of painless, mild electrical stimulation to a muscle or muscles to help them move.  

The treatment is administered by relatively small, battery-powered devices. FES devices work by sending low-level electrical impulses to damaged nerves. While these devices are effective for many people with MS, they may not be appropriate for everyone. If you are considering an FES device, ask your MS healthcare provider about how to get evaluated by a rehabilitation specialist with experience in MS to determine the correct treatment plan. You can find a rehabilitation specialist using our Find Doctors & Resources tool. 

Cost and health insurance coverage

The cost, health insurance coverage and availability of FES devices varies. Oftentimes these devices are not covered by insurance. You will want your MS healthcare team to assist you in the process of getting your device covered by health insurance. Your MS healthcare provider may refer you to specialists like physiatrists (rehabilitation physicians), physical therapists and orthotists. They can provide supportive documentation such as letters of medical necessity and therapy notes.  

If the device is not covered by your health insurance, check with the device manufacturer. They may offer financial assistance. For information on appealing insurance coverage denials, visit Health Insurance Appeals and Exception Requests or Ask an MS Navigator, highly skilled, compassionate professionals who can connect you to the information, resources and support needed to move your life forward.

Types of FES devices

FES for leg or foot weakness 

Some people with MS have difficulty lifting their foot (“foot drop”) while walking and are at risk of falling. MS can also cause weakness in the thigh muscles, leading to difficulty standing up from a chair or lifting the legs for walking or climbing stairs. Your MS healthcare provider may recommend physical therapy to improve strength and address any stiffness. In addition to physical therapy, some people may need to use medical equipment — such as a cane, walker, ankle foot orthotic (AFO) or FES device — to help them walk. 

FES devices for foot drop or thigh weakness can be used alone or in combination, depending on where you experience weakness. The electrical impulses activate leg muscles to allow them to lift the foot or move the leg. You would usually wear these devices continuously while you were up and about. FES devices may improve your ability to do daily activities like standing up from a chair, walking and climbing stairs. Use of an FES device may also decrease the energy cost of walking and decrease fatigue. Evidence shows, however, that FES devices may help while on, but may not help with long-term improvement in how well your muscles move when taken off. 

FES for hand weakness 

Hand weakness may occur for some people with MS, making it difficult to grasp objects and perform activities of daily living like cleaning, preparing food, getting dressed or writing. There are some FES devices that stimulate the muscles of the hand to help you perform these activities. These devices may be used during physical or occupational therapy sessions while practicing activities of daily living or performing strengthening exercises. Other devices may be used at home.  

Hand strength and ability to grasp objects may improve for some people who use FES devices. Some people may experience less spasticity. These devices may also be used to stimulate muscles at rest to increase blood flow, decrease pain and slow the muscles from wasting away (also called “muscle atrophy”). Again, FES devices may help while on, but may not help with long-term improvement. 

FES cycling

Functional electrical stimulation can be used for exercise with specially designed stationary bicycles. While using an FES cycle, electrical stimulation is applied to the leg muscles to time muscle contractions to help the user pedal. Some cycles can provide additional assistance with a motor that moves the pedals. This enables people with weakness or mobility limitations to exercise and challenge their cardiovascular system. FES cycles typically lack a seat, so there is space for people who use a wheelchair to remain seated. These devices may be used in therapy settings, adaptive fitness centers or in the home.  

FES cycling shares some of the benefits of other forms of exercise. It may reduce fatigue and pain and increase endurance (the ability to exercise for longer at more intense levels). FES cycling may decrease spasticity, increase cognitive processing speed and improve quality of life.  

FES cycling devices are not typically covered by health insurance and a limited number of providers are skilled in the use of these devices. Connect with your physical therapist to determine if you are eligible for a trial related to the use of FES for exercise purposes. There are some disadvantages to FES devices, such as potential skin irritation or equipment failure, and they typically cannot be used near water. 

Additional resources


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