Question
What are some contraindications or red flags for electrical stimulation use?
Answer
Let’s talk about some red flags when you are utilizing electrical stimulation. These things do not necessarily mean that you can never utilize electrical stimulation with this patient. These are just things to consider before you make a determination if the treatment is appropriate.
Electrical Devices
The first red flag is use of a cardiac pacemaker or implanted electrical device. We clearly do not want to disrupt the appropriate functioning of a cardiac pacemaker. Additionally other patients may have some sort of implanted electrical device. Some individuals who have tetraplegia have a diaphragmatic pacer. It is similar to a cardiac pacemaker, but it is attached to the diaphragm to facilitate more independent breathing. Often our patients may have some sort of pump delivery system for a medication. A common one is a Baclofen pump. That does not mean that you can never do e-stim with these patients, but it does mean that you need to consider if it is appropriate, where on their body are you utilizing the stimulation, and will that interfere with the electrical signal of the device. With any of these red flags, if you have questions, it is always appropriate to ask the physician for medical clearance or discuss this with the patient’s nurse, physician or someone who is overseeing their medical care.
Malignant Tissue/Metastases
A second red flag that we want to be aware of is malignant tissue or the presence of metastases. Use of electrical stimulation has in the past been linked to changes in tissue growth, and while it is not always contraindicated, we want to consider if it is wise to use electrical stimulation over that site. That patient may have metastases that have changed their bone density or have caused different medical issues. We want to make sure that we are paying attention to that factor.
Impaired/Absent Sensation
Using electrical stimulation with someone with impaired or absent sensation is not a hard, solid contraindication. I use electrical stimulation with patients with impaired or altered sensation on a fairly regular basis. Some patients may feel nothing when you are utilizing electrical stimulation and you will want to make sure that you are paying attention to what they look like, how they are talking to you, etc. You want to make sure that their vitals are remaining stable. Is the electrical stimulation being tolerated by their body or is it being rejected as some sort of noxious stimulus? If the patient is starting to exhibit signs of change since you have initiated use of the electrical stimulation, you will want to discontinue and assess quickly.
Someone with impaired sensation may have some ability to tell you if the stimulation hurts, if it is too strong or too weak. Some patients also experience hypersensitivity. They may have a lower tolerance to stimulation than you would initially anticipate with someone with spinal cord injury. Again, this is not a hard and solid rule that you can never do electrical stimulation, but you want to make sure that it is a factor that you are watching.
Epilepsy/Pregnancy
It is not always contraindicated, but in the cases of epilepsy and pregnancy, I highly recommend that you consult with the patient’s medical team to determine if it is appropriate.
Thrombosis/Hemorrage
This also stands for patients who have a history of thrombosis or hemorrhage. If the patient is having active thrombosis or hemorrhage, they probably should not be in therapy. They should probably be in an acute care setting. These are also just things that you want to consider.
Cognition
Finally, when you have a patient with reduced cognition, you want to make sure that you are explaining to them what they are going to be feeling. This depends on the level of cognitive function of the patient. If they are someone who is cognitively at a very low level, it may not be the most appropriate intervention to use at this time. Depending upon the situation, we would need to consult with family before utilizing a treatment such as electrical stimulation.
