A Therapist’s Perspective

A Therapist’s Perspective on StimRouter as a Treatment for Chronic Pain

by Nirav Patel, PT, DPT | Complete Balance Solutions Institute for Rehab 

 

Pain is major deterrent to advancements in recovery and healing in rehabilitation. Protective muscular guarding and posturing in the presence of pain can limit therapeutic interventions, and lead to weakness, atrophy, and eventual loss of use and function. Dr. Nirav Patel, PT, DPT, a physical therapist and Director at the Complete Balance Solutions Institute for Rehabilitation in Orange County, CA, says to other therapists, “If we can make changes in pain levels in our patients, we can make huge recovery. As a therapist, you’re climbing a huge uphill battle in motor activity and control in the presence of pain. Pain modulation must be a first step, because when you decrease the pain, you decrease motor inhibition and spasticity, and get greater range of motion and greater functional use.”  

 

Dr. Patel cites his patient Jeff as an example of how alleviating chronic pain has led to significant gains in therapy, overall function, and quality of life. Jeff had been diagnosed with relapsing/remitting multiple sclerosis and presented with shoulder and foot pain. To help Jeff manage his pain, the StimRouter Peripheral Nerve Stimulator was implanted near his axillary and peroneal nerves to target the pain at its origin. Patel describes Jeff before his implants: 

 

“Jeff had hypertonicity in his left shoulder adductors and internal rotators, and at his elbow flexors, so his elbow was constantly jabbing into his ribcage. He also had hypertonicity and spasticity in his gastrocnemius and soleus muscles along with his hip adductors and quadriceps. Jeff walked with a very scissored gait, along with limited knee flexion during the swing phase of gait.” 

 

As one of Patel’s long-term patients, he typically spent 20-30% of each clinical visit on the shoulder with little to no gains, despite using surface NMES, TENS and EMG/sensory feedback.

With the StimRouter, we saw an immediate drop in pain,” Patel stated. “And in a matter of two to three weeks, we’ve seen a rapid, 30% improvement in range of motion, tolerance to movement and hypertonicity.”

The difference is getting stimulation directly to the axillary nerve, which then can affect its collateral branches.” Another key element that factored into Jeff’s persistent gains was the device’s ease of use, for both the clinician and the patient. “Learning to use the StimRouter was easy.” says Patel. “For the clinician, device programming is very rapid. And for the patient, learning to use the StimRouter is very straight forward.” 

 

Patel notes how Jeff’s pain reduction led to other gains, “Stimulation of the axillary nerve immediately reduced his shoulder pain, which also changed his tone, to balance out the firing patterns of his scapular muscles. This allowed him to abduct his arm more freely and maintain a better sitting posture [which enabled] improved function throughout the kinetic chain.

 

“For example, Jeff began to extend his elbow, allowing for a more normal arm swing during gait. With a better arm swing, he improves his lower extremity activation, seeing greater stride length, gait speed, etc. Since having a StimRouter implanted near his peroneal nerve, he’s benefited from less foot pain and hypertonicity in his adductors and soleus/gastrocnemius complex, allowing for a much more efficient gait.”

 

The gains that Dr. Patel describes are not only physical. Pain control for Jeff has meant an improved relationship with his children and being able to do more things with his family. “That’s been huge for Jeff…the improvements in social function,” says Patel. “He is an avid musician and is now enjoying playing the drums with his daughter.

 

“Even months after his implant, he is still making progress. When he used the StimRouter while drumming, he began to gain isolated wrist ulnar deviation without elbow flexion, a very important motion for drumstick control.” 

 

Even though most of Dr. Patel’s experience using StimRouter has been with multiple sclerosis patients, he sees the value it can provide those with mononeuropathic pain, and encourages clinicians to consider it as an effective tool for pain management. He says, “The first thing to address is pain, and this will allow you to set accurate expectations for outcomes in therapy.”