FES Devices for Wrist Drop
For an adult patient with wrist drop due to a neurological condition, use a functional electrical stimulation (FES) device with surface electrodes applied to the wrist and forearm extensor muscles. 1
Specific Device Characteristics
- Surface electrode systems are the recommended technology, not implantable devices, for wrist drop rehabilitation 1, 2
- Multi-field electrode technology (such as Fesia Grasp) provides superior muscle selectivity and can generate a wider range of hand and wrist movements compared to traditional single-field electrodes 3
- The NESS H200 is a commercially available option, though its rigid arm splint design may not fit all patients and can prevent tenodesis grip 4
Critical Implementation Requirements
Apply the FES device within the first 6 months post-stroke for optimal motor recovery outcomes, as this represents the critical window for neuroplasticity 1, 5
Treatment Protocol Structure
- Use FES for 30 minutes, 3 times daily during active attempts at wrist extension 6
- Never use FES as standalone treatment - it must be combined with intensive task-specific wrist extension practice 1, 5
- The stimulation should cause minimal to virtually no pain during application, with sessions lasting 45-60 minutes maximum 2
Progressive Exercise Integration
- Start with supported wrist extension movements on a table surface, advancing to unsupported movements as control improves 1
- Add structured resistance training beginning at 40% of 1-repetition maximum with 10-15 repetitions, progressing to 41-60% intensity as tolerated 1
- Perform resistance training 2-3 times per week to allow adequate recovery between sessions 6
Expected Outcomes and Limitations
The primary measurable benefit is improved muscle force in wrist extension, not necessarily functional improvements in activities of daily living 1, 5
- Evidence demonstrates short-term increases in motor strength and motor control with reduction in impairment severity 7
- Most motor recovery gains occur within the first 6 months, making early intensive rehabilitation critical 5, 6
- Continue rehabilitation for 9-12 months for optimal functional recovery, even after wrist extension returns 6
Critical Pitfalls to Avoid
- Do NOT use static splinting or immobilization of the wrist, as this prevents restoration of normal movement and promotes learned non-use 1
- Do NOT delay treatment - waiting beyond 20 days without improvement signals that passive recovery alone is insufficient 6
- Do NOT progress resistance too quickly - start with very low intensity during initial sessions to avoid muscle damage 6