What is the recommended functional electrical stimulation protocol using the MH‑6000 for a patient with radial nerve palsy?

Functional Electrical Stimulation for Radial Nerve Palsy

I cannot provide specific MH-6000 device protocols because the evidence does not contain manufacturer guidelines or clinical studies for this particular device model in radial nerve palsy rehabilitation.

General FES Approach for Peripheral Nerve Injury

For radial nerve palsy causing wrist drop, functional electrical stimulation should be applied to wrist and forearm extensor muscles for 30 minutes, three times daily, during active attempts at wrist extension, initiated within the first 6 months of injury. 1, 2

Critical Distinction: FES vs TENS

• FES delivers motor-level currents that actively contract paralyzed muscles and provide proprioceptive feedback essential for motor recovery, whereas TENS only provides sensory-level pain modulation without muscle contraction. 1
• For radial nerve palsy with wrist drop, FES is the appropriate modality—not TENS—because functional motor recovery requires actual muscle depolarization and movement. 1

Electrode Placement and Parameters

• Position surface electrodes over the motor points of wrist extensors (extensor carpi radialis brevis/longus) and finger extensors (extensor digitorum communis). 1, 2
• Use tetanic stimulation frequencies (25-75 Hz) with pulse durations of at least 0.5 ms to produce functional muscle contractions. 3
• Set stimulation intensity to maximum tolerable level and increase whenever possible, starting low during initial sessions to avoid muscle damage. 3
• Use on-times of at least 4 seconds to generate adequate force for functional movement. 3

Integration with Active Rehabilitation

• FES must be combined with intensive, progressive, task-specific wrist extension exercises—stimulation alone is insufficient for functional gains. 1, 2, 4
• Begin with supported wrist extension movements on a table surface, advancing to unsupported movements as strength improves. 2
• The American Heart Association recommends FES combined with active exercise rather than static splinting for severe wrist drop. 1, 2

Timing and Duration

• Initiate FES within the first 6 months post-injury to align with the critical window for motor recovery and achieve stronger efficacy. 1, 2, 4
• FES is typically used as a time-limited intervention during the first several weeks to months of rehabilitation. 1, 2, 4
• Training frequency of 2-3 times per week allows sufficient muscle regeneration between sessions. 3

Expected Outcomes

• Meta-analysis demonstrates significant increases in wrist-extension muscle force with FES (high-quality evidence). 2
• Short-term improvements in motor strength and motor control occur with measurable reduction in impairment severity. 2, 4
• Evidence for functional outcome improvements in activities of daily living is less consistent than improvements in muscle force. 2, 4

Critical Pitfalls to Avoid

• Do not use static splinting or prolonged immobilization—this promotes learned non-use, muscle deconditioning, compensatory movement patterns, and poorer functional recovery. 1, 2
• If a removable splint is required for positioning, monitor closely and discontinue if pain or skin breakdown occurs. 1, 2
• Do not confuse FES with TENS or use TENS when motor recovery is the goal. 1
• FES cannot be used as a standalone treatment—it requires concurrent active motor practice. 1, 2, 4

Surgical Considerations

• For patients presenting early who can tolerate longer recovery time, nerve transfers combined with pronator teres to extensor carpi radialis brevis tendon transfer demonstrate superior grip strength compared to tendon transfers alone. 5
• Both nerve transfers and tendon transfers show significant improvements in grip strength, pinch strength, DASH scores, and quality of life postoperatively. 5