One of the most common questions I receive comes from people who've had a denervating injury—whether spinal cord injury, brachial plexus injury, or another peripheral nerve condition—years or even decades ago. They've recently learned that electrical stimulation might help preserve or improve their muscle condition, and they want to know: Is it too late for me?

This is an important question that deserves a thorough answer. The research evidence and my clinical experience both suggest that while earlier is definitely better, "too late" is rarely the correct conclusion. In this article, I'll examine what the evidence actually shows about late intervention, which factors influence outcomes, and how to decide whether it's worth trying in your specific situation.

We don't discuss the technical aspects of stimulation. This has been covered in other articles on this site. Recognise, however, that the stimulation patterns are designed to work directly with the muscle fibre and do not rely on an intact peripheral nerve.

Transcutaneous spinal cord stimulation (tSCS) represents a promising noninvasive neuromodulation technique for rehabilitation in spinal cord injury (SCI) and other neurological conditions.

From this article you will gain a clear understanding of how tSCS is used as a priming tool within rehabilitation, the research principles that guide its clinical application, how it is integrated alongside task-specific therapy, and what types of functional improvements and neuroplastic changes clinicians aim to achieve when it is delivered consistently over time.

Stroke rehabilitation is a race against time. The first weeks and months after a stroke represent a critical window for neurological recovery, when intensive therapy can make the greatest difference to long-term outcomes. Anything that delays or limits that rehabilitation—including preventable complications like heel pressure ulcers—costs the patient precious time.

Yet the very factors that make stroke rehabilitation urgent also make heel protection challenging. The hemiplegic leg lies immobile. Sensation may be impaired. Muscle tone may push the heel into sustained contact with the mattress. The patient cannot feel the damage as it occurs.

This article examines why stroke survivors face particular heel vulnerability and how to balance protection with the mobilisation that recovery requires.

Intensive care patients face the highest pressure ulcer prevalence of any hospital setting—14.32% according to international prevalence surveys. The heels account for a substantial proportion of these injuries. And unlike many ICU complications, heel pressure ulcers are largely preventable with appropriate intervention.

Yet in the complex, high-acuity environment of intensive care, heel protection can be overlooked. The focus—rightly—is on keeping the patient alive. Organ support, haemodynamic stability, ventilation, sedation. Heel protection rarely tops the priority list. But if a heel pressure ulcer occurs then this complicates continuity of care.

This article makes the case for implementing prophylactic heel offloading as a standard component of ICU care, and examines what effective implementation looks like in practice.

Goal setting in rehabilitation can be particularly difficult. Clients understandably want to know: “How soon can I see the benefits of a particular intervention?” The benefit can be perceived in two ways: the extent of relief provided and the duration of the relief.

As a product and service provider, it's important to us that we manage expectations. That we don't over-promise and under-deliver, and for that reason, we work with medical devices that have at least some research guidance on expected results. Even in the best cases, there will there be individual variations in how someone responds to an intervention.

Transcutaneous spinal cord stimulation (tSCS) represents a promising noninvasive neuromodulation technique for rehabilitation in spinal cord injury (SCI) and other neurological conditions such as multiple sclerosis (MS).

This article examines three distinct therapeutic applications—spasticity, pain, and functional recovery—each with different treatment requirements and expected outcomes. In basic terms, we review how long treatment should last before beneficial effects emerge and, once they do, how long they will last.

I recently came across an interesting newsletter item from "Building the Elite" about the relative importance of training volume versus intensity.

The argument—made by someone preparing candidates for special forces selection—was that volume is the primary training variable to manage. This is because it has the greatest impact on the training programme's effectiveness, while intensity determines the type of adaptation you're targeting.

This struck me as highly relevant to neurological rehabilitation. Let's see if you agree.