Stim2Go from Pajunk is proving a very popular system for electrical stimulation due to its flexibility. In addition to supporting FES Cycling, it boasts many novel applications and the ability to create custom applications. Amongst its programs, there have been a number of transcutaneous spinal cord stimulation (tSCS) applications. Up until now, these were typically utilised to target severe spasms or pain.

We're getting to grips with some new cervical tSCS programs and two combined cervical-lumbar tSCS programs. These place one electrode on the neck and another on the lower back, and run both in the same 20-minute session. It is in beta testing, available under European and UK medical device rules only, and not cleared in the United States. I want to walk through the idea behind this configuration and what the human evidence shows.

Over roughly 250 years, therapeutic electrical stimulation has jumped to a new level perhaps seven times, and each jump was made possible by a new technological development. It might have been a way of handling current, storing it, generating it, shaping it, measuring it, timing it, or using it to tune the nervous system rather than drive it, and finally today triggering it from the person's own movement or intention. These are the stages I allude to in the title.

The first stimulator I worked with, as a PhD student in the late 1970s, filled a good part of a laboratory bench and needed someone who understood it standing beside it. The Stim2Go electrical stimulation device I carry to homes or clinics now is the size of my hand. It can be strapped to a client's thigh, senses when they start to move, and is set up from an app on my phone. Both deliver a pulse of current to a nerve. Almost everything else about them has changed.

When I demonstrate an FES cycling system, spasticity is usually in the room before I have finished setting up. A leg that will not settle onto the pedal. A knee that pushes out straight at the wrong moment. A foot that starts bouncing the instant it takes any weight. The person in the chair rarely calls it spasticity. They say their legs have a mind of their own, or that everything goes rigid when they transfer, or that the spasms wake them at three in the morning. The clinical word comes later, if it comes at all.

This article is for the person who has just been introduced to that word, or who has lived with the thing itself for years without anyone quite explaining it. I want to cover what spasticity and spasms actually are, why they happen after a spinal cord injury, a stroke or with multiple sclerosis, what they do to daily life, and what genuinely helps, from medication through to electrical stimulation. I will try to be clear about what the evidence shows and what it does not; if different people have told you contradictory things, that is partly because the field itself contains genuine uncertainty.

After a neurological injury, whether a spinal cord injury, a peripheral nerve injury, or a period of enforced immobility, clients often ask: "Will electrical stimulation bring the muscle back?"

I have learned to pause before answering, because "back" hides two quite different questions. The first is about size: will the muscle get bigger again? Obviously, this is what people notice when they look down at their legs. The second is about substance: will the tissue that returns actually be muscle, in the working sense of the word, rather than a mixture of shrunken fibres, fat and scar? This is less obvious to a client, but it's what we actually need. Researchers call this second property muscle quality, and it is the more important of the two. It is also the one that almost nobody explains to patients.

In this article, I want to walk through what muscle quality means, how it is measured, what happens to it after injury, and what electrical stimulation has been shown to do about it. I will cover both of the situations we work with: innervated muscle, where the nerve supply is intact and conventional stimulation applies, and denervated muscle, where the nerve supply has been lost and an entirely different approach is needed. The evidence differs between the two, and so do the limits of what is possible, and I will be plain about both.

One of the quieter worries in rehabilitation is rarely about the therapy itself. It is about money. Equipment is expensive, budgets are tight, and funding is often uncertain until late in the process. The fear we hear most is not "will this work," but rather "will I spend a significant sum and end up with the wrong thing, or with several things that do not work well together." Does this sound familiar?

It is a reasonable worry, and it deserves a straight answer rather than a sales pitch. This article looks at one practical way of reducing that risk: choosing a single, flexible stimulator that covers several rehabilitation needs, rather than a separate machine for each. The device we have in mind is the Stim2Go, and the point is not so much the brand as the principle behind it.

Ask someone in the early stages of recovery from a spinal cord injury or stroke what they most want to do again, and the answers are often smaller and more specific than you might expect. Not "run a marathon." More often, it is something like rising from a chair without help, managing a transfer to the bed, or pushing up to standing so that getting to the toilet is your own business and nobody else's.

Sit-to-stand sits at the centre of all of that. It is one of the most important movements in daily life and one of the first functional milestones a therapist will work on. If you can move reliably between sitting and standing, a great deal of independence follows. This article looks at how electrical stimulation, and in particular a responsive electrical stimulation device like the Stim2Go, can support sit-to-stand practice as part of a wider rehabilitation programme.