Differences and Commonalities of Electrical Stimulation Paradigms After Central Paralysis and Amputation

Patients with spinal cord injury (SCI) or with severe brain stroke suffer from life-lasting functional and sensory impairments. Other traumatic injuries such as limb loss after an accident or disease also affect motor function and sensory feedback and impair quality of life in those individuals. Invasive and non-invasive functional electrical stimulation (FES) is a well-established method to partially restore function and sensory feedback of paralyzed and phantom limbs. It is also a supporting technology for the rehabilitation of the neuromuscular system and for complementing assistive devices.

This work reviews the current state-of-the-art of FES as a technology for restoring function and supporting rehabilitation therapy and assistive devices.

Electrodes, electrical stimulation, use of brain signals for rehabilitation and control, and sensory feedback are covered as parts of the whole. A perspective is given on how clinical and research protocols developed for patients with SCI and brain injuries can be translated to the treatment of patients with an amputation and vice versa. We further elaborate on how motor learning strategies with quantitative electrophysiological and kinematic measurements may help caregivers in the rehabilitation process. Insights from practitioners (collected during a workshop of the IFESS 2025) have been integrated to summarize common needs, open questions, and challenges.

The information from the literature and from practitioners was integrated to propose the next steps towards establishing common guidelines and measures of FES in clinical practice towards evidence-driven treatment and objective assessments.