Ever done TeleFES?! Is that even a thing/word?! Well, have you ever wondered whether you could do FES rehab on your weak arm and hand at home, online with your ARNI instructor or another therapist – and is it worth it?? Well, I’d say yes it can be done – and it indeed could be worth it, especially if your hand is more weak and floppy (flaccid) than clenched tight (spastic).
As you know, FES sends a small current to the nerve that fires a muscle in your weak arm, so when you try to move, the current helps your hand or wrist complete the movement. Decades of work (Cauraugh in 2003, Hara in 2008, a meta-analysis of the field in 2015 etc) show it’s really a motor-relearning tool, rather than a passive treatment you sit and receive – and expect will work well foy you. You have to try and make the movement yourself, and the stim completes it. It also obviously doesn’t give you more reps! You do the same number either way!
But, if your hand visually barely moves when you try, and not much happens that you can see (neurologically it’s still doing a hell of a lot, btw), you’re still not completing the ‘rep’ (task). But with FES, the hand actually opens when you try so you get a whole movement to practise completing instead of a ‘failed’ one… your own effort and the current together complete the task. Also, it’s less used to prime before a session btw, it facilitates you to practise a task you couldn’t otherwise can’t do. That’s one of the reasons why it suits a weak, flaccid hand best (if your hand is clenched tight with spasticity, FES can still be used). Btw, the ‘triggered’ versions, where the stim fires when you try to move, work better than the ones that just cycle on and off on their own. This suits telerehab btw because task practice can be supervised and guided remotely. The therapist sets the stimulation up with you over the screen, watches your attempts, corrects your movement, grades the task up or down and adjusts the stim as you go.
Does the evidence back it? Well, most home trials so far test feasibility rather than effectiveness. A Sheffield team published one last year in 2025 (in the Journal of NeuroEngineering and Rehabilitation) using a system that fired the FES when it detected the person attempting to move. Seven chronic survivors did nine home sessions over about three weeks, setting the kit up themselves with a carer and remote guidance from a physio. Arm function on the Fugl-Meyer scale rose by an average of 3.83 points, which was statistically significant but below the 4.25 points usually treated as a meaningful change, and it varied widely between people. The authors called it evidence of feasibility and acceptability, not of effectiveness. Also, with no control group the gains can’t be put down to the FES alone. The wider evidence points the same way; a 2022 meta-analysis of home arm rehabilitation found programmes using electrical stim did better than home programmes without technology (SMD 0.64, a moderate effect). A 2025 home-FES study of 52 chronic survivors reported 74% adherence and 73% satisfaction with functional gains, though that programme treated walking and balance rather than the arm. So, across telerehab trials generally, remote sessions tend to perform about as well as face-to-face.
No one’s yet run a trial of telerehab with FES against telerehab without it, so there’s no proof it beats ‘ordinary’ online upper-limb rehab with a physio or ARNI trainer. But for me, the logic and the older FES evidence both point the same way. If your hand is currently too weak to complete the movement on its own, and you can set the FES up and adjust it properly with someone online who then sets you tasks and monitors you while you do them, it could well do more for you than the same session without it.
The take away is if you’re going to try this paradigm, whether you’ve got flaccidity, spasticity or a mix of both… you have to TRY every single rep yourself. If you just let the current do the ‘opening’ for you, however guided it is via telerehab assistance, it’s going to be far less effective that you trying as hard as you can, with the current finishing the movement off that you can’t quite manage yet. Why not ask your ARNI Instructor or physio to look into setting something up for you?!
