Functional electrical stimulation now recommended for a wider range of neurological conditions

NICE NG252 is the first guideline to recommend functional electrical stimulation (FES) for people with lower motor neuron lesions, not just upper motor neuron conditions like stroke. What this means for access.

Until October 2025, NICE guidance on functional electrical stimulation (FES) was limited to a single recommendation: FES for drop foot caused by upper motor neuron conditions such as stroke, multiple sclerosis, and brain injury (IPG278, originally issued 2009).

NICE NG252, the new rehabilitation guideline for chronic neurological disorders, changes this. For the first time, NICE recommends considering FES for people with muscle weakness of the lower limbs caused by an upper motor neuron lesion alongside gait training. Crucially, the guideline committee also noted that FES can optimise timing and strength of muscle contractions during walking for people with lower motor neuron lesions where the nerve lesion is incomplete. This is the first time NICE has extended FES recommendations beyond upper motor neuron conditions.

The guideline also recommends considering neuromuscular electrical stimulation (NMES) to add muscle strength for both upper and lower limbs in people with peripheral or central nerve disorders. This is a broader recommendation than FES alone and recognises the growing evidence base for electrical stimulation across neurological rehabilitation.

What does this mean practically? NICE recommendations do not automatically create NHS funding. Access to FES services remains variable across the country, with some areas having established clinics and others having none. However, NICE recommendations strengthen the case for commissioning and funding. For families and solicitors, they provide an evidence base to cite in EHCP disputes and Tribunal proceedings where FES has been recommended but not provided.

Thrive therapists are experienced in assessing suitability for FES and can include FES recommendations in independent physiotherapy reports where clinically indicated. If you'd like to discuss whether FES might be appropriate, get in touch for a free initial call.