Scope of application

Be it muscle strengthening after accident or surgery, treatment of paralyzed muscles, incontinence, pain therapy or rehabilitation after stroke – the electrotherapy device STIWELL med4 offers a comprehensive therapy concept. Another unique feature of the STIWELL med4 is the possibility to stimulate with “MF” pulses.

Select your field of interest:


  • Ischemic or hemorrhagic stroke
  • Neural lesions, pareses, spasticity

Muscle weakness

  • Denervated muscles (peroneus, arm and hand pareses, etc.)
  • Pain therapy (acute and chronic pain)


  • Urinary incontinence
     - Stress incontinence
     - Urge incontinence
     - Mixed incontinence
  • Fecal incontinence

How does electrotherapy work and what can it do for me?

Electrotherapy is the therapeutic application of electrical pulses in medicine and physical therapy. Electrotherapy is used in rehabilitation to strengthen muscles, relearn movements and support the regeneration of the nervous system.

Electrical pulses cause the muscles to contract with the objective to build up and strengthen them. The electrical signals which trigger muscle contraction are transmitted from the device to the muscle through the skin. Electrically conductive contacts, so-called electrodes, are attached to the skin. Your physician or therapist will show you the most effective electrode placements for your application when fitting the device to your needs.

Muscle activity in the body is usually controlled by the nervous system which stimulates muscle contraction with electrical signals. When parts of the nervous system (for instance parts of the brain or a nerve) are damaged, signal transmission may be impaired so that signals may be incomplete when reaching the muscle or may not reach the muscle at all. The causes for such damage may be stroke, accident or infection.

As a consequence, these muscles will be less used and muscle mass decreases.
An electrostimulation device such as the STIWELL med4 is used in rehabilitation programmes to prevent muscle atrophy and support the regeneration of the nervous system. With transcutaneous electrical nerve stimulation (TENS) electrotherapy can also be used in pain management.

Has effectiveness of electrotherapy been proven?

The effectiveness of functional electrotherapy has been proven in several studies. The international guidelines are based on these studies and recommend suitable therapy. Contact us for detailed information about studies and guidelines.


Stroke – Training of motion sequences

The STIWELL med4 can be used after stroke and other neurological disorders (traumatic brain injury, cerebral palsy in infantile brain damage, multiple sclerosis, etc.) as follows:

  • (Re)learning of movements and everyday activities
  • Muscle relaxation in cases of increased muscle tone (spasticity)
  • Muscle strengthening in cases of nerve damage, pareses, peroneal nerve paralysis (foot drop) and in arm/hand rehabilitation after hand surgery

Multi-channel functional electrostimulation

In central neural weaknesses or deficits, electrical pulses can support muscle function. Functional electrostimulation uses these electrical pulses to partly restore or compensate motor deficits due to injury or illness. With the help of targeted therapy, the human brain is able to transfer functions no longer available in damaged areas to undamaged areas (neuroplasticity).

Simultaneous or sequential activation of up to four muscle groups allows developing even complex physiological movement patterns with the STIWELL med4. The individual muscles are sequentially electrically stimulated for a complete movement.

The STIWELL med4 ideally supplements physiotherapeutic and ergotherapeutic applications aiming at practicing challenging motor tasks (e.g. grasping and releasing objects or pinpoint hand-to-mouth coordination - see pictures below) and relearn motion sequences.

With EMG-triggered multi-channel electrostimulation the STIWELL med4 can be used to practice voluntary movements and to strengthen the muscles. Interaction with the nervous system allows successful treatment of many neurological disorders.

Thomas Schick, MSc, Clinical Specialist STIWELL, informs about the many application areas of functional electrostimulation and explains its function with practical examples.

He has many years of experience as senior physiotherapist in different rehabilitation centres and is a lecturer in the area of EMG-triggered multi-channel electrostimulation.

Application examples of multi-channel functional  electrostimulation:

Everyday movements such as grasp/release, open/close hand, hand to mouth, arm extension and stand up from sitting position can be practiced regularly with the STIWELL med4 electrotherapy device. Targeted training of finger and hand movements, e.g. precision/lateral pinch, is also possible. The multi-channel functional  stimulation programmes are individually programmed.

Functional electrostimulation (FES) STIWELL
Relearning of movements
STIWELL functional multichannel electrostimulation
STIWELL Stroke treatment
STIWELL Relearning of movements
STIWELL Stroke rehabilitation
Precision and lateral pinch
STIWELL precision pinch
STIWELL lateral pinch
Lateral pinch with the STIWELL med4
Arm extension
STIWELL med4 Electrotherapy
Electrotherapy neurological disease
Stand up from sitting position
STIWELL stand up from sitting position
Stand up from sitting position
Stand up from sitting position with the STIWELL med4

Facial nerve paresis

The STIWELL med4 feedback programmes can be used in the therapy of facial nerve paresis, e.g. after neurological disorders, nerve damage or in idiopathic pareses, etc.

Depending on the clinical symptoms, voluntary muscle contraction, muscle relaxation and intermuscular coordination can be practiced. Visual and acoustic feedback with specially developed computer games helps the patient become aware of and actively change muscle tone.

In addition to the purely EMG-based biofeedback training, the STIWELL med4 allows combining biofeedback with electrotherapy. The programme “EMG-triggered (1 EMG)” can be used to activate the mouth or eyes. Electrostimulation is triggered as soon as the patient reaches a certain muscle tone. The programme “EMG-triggered (2 EMG)” additionally trains minimizing inadvertent movements.

STIWELL therapy of facial nerve paresis

STIWELL study of facial nerve paresis

Physicians at the ENT university clinic Jena investigated the EMG feedback training with the STIWELL med4 in cases of chronic facial nerve paresis as a therapy for persistent defect after healing.

They developed the training programme from the existing STIWELL med4 programmes for home therapy: First, muscle contraction and relaxation are trained to increase awareness. The subsequent exercises strengthen the affected muscles. Special focus is also on muscle coordination to avoid synkinetic movements.

After initial training on how to use the device and attach the electrodes, patients trained regularly and independently at home. Results showed that biofeedback training in cases of facial nerve paresis can support home therapy.

Source: Fabian Volk G et al. EMG Biofeedback Training zuhause… Laryngo-Rhino-Otol 2014; 93:15-24.


Fasoli and colleagues (2002) investigated the differences between tasks with internal and external focus after stroke. Movements – particularly with regard to speed – were better executed with an external focus. The results recommend the use of tasks focusing the patient’s attention to external factors when executing everyday movements to improve speed and strength of the hemiparetic arm.

When engaging in activities, it is crucial to focus on the goal of the movement (externally), rather than the movement itself (internally).
(Dr. Gabriele Wulf, 2009: „Aufmerksamkeit und motorisches Lernen“)

Muscle strengthening in cases of muscle weakness

STIWELL Muscle strengthening

Using the STIWELL med4 in cases of muscle weakness:

  • Muscle strengthening, muscle coordination after accident, surgery and illness, e.g. shoulder, arm, hip, knee and for arm/hand rehabilitation after hand surgery
  • Strengthening of back, abdominal and pelvic floor muscles in various spinal cord diseases (nerve root compression after herniated disk, back pain, etc.)  
  • Strengthening of weak, denervated muscles due to peripheral nerve damage and incomplete tetraplegia

Electromyostimulation (EMS) is a conservative treatment of muscle contraction by electrically induced pulses. Decreasing muscle strength during immobilization (e.g. postoperatively) and muscular imbalance are avoided. Prophylaxis and therapy of muscular atrophies with EMS can help avoid orthopaedic secondary injuries and shorten the period of inpatient treatment.

STIWELL Muscle building
Electrotherapy electrodes

As shown in the illustration on the left, flexor (agonist) and extensor (antagonist) can be treated alternatingly. Bipolar stimulation as shown in the illustration on the right (two electrodes per muscle group) is a typical application in the rehabilitation of atrophied or weakened muscles.

To improve muscle strength and muscle coordination, electrotherapy should be used regularly and also at home. EMS is a valuable supplement to conventional therapy and can contribute to successful treatment.

Muscle strengthening after knee surgery

STIWELL has developed a physiological method to avoid pain and support muscle strengthening in the often very painful rehabilitation training after knee surgery.

This special STIWELL med4 programme supports muscle strengthening after knee surgery with targeted, EMG-triggered electrostimulation. With EMG-triggered electrostimulation the patient must actively contract the muscle. Electrostimulation is triggered after reaching a previously defined threshold.

The muscle is stimulated with slowly increasing current with the previously set intensity. Then the current slowly decreases. The hamstring muscles are gently strengthened without straining the knee.

Denervated muscles

A denervated muscle cannot be stimulated by the injured peripheral nerve. Preset, automatic STIWELL med4 programmes are based on a training module with natural muscular activity. Peripheral palsy is treated with triangular pulses which are able to stimulate the peripherally paralyzed muscles while simultaneously only slightly stimulating the surrounding sensitive nerve fibers.

Pain therapy

Transcutaneous electrical nerve stimulation (TENS) is a symptomatic and conservative pain therapy. It is based on the application of electrical pulses through the skin (transcutaneous). Variable settings of stimulation parameters allow treating acute and chronic pain. The patient feels only a slight tingling or minor muscle contraction under the electrodes. Treatment can be conveniently included in a daily routine and – in the best case – help reduce pain medication. Electrotherapy can be used to train and strengthen the back extensors to reduce back pain.

MF programmes

These programmes are used to strengthen muscles, facilitate metabolism, reduce pain, release tensions and are suitable for the following indications: Muscle atrophy, disorders or injuries of the central nervous system (CNS), regenerable peripheral neural lesions, neuro-orthopaedic functional disorders. “MF 3 kHz (EMG)” offers the additional option of EMG-triggered stimulation.

Incontinence - pelvic floor exercises

Incontinence treatment with the STIWELL med4 includes:

  • Strengthening of the pelvic floor muscles in cases of urinary and fecal incontinence
  • Training of voluntary contraction and relaxation of the pelvic floor muscles with biofeedback (e.g. in cases of incontinence after childbirth)

Electrostimulation is used to additionally strengthen muscles; in particular, it improves the frequently insufficient muscle endurance and illustrates the information the patient needs to learn. It is a therapy option to treat urinary and fecal incontinence with lasting success. Electrotherapy strengthens the pelvic floor muscles with electrical pulses.

The electrodes are attached in and on the body (see illustration: use of vaginal or anal electrode).
STIWELL Incontinence treatment

The electrodes record even minute muscle activity which is not typically consciously noticed. The patient can read out the intensity of muscle contraction on the display of the device or receives an acoustic feedback (biofeedback).

The STIWELL med4 EMG-triggered electrostimulation allows combining biofeedback and electrotherapy. This treatment trains and strengthens the pelvic floor in a controlled manner. In gynecology, electrotherapy in combination with biofeedback is particularly suitable for the treatment of uterine prolapse or connective tissue disorders after childbirth.

In EMG-triggered electrostimulation the patient must actively contract the muscle. At the end of contraction or after reaching a preset threshold they receive an input (electrostimulation) additionally activating the muscles. This helps the patient to get a feel of their pelvic floor.

Special 2 EMG-triggered programme

When training the pelvic floor, it often happens that the gluteal muscle or the hamstring muscles contract, but not the pelvic floor muscles. In the STIWELL med4 - 2 EMG training the patient is alerted to activate the correct muscles (pelvic floor). In contrast to other electrotherapy devices, two EMG channels allow measuring the activity of two different muscle groups. The pelvic floor muscles are activated after inserting the vaginal or anal electrode. At the same time the gluteal muscle and/or the hamstring muscles should be relaxed (self-adhesive electrodes measure gluteal muscle tone). Only after reaching a preset threshold by contracting the pelvic floor muscles while at the same time relaxing the gluteal muscle, the pelvic floor is electrically stimulated and thus strengthened. This helps the patient to voluntarily activate their pelvic floor muscles.

Inpatient & Outpatient Use

Its easy application and handy size make the STIWELL med4 ideal for inpatient and outpatient use and for home therapy.

The physician/therapist can select one or more programmes, set patient-specific parameters and then lock the programmes. Patients can only access their individual programmes. The intensity can be preset and saved in the device. This ensures that the patient uses the correct stimulation intensity for home therapy.

Successful treatment requires daily application. The intensity of the exercises is determined by the patient’s symptoms and constitution. Please contact us with any questions you may have.

Get in touch

Please contact us to find the most appropriate solution for you.