14 msfocusmagazine.org as the ankle while walking. It works in a similar manner to FES for foot drop, in that it stimulates specific nerves in either the front or back of the thigh to prevent buckling and allow for greater ease when moving and controlling the leg. Despite these benefits, FES for foot drop and thigh weakness is not for everyone. If the foot drop is so severe that the ankle cannot be stretched adequately, FES will not be effective because it requires at least some ankle mobility. If there is also significant weakness in the hip and knee muscles, FES for foot drop alone would not be appropriate because it does not control those muscles. In that case however, FES for the thigh and ankle would be a more appropriate option, but there is limited research regarding the effectiveness of the thigh component. Another potential problem with FES is that the electric stimulation required may be so uncomfortable that some may not want to use it. FES devices also require some sort of training period to find the most appropriate amount of stimulation and where to place the electrodes to optimize its effectiveness. Lastly, FES devices are generallynot covered by insurance, and can cost approximately $5,000 to $6,000. The most commonly used FES devices are the NESS L300 and L300 Plus by Bioness, and WalkAide by Innovative Neurotronics. FES Cycling FES cycling has been utilized predominantly for those with spinal cord injury, but can also be used for those with MS. Electrodes are placed on different muscles on one or both arms or legs, and can assist or resist the individual during cycling using a special ergometer (arm/leg cycle). This has a host of benefits, including maintaining available range of motion, strength and endurance training, aerobic fitness, and fatigue and pain reduction. These can positively affect an individual’s mobility and quality of life. An advantage to the FES cycling is that it can be used for all patientswith MS,whethertheyare ambulatory or not. More research into the short- and long-term effects is currently being conducted, but it can be safely utilized in both outpatient clinics and home settings. Just like with the FES foot drop devices, an FES cycle setup may not be covered by insurance, and can be expensive, about $15,000 to $20,000 for home use. The companies that manufacture FES cycling include RestorativeTherapies andTherapeutic Alliances. Transcutaneous Electrical Stimulation (TENS) Transcutaneous electrical stimulation (TENS) is a portable device that provides electrical stimulation directly over the skin to different nerves to aid in providing relief for pain, spasms, and spasticity. They have been utilized for many years for persons with musculoskeletal pain, but research has demonstrated that it is a safe and viable option for certain MS symptoms, especially when combined with other active therapies, such as exercise and stretching. AlthoughTENSwill not cure the underlying cause of the pain, it may provide some much- needed relief when pain medication is either unavailable or ineffective. Keep in mind,