At only a few months of age it became apparent that something was wrong with Chloe Dent, with paediatricians eventually diagnosing her with global functional disability.
“She didn’t take her first step till she was over two,” Chloe’s mother, Nancy Dent, told me. “Her cognitive ability just wasn’t there.”
Dent is a cattle farmer in the New England region of New South Wales. The lack of services and isolation in her hometown of Wallabadah (population 421) left her feeling overwhelmed as her family struggled to cope with the challenges of raising a child with a disability.
In October 2018, a cranial sacral therapist told Dent about “a new thing” he had come across which could potentially help her daughter.
“The Mollii Suit has changed Chloe’s world,” says Dent. “Her reading and writing have improved at school, her speech is clearer and she is able to put more words together. The circuits inside Chloe’s body that weren’t working are now getting stimulated, and the more she uses the suit, the more these circuits are running smoothly.”
The Mollii Suit is an innovative concept, developed in 2009 in Stockholm, Sweden, by chiropractor Fredrik Lundqvist, physiotherapist Jörgen Sandell and H&M designer Andreas Halldén.
Inspired by transcutaneous electrical nerve stimulation (TENS) therapy, they envisioned an outfit that could be worn intermittently, delivering electrical impulses to tight and spastic muscles, thereby relieving pain and improving mobility for patients suffering from cerebral palsy, acquired brain damage, spinal cord injury and stroke.
The full body synthetic outfit, similar to a wetsuit with a zipper down the front, contains a detachable battery which is connected to 58 electrodes strategically embedded to cover the arms, legs and torso.
The concept of using electrical current as therapy is not a new one, going back for thousands of years to the ancient Egyptians, who would use electric catfish of the Nile for relief of arthritis pain.
In 1965 Canadian psychologist Ronald Melzach and British neuroscientist Patrick Wall came up with a means of explaining how electrical therapy could help with pain when they described the gate control theory, the basic concept of which stands to this day.
They proposed that both thin (A γ and C) nerve fibres – which transmit pain – and large diameter (A β) nerve fibres – which transmit touch, pressure and vibration – meet in the dorsal horn of the spinal column.
When there is stimulation of large diameter nerve fibres, say by rubbing a stubbed toe, then that impulse will help “close the gate” in the dorsal horn to painful stimuli from thin nerve fibres from the toe, thereby reducing pain transmission up the spinal cord to the brain and lessening the sensation of pain.
In 1974 neurosurgeon Norman Shealy helped develop a portable electric nerve stimulation device known as the transcutaneous electrical nerve stimulation (TENS) machine.
Since then TENS machine usage has become widespread, with numerous clinical studies showing benefit in reducing not only acute pain, such as labour contractions, but also some forms of chronic pain including diabetic neuropathy.
The inventors of the Mollii Suit have taken the concept of the TENS machine, and extended it even further, by applying electrode points all over the body, rather than just to a small restricted area such as the lower back or knees.
“To really block out pain signals we need enough signals from many body parts to come in and take up as much space as possible in a given neural pathway,” Sandell, the co-inventor of the suit, told me.
I met up with him when he was touring Australia to help train practitioners on the use of the Mollii Suit.
“Opioid receptors are like little power plants in different parts of the central nervous system that are activated when we take morphine,” Sandell, who is 50, said.
“But specific electrical frequencies, the same as what we are using in the Mollii Suit, have been shown in studies to activate these opioid receptors, so we can get an almost morphine-like effect without the morphine.”
In 2008 Sandell was teaching neurology and neurorehabilitation at the Chiropractic College at the Karolinska Institute of Medicine in Stockholm, when he was approached by one of his chiropractic students, Fredrik Lundqvist, who was working as a part-time carer for a retired doctor who was suffering from severe, progressive multiple sclerosis.
The doctor was using a large, stationary TENS machine to help relieve discomfort from spasticity of his legs. Willing to try anything he had encouraged Lundqvist to place the TENS electrodes over different parts of his body, and use different frequencies and intensities of the electrical current, to see if the alternatives helped.
A consistent pattern emerged – setting the machine to 20 hertz appeared to offer the most pronounced muscle relaxation.
In addition to the 20 hertz electric current the doctor also felt the greatest system relief occurred if multiple electrodes, rather than just two, were placed over different parts of his body. However it took up to an hour and a half to get all the electrodes in place before therapy could begin.
“We thought, ‘Wouldn’t it be great if there was a wearable garment with electrodes in it?’” Sandell said.
In a fortuitous turn of events, Lundqvist happened to know designer Andreas Halldén, who agreed to be involved in creating a garment.
In a tragic twist, the doctor with multiple sclerosis never got to try out the suit himself as he passed away from complications of multiple sclerosis in 2013, the very same year that the Mollii was approved for the European market.
His legacy, however, has directly helped his own son, who was born with cerebral palsy, and now uses the Mollii Suit himself.
Although the exact biophysical mechanism by which the Mollii Suit provides benefit is unknown, there are several plausible explanations.
In October 2017 Inerventions, the company set up by Lundqvist to develop and market the Mollii Suit, released a publication titled “Theoretical framework for the clinical application of Mollii”.
It describes how electrical stimulation from electrodes placed in the Mollii Suit likely helps spastic muscles by evoking sensory input and triggering muscular activity in antagonistic muscles (muscles that move in opposing directions across a joint to the spastic muscles) and eliciting reciprocal spinal inhibition (relaxation) in the spastic muscles, thereby easing soft tissue contractions.
It is also possible that neuroplasticity (the ability of the central neural system to change in response to repetitive stimuli) may be induced, enabling long term improvements in muscle tone and strength.
Multiple case studies have been published showing positive benefits of Mollii Suit use in a wide range of clinical conditions including stroke, cerebral palsy, acquired brain injury, spinal cord injury, multiple sclerosis and chronic pain.
At present there are at least ten university or hospital-backed studies being conducted around the world on the clinical effectiveness of the Mollii Suit.
A 2020 study published in the Journal of NeuroEngineering and Rehabilitation found that stroke patients with spasticity and hemiplegia experienced improved sensorimotor function and gross motor movements, as well as reduced spasticity and decreased muscle tone, after using the Mollii Suit at home for one hour, every second day, for six weeks.
A 2018 randomised case-control study of children with spastic cerebral palsy, conducted by the Department of Children’s Rehabilitation at the Lithuanian University of Health Sciences, showed that children randomised to hour-long Mollii Suit usage, three times a week for three weeks, gained as much improvement in gross motor function and mobility as children who were randomised to conventional physiotherapy.
And in 2014 a non-randomised evaluation of 117 patients using the Mollii Suit showed that every patient reported at least some degree of improvement.
As with any medical treatment, it is essential to consider the possibility that benefits from the Mollii Suit may be at least partly due to the placebo effect.
However Dr Naji Riachi, the head of neurology and assistant dean for clinical research at the Lebanese American University Medical Centre, Beirut, believes there is more than just mind over matter to the Mollii Suit.
“I think that every patient with spasticity should try the suit and find out whether they could get an improvement from it or not,” he said.
The Mollii Suit is touted by its makers as safe to use, with no known side-effects. The fabric is latex free, comprising 82 per cent nylon and 18 per cent spandex, and each component in the suit is hypo-allergen tested. The few contraindications that exist for its use include anyone with electrical implants or medical devices such as pacemakers, pumps or shunts that may be affected by magnets.
Although the Mollii Suit is relatively new on the Australian market, it has already received approval for National Disability Insurance Scheme (NDIS) funding for assistance in its rental and purchase.
It costs $15 000 AUD to purchase the suit, which comes with a 12-month warranty, or $1500 AUD a month to rent. If, after renting a suit, someone decides to purchase the suit then 50 per cent of their rental fees will be deducted from the suit’s purchase price. Alternatively, after 12 months’ rental, ownership of the suit is transferred to the renter.
Surfers Health Medical Centre Practice Principal Dr Mark Jeffery is a clinician with over 30 years’ experience who is facilitating the use of the Mollii Suit in his surgery for patients with fibromyalgia and spasticity.
“Most patients get an immediate, positive result,” he told me. “But this is not just one magic bullet therapy. If they show a benefit, these patients need to continue with this therapy. But with neural plasticity, one would imagine that there are new neural pathways that are developing, that are beneficial for the condition, and the patient can use their device less and less.”
- Watch as exercise physiologist Renee Woodrick talks about her experiences with the Mollii Suit and the benefits she has seen in her clients after using it:
Suvi Mahonen is a Surfers Paradise-based journalist. Her work appears in The Australian, the Australian Quarterly, Mamamia and other health and lifestyle publications. Follow her on Facebook, YouTube and online art-selling platform Redbubble.