This high-tech equipment provides patterned electrical stimulation to the surface of muscles, which stimulates nerves and evokes muscle contractions and activity. Surface electrodes are placed on one or both sides of the patient’s body, this could be on their legs, torso or arms, depending on the focus of the treatment and the equipment being utilized for that session. The electrodes are then connected to the computerized brain of the machinery that controls the output of the electrical stimulation. The robotic walker, FES cycle, or Xcite functional stimulator then provides the appropriate amount of electrical stimulation to move the muscles to enable body weight supported walking, cycling, and other functional tasks such as transfers and bed mobility. It also measures the amount of effort the patient is exerting and automatically measures each patient’s progress.
FES enables the individual who may have lost voluntary control over their muscles due to injury or illness to cycle, walk, stand, balance, reach or other activities they are working on as part of their plan of care. Patients can even use some of the FES equipment without transferring from their wheelchairs. This exercise relaxes spasms, improves circulation, maintains or increases range of motion, and prevents muscle atrophy that often accompanies lack of use.
FES Cycling systems allow individuals with partial or complete paralysis of the legs or arms to pedal a stationary cycle or arm cycle respectively (using a motorized ergometer) with their own muscle power – despite their paralysis.
The ability to power the bike oneself using the electrical stim is much more beneficial than simply using a motorized bike to move the legs or arms. This results in effectively reversing many of the detrimental effects on an individual’s fitness level that has suffered a neurological injury or illness.
At TryAbility NeuroRehab, therapists prescribe cycling sessions to address compromised bone density, decreased muscle girth, poor cardiovascular endurance, and to manage spasticity. Our therapists use the smart Xcite NMEs software for postural re-education, resistance training, and static and dynamic balance exercises, to amplify clinical efficacy. The Xcite systems allows the patient to sequentially contract the muscles at the appropriate time during an activity to mimic normal task performance, and assists the therapist who can guide the patient to perform task specific training while minimizing compensation thereby enhancing CNS plasticity.
Neuroprosthetics such as the Bioness L300 Go, and the WalkAide are hallmarks of FES technology. At TryAbility, our therapists are trained in the use of both types of neuroprostheses, and work closely with the vendors to identify and trial the devices with appropriate patients.
What are the benefits of FES?
Evidence behind FES
Bakkum AJ, de Groot S, Stolwijk-Swüste JM, van Kuppevelt DJ; ALLRISC, van der Woude LH, Janssen TW. Effects of hybrid cycling versus handcycling on wheelchair-specific fitness and physical activity in people with long-term spinal cord injury: a 16-week randomized controlled trial. Spinal Cord. 2015; 53: 395-401.
Bethoux et al. Long-term follow-up to a randomized controlled trial comparing peroneal nerve functional electrical stimulation to an ankle foot orthosis for patients with chronic stroke. Neurorehabil Neuro Repair. 2015; 29: 911-922.
Glinsky J, Harvey, L, Van Es P. Efficacy of electrical stimulation to increase muscle strength in people with neurological conditions: a systematic review. Physiother Res Int. 2007; 12: 175-94. Howlett O, Lannin NA, Ada Louise, McKinstry C. Functional electrical stimulation improves activity after stroke: A systematic review with meta-analysis. Arch Phys Med Rehabil. 2015; 96: 934-943.
Kapadia N, Masani K, Catharine Craven B, Giangregorio LM, Hitzig SL, Richards K, Popovic MR. A randomized trial of functional electrical stimulation for walking in incomplete spinal cord injury: Effects on walking competency. J Spinal Cord Med. 2014 Sep;37(5):511-24.
Koyuncu E, Nakipoğlu-Yüzer GF, Doğan A, Ozgirgin N. The effectiveness of functional electrical stimulation for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients: A randomized controlled trial. Disabil Rehabil. 2010;32(7):560-6.
Kressler J, Ghersin H, Nash MS. Use of functional electrical stimulation cycle ergometers by individuals with spinal cord injury.Top Spinal Cord Inj Rehabil. 2014 Spring;20(2):123-6. Michlovitz SL, Bellew JW, Nolan TP. Modalities for Therapeutic Intervention, 5th Ed, FA Davis, Philadelphia, PA, 2012.
Pereira S, Mehta S, McIntyre A, Lobo L, Foley N, Teasell R. Neuromuscular electrical stimulation for improving gait in persons with chronic stroke. Top Stroke Rehabil. 2012; 19(6):491-498.
Quandt F, Hummel FC. The influence of functional electrical stimulation on hand motor recovery in stroke patients: a review. Experimental & Translational Stroke Medicine. 2014; 6:9. Robbins SM, Houghton PE, Woodbury MG, Brown JL. The therapeutic effect of functional and transcutaneous electric stimulation on improving gait speed in stroke patients: a meta analysis. Arch Phys Med Rehabil. 2006; 87: 853-9.