Functional Electrical Stimulation is commonly used in the rehabilitation of individuals with Spinal Cord Injuries. It works by passing an electrical current through a paralysed muscle causing it to contract.
The electrical current uses the peripheral nerves to pass the current to the muscle (the peripheral nerves must be intact for a contraction to occur)
In patients with a COMPLETE spinal cord injury, this contraction is not voluntary and cannot be replicated when the stimulation is removed.
In people with an INCOMPLETE spinal cord injury, this contraction may be stronger than what can be performed without the stimulation.
The aim is to restore or improve function in the paralyzed muscles.
FES is commonly used for exercise, but also to assist with breathing, grasping, transferring, standing and walking. FES can help some to improve bladder and bowel function. There's evidence that FES helps reduce the frequency of pressure sores.
Will FES work on everyone with a Spinal Cord Injury?
The answer to this is no, FES is only effective in Upper Motor Neurone Spinal cord injuries. UPPER MOTOR NEURONE LESION Damage has occurred directly to the spinal cord. The spinal nerves coming off the cord and passing to the limbs are intact. Increased reflexes and spasticity are seen. Electrical stimulation to get muscle contraction is possible.
LOWER MOTOR NEURONE LESION Damage has occurred to the spinal nerves after they have come from the spinal cord. This occurs in injuries below T12 when damage occurs to the Cauda Equina (Horses Tail). Decreased reflexes and flaccid muscles are seen. Electrical stimulation to get muscle contraction is not possible.
FES can help to improve function to muscles
Whilst i was in physio it was explained to me that as I have Cauda Equina Syndrome, FES would not work on me, as i am classed as Lower Motor Neurone. The physio still decided to give it a try on my glutes, just to confirm. She started the electrical impulses at level 1 and then gradually up to level 10. She explained that at level 10 my butt cheeks should be clenching...but they failed to elicit a response at all lol
The Benefits of FES (Functionable Electrical Stimulation) Cycling
What is FES Cycling?
FES cycling uses co-ordinated electrical stimulation to create a cycling pattern. This cycling pattern exercises the large muscles of the legs as running or cycling would do in a person who doesn’t have a spinal cord injury.
What does FES cycling do?
Research has shown some positive benefits:
• Increase in bulk of stimulated muscles
• Increase in bone density in some leg bones
• Help reduce body fat content
• Helps exercise the heart
• Reduces risk of diabetis
• Helps reduce Spasticity
• Helps Maintain flexibility
Who will Benefit ?
• People with incomplete injuries may see improvements in their ability to voluntarily use their muscles
• People with an upper motor neurone lesion (FES is not normally effective in lower motor neurone lesions) • People who cant participate other forms of cardiovascular exercise
Will FES cycling help recovery?
There is no evidence that FES cycling will stimulate motor recovery if you are not able to contract any muscles below the level of your injury.
If you have an incomplete injury and can contract muscles but they are weak, FES cycling is one way to promote use of the intact pathways and train your
muscles to work better. Other activities you undertake in therapy sessions also promote the use of these pathways.
How much FES cycling do I need?
Ideally 3 times a week at 30 mins a time.
The FES cycle must be set up to provide the correct intensity for you to get a training effect.
As with any form of exercise, the benefits of FES cycling are only retained while you maintain your exercise
Risks to Consider
Some individuals have been known to suffer from AD whilst cylcing. After cycling muscle spasms can be stronger (more so as their leg muscles get stronger)
You could possibly develop other injuries to your skin or joints if you are not set up on the cycle properly (Blisters, pressure ulcers, strained joints, broken bones etc
I think FES is great - have seen it do amazing things in the recovery of fellow SCI folks. I was disappointed, when in rehab, it was explained to me why I couldn't use FES (lumbar injury).
However there are now units available which can stimulate denervated muscles. This for example:
I think FES is great - have seen it do amazing things in the recovery of fellow SCI folks. I was disappointed, when in rehab, it was explained to me why I couldn't use FES (lumbar injury).
However there are now units available which can stimulate denervated muscles. This for example:
It's VERY expensive though - around £4,000 I believe.
Thankyou for sharing this sci... Ive taken a read and it looks very interesting. I too was disappointed when i was advised in rehab that FES would not work for me.
It's very strange that FES doesn't work on lower injuries but it's great that there's a new unit that can be used to stimulate the muscles! To be honest if that machine works like an FES bike but better, £4,000 is a pretty good price compared to what the FES bike goes for (around $50,000).
Curious, is there any complete para's that have had luck with the FES and if so what level is your injury? I was approved for an FES system and when I tried to order my supplier (motion specialties) could not order because it had not been approved in Canada? I was looking forward to getting one but no-go. this was 1 1/2 years ago.
Curious, is there any complete para's that have had luck with the FES and if so what level is your injury? I was approved for an FES system and when I tried to order my supplier (motion specialties) could not order because it had not been approved in Canada? I was looking forward to getting one but no-go. this was 1 1/2 years ago.
Thanks Will
Thats such a shame willvape, i hope the situation changes so you get the chance to use one. Im sure it will be of some advantage but as you mention, it would be great to hear from some people who have used it with success.
willvape, what do you mean by having any luck with using FES? I see paras using it all the time. What's your injury level?
I'm t7 complete, I wasn't sure if anyone with similar had luck with it stimulating their muscles and was able to peddle. I've never tried one with FES, just the one at Lyndhurst that powered itself.
willvape, what do you mean by having any luck with using FES? I see paras using it all the time. What's your injury level?
I'm t7 complete, I wasn't sure if anyone with similar had luck with it stimulating their muscles and was able to peddle. I've never tried one with FES, just the one at Lyndhurst that powered itself.
Will
It'll definitely work for you. The motorized bikes without the electrodes are called MotoMed's. Definitely try a FES bike if you can
Something that many people might not know about FES bikes is that they also can work to stimulate the nerves in the legs. I've worked with some LMN injuries and modified the settings to aim for "sensation" rather than a visible contraction. It's still hit or miss as every injury is different, but I've seen many cases of FES bikes increasing sensation as well as muscle mass. Here's the link for RTI, who are the main manufacturers and distributors of FES bikes. Restorative Therapies. Also if you do have a MotoMed we were able to test their electrical stimulation component of the passive gait trainer they sell. I found the stim to affect my clients a bit differently, but I don't have a definite answer of whether it's better or worse than the RTI FES bikes. MotoMed EStim. Hope it helps!