Functional Electrical Stimulation (FES) is the application of electrical current to excitable tissue to improve or restore functions lost in neurologically compromised subjects” (Peng et al., 2010).
Electrical stimulation is focused in certain skin surface areas of the body such as the calves and thigh to activate paralysed or weakened muscles using electrodes
Varying types of current can be applied that influence the specificity, effect, ease of application and comfort. For optimal effects the peripheral nervous system is required to be intact, so the neurological compromise is central nervous system (brain and spinal cord) in origin.
This is not to say effects cannot be gained with damage to the peripheral nervous system, but they are likely to require much higher levels of current and will generate smaller, less powerful contractions.
The benefits of FES
Using FES will create patterned movement in conjunction with for example the exoskeleton which will enable the muscles to work and perform activities even though they may be weak or paralysed through neurological disease or injury. This activity will:
During passive rehabilitation muscles are moved mechanically so in theory muscles don’t do any of the work. Active rehabilitation such as using the exoskeleton and FES together allows muscles to do the work they are meant to do. This is achieved either by an individual moving their muscles on their own, or when muscles are activated by FES.
This means that active rehabilitation ensures muscles are working and performing the activity.
At what stage of rehabilitation is it best to use FES?
FES stimulation can be applied at any stage across the entire continuum of care from the acute phase to chronic intervention. For some FES is a short-term intervention. Whilst, for others, where recovery is longer or less function is regained, patients may benefit from using FES long term at a facility such as that provided by the No Barriers Foundation.
Which pathologies are FES most beneficial for?
FES is useful for stroke and spinal cord injury with strong evidence that FES can make an impact are spasticity and pressure ulcers in SCI. For the stroke group the benefits are likely to be improved movement and enhanced motor control.