Functional Electrical Stimulation

What is Functional Electrical Stimulation (FES)?

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:

  • Improve blood sugar homeostasis
  • Enhance cardiovascular function
  • Enhance endothelial function
  • Decrease chronic inflammation
  • Regulate hormone levels
  • Preserve/build musculoskeletal & neuromuscular integrity
  • Decrease depression, increase cognition

How does FES fit into rehabilitation therapy?

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.

Contact us today at hello@nobarriers.ie for more information


Exoskeleton & Stroke Rehabilitation

Stroke is the leading cause of serious long-term disability with many survivors sustaining functional limitations in activities of daily living as a result of stroke. Many stroke survivors have long-term walking impairment due to hemiplegia or hemiparesis. Impaired ambulation due to hemiplegia or hemiparesis is associated with increased fall risk, limited community participation, and an overall decreased quality of life.

Post-stroke, the long-term goal of rehabilitation is successful reintegration into the community, with recovery of walking ability as a key functional objective. This recovery of function is achieved with progressive, task-specific, repetitive training based on the principles of motor learning and neuroplasticity. Targeted rehabilitation can help to reorganise the brain to relearn skills that may have been lost during, or because of, stroke, with the goal of helping survivors regain their independence. Rehabilitation goals may include coordinating leg movements, shifting weight to walk, or balancing during sit-to-stand transfers.

Functional Improvements

Advances in technology are changing the rehabilitation process. Robotic exoskeletons used during stroke rehabilitation assist with walking during the recovery process by providing earlier mobility and restored independence. Exoskeletons may enhance post-stroke gait training, helping to guide weight shifts and improve step patterns and cadence and enabling individuals to stand and walk over ground early in the recovery process.

For gait rehabilitation after stroke, the technology applications typically include a wearable device such as a robotic exoskeleton, with hip and knee motors providing assistance during walking. A key part of the rehabilitation process is therapy progression, and exoskeleton technology provides options to encourage progress and document improvements. The device chosen should have options for asymmetrical control of the lower limbs and facilitate pre-gait training, transfers, stepping, and balance training.

Additional Benefits

While functional improvement is the primary goal of stroke rehabilitation, exoskeleton devices also have the potential to empower and motivate patients. Initial gait training sessions in the exoskeleton often include meaningful walking time indoors and outdoors, which can improve patient morale, motivation, and enthusiasm. Over the past year using the Ekso GT exoskeleton, we have also seen increased steps per session, improved gait symmetry and balance, and improvements in functional independence throughout many patients rehabilitation.

The ultimate goal of the No Barriers Foundation is always be to maximise recovery of function to support the patient’s ability to maintain independence at home and in the community.

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Healthy Workplace = Happy Workplace

It turns out that a lack of exercise in our lives is a silent killer. The World Health Organisation lists physical inactivity as the fourth biggest risk factor for death in adults across the world.

The latest research shows when it comes to heart disease, leading a sedentary life is as great a risk factor as smoking and obesity. In fact, inactivity in terms of disease risk, is more dangerous than being overweight.

If you spend long periods of time sitting, this is particularly bad news, as it increases your risk of heart disease, obesity, diabetes and cancer. The most current research has shown that even normal weight individuals that are inactive, are at risk of developing disease. There is a molecular pathway that is essential to burning fats, that shuts down with inactivity, and that subsequently increases your risk of developing heart disease.

And unfortunately you can’t bank the benefits of exercise from your youth, hoping it will help you 40 years down the line. The ideal scenario is to have been active throughout your lifespan, but research has shown that your health can benefit from physical activity at any age, meaning it doesn’t matter when you start, as long as you start!

Physical activity performed regularly, can help to prevent and manage over 20 chronic medical conditions. These include coronary heart disease, stroke, type 2 diabetes, cancer, obesity, mental health problems and musculoskeletal conditions.

And the good news is that we can combat the negative effects of prolonged sitting (total of 8 hours or more) with regular physical activity. The reality is that hectic schedules can make it seem impossible to fit workouts into your busy week. The prospect of packing a gym bag, trudging to your local gym, working out, showering, changing, and trudging back to where you came from, can feel like a lot of effort. But when we neglect exercise, we not only put both our physical and mental health at risk, but we also negatively impact our productivity and effectiveness at work.

And you would be surprised at the number of opportunities there are in a working day, to increase your activity levels.  You can in fact accumulate activity that is beneficial to health, in lots of different ways during the day.


17 Ways to Be More Active at Work

– Thinking on your Feet – Why it Pays to Be Physically Active at Work Client Newsletter

– Stretching Exercises for the Workplace

– Strengthening Exercises for the Workplace

– Why Posture Matters

– Optimal Desk Posture Infographic

– Carpal Tunnel Infographic

– Preventing and Treating Carpal Tunnel Syndrome

– Carpal Tunnel Rehabilitation Exercise Sheet

As physiotherapists we can help with a wide range of issues caused by long periods of sitting at a desk, including back and neck pains, tingling in your hands, carpal tunnel syndrome, even regular headaches experienced at work.

Please get in touch through our website at www.nobarriers.ie or email hello@nobarriers.ie if you need advice.

Add Days to Your Life AND Life to Your Days

Life expectancy is at its all-time high, the fact that so many people are living longer, well into their 80s and 90s is a wonderful ideal. However, the sad reality is that living longer doesn’t always include a good quality of life, it’s not a package deal.

Many people outlive their children and their pensions, and end up feeling like they’ve become a financial, physical and emotional burden on their families. Swallowing handfuls of pills every day, losing independence and requiring nursing care is not the way most people would choose to spend their last years.

However, there are steps you can take to reduce the risk of this outcome. Making a conscious decision to take small steps (literally) from today, could make all the difference in your life going forward.

Physical activity (PA) or exercise, when performed regularly, has been proven to prevent and help manage more than 20 chronic conditions. These include coronary heart disease, stroke, type 2 diabetes, cancer, obesity, mental health problems and musculoskeletal conditions. Sadly, you can’t bank the benefits of exercise from your youth. Ideally being active throughout your lifespan would give optimal health benefits, however research has shown the health gains achieved through PA can be attained at any time. So, it doesn’t matter when you start as long as you start!

Now we’re certainly not saying you have to sign up for an IronMan Ultra-Triathlon or become the next Crossfit Superhuman. Physical activity includes all forms of exercise, such as everyday walking or cycling to get from A to B, active play, work-related activity and active recreation; such as working out in a gym, dancing, gardening or playing active games, as well as organised and competitive sport.

Physical inactivity is the fourth leading risk factor for death. The latest research shows that a sedentary life is as great a risk factor as smoking and obesity, for heart disease risk. Sedentary behaviour is not simply a lack of activity but a cluster of individual behaviours where sitting or lying is the dominant mode of posture, and energy expenditure is very low.

Inactivity was always associated as a cause of being overweight or obese, which in turn results in an increased risk of heart disease and diabetes. However, the most current research has shown that even normal weight individuals that are inactive, are at risk of developing disease.

While you can blame it on your job or school that forces you to sit for hours in a day, you can also mitigate the negative effects with just 60-75 minutes of moderate intensity PA a day.

Regardless of your activity starting point, there are benefits to be gained for anyone who increases their activity levels. Individuals that follow the recommended physical activity guidelines have shown to have optimal health benefits of a 39% reduced risk of dying from any disease. However, anything is better than nothing – even doing half the amount of the recommended weekly activity has shown a 20% lower risk of mortality.

Regular physical activity roughly halves your chance of developing some cancers, like bowel and breast cancer. Studies have shown that people who continued to exercise once diagnosed with cancer had significantly less cancer deaths and any-cause death than those who were inactive.


If you’d like to know more, you can contact us for our Gold Standard Physical Activity Recommendations leaflet, along with additional exercise advice for people suffering from the following conditions, all of which can benefit significantly with regular physical activity.


  1. Staying Healthy and Preventing Disease
  2. COPD
  3. Depression
  4. Musculoskeletal Pain
  5. Type 2 Diabetes
  6. Cancer
  7. Dementia
  8. Falls and Frailty
  9. Inflammatory Arthritis and Osteoarthritis
  10. Heart Disease

Contact us at https://nobarriers.ie/contact/


Prevent Disease and Stay Healthy

The benefits of physical activity for healthy people include:

Improved mood and mental health: Physical activity changes hormones in the brain and increases a release of endorphins (the happy hormones) and reduces cortisol levels (stress hormones). In addition, physical activity has been proven to reduce the risk of developing depression and been helpful in managing depression. People who are more active also have a lower chance of reaching burnout and are better at managing stress levels. With more activity you are able to get fitter and stronger and consequently do more – this in turn helps build your self-esteem and self-worth, motivating you to do even more and achieve things you never thought possible. You may also choose to exercise with others or in a group and the socialising with others can also be hugely positive on your mood.

Improved cognitive function: Dementia risk is reduced by up to 24% in people who engaged in moderate to high levels of activity. And Alzheimer’s disease risk was reduced by 37% in people with high levels of physical activity.

Maintain healthy weight: Exercise alone won’t guarantee long-term weight loss, a balanced diet and behaviour change is also necessary. However, exercise helps regulate your blood sugars, improve your glycaemic index and build lean muscle mass. This healthy body image and improved body composition will allow weight control, improved fitness and improved function. Weight loss also reduces the load on your joints and stronger muscles support more stable joints, allowing you to do even more.

Live longer: Low fitness has been attributed as a cause of 16% of deaths. Regular physical activity reduces the risk of death by 30%. People who exercise regularly can live for an additional 4.5 years compared to sedentary people. This is all because of the effects of physical activity on muscles, bone health, blood vessel function, nerve function and chemicals in the brain and blood vessel walls. The benefits to your psychological well-being are also likely to contribute to living longer.

Reduced chance of falls: Exercise has been proven to reduce the risk of falling by as much as 21% because you have stronger muscles and more stable joints. Regular exercise also promotes better ‘communication’ with the nerves from the brain to the feet and benefits balance, control and co-ordination, all of which are required to make you more stable on your feet. People doing specific balance exercises with daily activity reduced their fall risk by as much as 49%.

Improved quality of life: Regular physical activity will improve your cardiovascular fitness (your heart and lungs), you will feel less breathless and able to do more. Stronger muscles demand less oxygen as they work more efficiently, so you are able to do more with less effort. All of this adds up to being able to fulfill chores, tasks and work more easily, stay independent, and enjoy life more.

Improved sleep and less fatigue: It is a well-known fact that as your fitness levels increase so your sleep improves. Improved sleep will help reduce feelings of tiredness. Also, the fitter and stronger you become the easier tasks and chores or exercises will feel, leaving you less tired and empowered to do more.

Manage stress: Exercise is a healthy outlet for nervous energy and a welcome distraction from negative thoughts and feelings. It helps reduce fear symptoms and catastrophisation and increases a sense of calm and overall well-being. Better sleep and improved socialising also leads to enhanced relationships. All these factors contribute to reducing stress levels through regular exercise.

A good idea before starting an activity is to sit down with your physiotherapist, GP or family member/friend and write down what it is you want to achieve. Set goals, easy achievable ones initially. These will help build self-esteem and confidence. Should you require more information contact us at hello@nobarriers.ie for more information or guidance.

Foods that may cause inflammation

Many recent studies have shown that constituents of some foods or drinks  may have anti-inflammatory effects. By choosing the right anti-inflammatory foods, and you may be able to reduce your risk of illness. Consistently pick the wrong ones, and you could accelerate the inflammatory disease process. Foods that may cause inflammation include the following;


  • refined carbohydrates, such as white bread and pastries
  • French fries and other fried foods
  • soda and other sugar-sweetened beverages
  • red meat (burgers, steaks) and processed meat (hot dogs, sausage)
  • margarine, shortening, and lard


The following foods are said to have anti-inflammatory effects, and these include;


  • tomatoes
  • olive oil
  • green leafy vegetables, such as spinach, kale, and collards
  • nuts like almonds and walnuts
  • fatty fish like salmon, mackerel, tuna, and sardines
  • fruits such as strawberries, blueberries, cherries, and oranges


To reduce levels of inflammation, aim for an overall healthy diet. If you’re looking for an eating plan that aims to reduce inflammation consider the Mediterranean diet, which is high in fruits, vegetables, nuts, whole grains, fish, and healthy oils. A healthy diet is beneficial not only for reducing the risk of chronic diseases, but also for improving mood and overall quality of life.


Prolonged Bed Rest with Injury or Disease – why this is not a good idea!

There are many reasons why prolonged bed rest and reduction in physical activity are not always the best options in managing already poor health; these include reductions in musculoskeletal performance, cardiovascular efficiency, pulmonary function, neuromuscular function, and psychological well-being.

Furthermore, reductions in physical activity causes muscle wasting, changes in muscle properties, and reductions in bone density. Muscle atrophy and reduced bone density lead to diminished musculoskeletal strength and performance and contribute to an increased risk for bone fractures and musculoskeletal injuries generally. Persons with generalised weakness and musculoskeletal atrophy should, whenever possible, include strength and cardiovascular training in their rehabilitation programs. It must be noted that compromised skeletal integrity such as fractures may in some cases prevent weight-bearing activities however; there is nearly always a form of non-weight-bearing aerobic activities that may be utilised for people with bone and joint disease that will promote benefits.


For more information contact No Barriers on hello@nobarriers.ie and we will be happy to advise you. Generalised weakness associated with illness or treatments can be more debilitating than the condition or disease itself. And it’s not just the physical deterioration that comes inactivity during illness, recent reviews of the literature support aerobic exercise training as positively influencing psychological well-being in both healthy subjects and people with for example cancer. Aerobic exercise training may influence psychological well-being through psychological and physiological factors. The psychological factors that result from aerobic exercise training and may positively influence psychological well-being include distraction from the stressful condition, enhanced self-esteem, improved self-efficacy from mastery of a task, improved physical independence, and the development of a social support group.

The health benefits that could be achieved from regular participation in moderate-intensity aerobic exercise include the following:


  • Reductions in premature death from heart disease
  • Reductions in the development of diabetes
  • Reductions in the development of high blood pressure
  • Reductions in the development of colon cancer
  • Reductions in depression and anxiety Improvements in weight control
  • Maintenance of bone, muscle, and joint health
  • Improved strength and fall prevention in older adults
  • Improved psychological well-being


With disease or disability that is on-going it is important your doctor approves any exercise prior to participation, this is especially important if you are undergoing treatment of any sort as exercise such as using the exoskeleton which may need to be monitored or conducted with special limitations/considerations or special specific exercise. If you are unsure about what are the best exercise for you contact us at No Barriers for a free telephone consultation to discuss this in more detail.