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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

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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.