Introduction to the world of FES

Introduction to Functional electric stimulation:

Hi everybody, welcome to the blog, we hope you are going to enjoy reading and learning about Functional Electrical Stimulation (FES) with our main priority on improving lower limb function. The primary objective of FES is to produce and control muscle contraction using electrical current as a stimulation mediator between a patient's desired motion and actual physiological contraction (Elder & Spetzler, 2003), (Embrey, Holtz, Alon, Brandsma, & McCoy, 2010).

FES success is largely influenced by the method of delivery of the current to the muscle we want to be stimulated. When an intact neural supply to the muscle is available, the FES focus is generating action potentials within the motor neuron to stimulate a muscle contraction. If the muscle is denervated, then stimulation of the muscle directly is required because the is no neural connection to send the electrical signal (Faghri, Garstang, & Kida, 2009). We delve into greater detail in following posts but in this post, we would like to outline our goal to you, the reader.

Throughout this blog, our primary aim will be to allow a thorough understanding of the basis and development of FES usage with a focus on the lower limb. We will outline a brief history, contraindications and limitations to use, safety considerations and then detail examples of the use of FES in today’s clinical environment. This blog will also aim to discuss future directions of FES and lower limb clinical management.

History of FES:
Electrical stimulation has been reported since 400AD. Below is a brief timeline of its evolution(Faghri, Garstang, & Kida, 2009):

FES Uses:

The primary goal of FES is to improve the functional capacity of the patient (Elder & Spetzler, 2003), (Scott, 2008). The uses of FES are extremely varied and innovative in design and application. These include: muscle strengthening and endurance, cardiovascular reconditioning, enhancement of limb function, standing and gait control, wound healing, reduction of osteoporosis, improving ROM, facilitation of voluntary responses and orthotic substitution (Faghri, Garstang, & Kida, 2009). Conditions that may lead to FES in lower limb use can be either neurological or muscular in origin; examples of these include spinal cord injuries, stroke patients, dystonia and footdrop. Functional lower limb training using FES includes cycle ergometry, gait pattern retraining and individual muscle activation (Faghri, Garstang, & Kida, 2009), (Elder & Spetzler, 2003). The picture below is to show you examples of FES and lower limb devices we have discussed.

http://lsro.epfl.ch/page-34300-en.html

http://www.scielo.br/scielo.php?pid=S1413-35552011000600003&script=sci_arttext
http://www.dothealth.com/companydetails.aspx?guid=45805578-77fb-41de-98a4-0dbaf583b87e&q=&c=Germany&i=&f=Emergency%20and%20Rescue%20Equipment%20/%20Rehabilitation&s=Occupational%20therapy%20equipment

We hope you have enjoyed our first blog and look forward to bringing you more information next time. Till then stay safe.

References:

Elder, W., & Spetzler, R. F. (2003). Functional Electrical Stimulation (FES). In J. A. Editors-in-Chief:   Michael & B. D. Robert (Eds.), Encyclopedia of the Neurological Sciences (pp. 401-403). New York: Academic Press.

Embrey, D. G., Holtz, S. L., Alon, G., Brandsma, B. A., & McCoy, S. W. (2010). Functional Electrical Stimulation to Dorsiflexors and Plantar Flexors During Gait to Improve Walking in Adults With Chronic Hemiplegia. Archives of Physical Medicine and Rehabilitation, 91(5), 687-696.

Faghri, P. D., Garstang, S. V., & Kida, S. (2009). Functional Electrical Stimulation (pp. 407-429)

Scott, T (2008) Functional Electrical Stimulation: The Future of Rehabilitation: Action online united spinal association, retrieved from http://www.unitedspinal.org/publications/action/2008/11/17/functional-electrical-stimulation-the-future-of-rehabilitation/