Functional Electrical Stimulation

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Functional Electrical Stimulation

• ZAIN SULTAN EE-01083-020
• NAEEM HUSSAIN EE-01083-039

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Functional Electrical Stimulation (FES)

• Functional electrical stimulation (FES) is a
  treatment that uses the application of small
  electrical charges to improve mobility in a
  number of conditions. It was first used in 1961
  in people following a stroke.

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Who may benefit from FES?

• As FES applies stimulation along the existing
  nerves, the nerve fibres between the spinal cord
  and the muscles they supply must be undamaged. In
  practice this means that the individual needs to
  be able to walk, even if only a few metres with a
  stick or crutch.

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Are there any risks or side effects?

• Electrical stimulation causes a tingling 'pins
  and needles' sensation on the skin.
• Although most people do not find this a problem,
  some people with MS(Multiple Sclerosis ) are
  quite sensitive to changes in sensory input and
  find the effect uncomfortable. A short period of
  stimulation at a low intensity usually overcomes
  this problem.

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Stroke Overview

• Brain Attack
• Damage due to lack of oxygen or blood
• Types of Stroke
• Hemorrhagic
• Ischemic

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Stroke Damage Resulting Disability

• Dependent upon location extent of damage
• Examples
• Inability to move parts of the body
• Paralysis (hemiplesia or total)
• Weakness in parts of the body
• Persistent gait deficits
• Swing phase
• Midsupport phase
• Drop foot

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Gait Deficits Post-StrokeDrop-Foot

• significant weakness of ankle and toe
  dorsiflexion muscles.
• These muscles
• help the leg clear the foot during swing phase
• control plantar flexion of the foot on heel
  strike.
• Causes toes to catch on the ground during swing
  phase

Figure from (Kelly, 1981)
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FES Clinical Applications to Stroke
Rehabilitation

• Dropped-Foot rehabilitation (ODFS)
• Improve functional mobility (during walking)
• Main Goals Improve coordination the different
  phases of gait.
• Restoration of motor control
• Prevent debilitating falls

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Spinal Cord Injury (SCI) Overview

• What is Spinal Cord Injury?
• Damage to the spinal cord that results in a loss
  of function
• Frequent Causes of SCI include
• Trauma car accident, gunshot, falls
• Disease polio, spina bifida, ataxia
• The spinal cord does not have to be
• severed for loss of function to occur
• The higher in the spinal column
• injury occurs, the more dysfunction
• a person will experience

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Spinal Cord Injury (SCI) Overview

• Two types of injuries
• Complete injury means that there is no function
  below the level of injury no sensation and no
  voluntary movement
• Both sides are equally affected
• Incomplete injury means that there is some
  functioning below the primary level of the injury
• May be able to use one limb more than another,
  may feel parts of the body that cannot be moved,
  or may have more function in one side of the body
  than the other

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SCI

• Cervical injuries usually result in quadriplegia
• Injuries above C-4 may require a ventilator
• Injuries at or below the thoracic level result in
  paraplegia

http//www.spinalinjury.net/html/_spinal_cord_101.
html
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 How many people have SCI?  Who are they?

• Approximately 450,000 people live with SCI in the
  US.
• There are about 10,000 new SCI's every year the
  majority of them (82) involve males between the
  ages of 16-30.
• These injuries result from motor vehicle
  accidents (36), violence (28.9), or falls
  (21.2).Quadriplegia is slightly more common than
  paraplegia.    

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Is there a cure?

•   Currently there is no cure for SCI. There are
  researchers attacking this problem, and there
  have been many advances in the lab (see research
  updates ). Many of the most exciting advances
  have resulted in a decrease in damage at the time
  of the injury. Steroid drugs such as
  methylprednisolone reduce swelling, which is a
  common cause of secondary damage at the time of
  injury.

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Current Research on FES usage in Stroke
Patients

• Burridge, J.H. et al (1997)
• Improvements shown in walking speed with FES
• Yoichi, S. et al (2005)
• Improvements shown in acceleration phase of
  walking with acceleration sensor FES

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Christopher Reeves

• Reeves recovery came 5-7 years after his injury
• began an intense exercise program under Dr. John
  McDonald
• Exercise program included
• Daily electric stimulation
• FES bicycle
• Spontaneous breathing training
• Aqua therapy
• Treadmill training

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FES Bicycle

• Allows a person with little or no voluntary leg
  movement to pedal a stationary leg-cycle
  (ergo meter)
• Cost approximately 15,000
• Some health clinics have
• the bikes
• Increase muscle mass and
• cardiopulmonary function

http/
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Conclusions

• Applications of FES seems to be an effective
  addition to stroke and SCI rehabilitation
  however, further research is needed and
  encouraged, especially with intramuscular FES
  systems.

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