This is a presentation from a webinar conducted for United Spinal Association. Discover how functional electrical stimulation (FES) has helped thousands of people get through rehab faster, improve their mobility and reclaim their independence. The proven track records doesn't lie. FES is the real deal.

1. Jennifer French, MBA
Executive Director
Neurotech Network
Active FES User
Rehab Solutions:
Functional Electrical Stimulation
Advancing Technology,
Enhancing Life
Developing technology that improves
the quality of life of individuals with
disabilities through the use of
Functional Electrical Stimulation and
enabling the transfer of the technology
into clinical deployment.
Helping people regain life thru
neurotechnology
Focusing on education of and
advocacy to access neurotechnology
devices, therapies and treatments for
people living with impairments, their
care-givers and medical professionals.
Rehab Solutions:
Functional Electrical Stimulation
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2. Objec&ves
Rehab Solutions:
Functional Electrical Stimulation
What is Neurotechnology?
Poten&al Health and Economic Impact:
 Reduced long term care costs
 Increased independence
 Accelerate rehabilita&on
 Improve quality of life
 More self‐reliance
 Decreased health management costs
.
Impact varies depending on device, therapy or treatment and specific user circumstances
Rehab Solutions:
Functional Electrical Stimulation
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3. Array of Applica&ons
Rehab Solutions:
Functional Electrical Stimulation
Categories of Neurotechnology
Rehab Solutions:
Functional Electrical Stimulation
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4. Examples of Neurotechnology
Neuromodula*on
 Deep Brain S*mula*on
 Sacral Nerve S*mula*on
 Spinal Cord S*mula*on
Neural Prosthesis:
 Hand & wrist s*mula*on
 Diaphragm Pacing System
 Drop Foot S*mula*on
Neural Rehabilita&on:
 FES Cycling
 Neural Re‐Educa&on System
 Robo&c Assisted Walking
NeuroSensing & NeuroDiagnos&cs
 EMG Communica&on
 EMG Monitoring
 EEG Interfacing
Photos courtesy of: St. Jude Medical, Medtronic, Synapse Medical, Bioness, Innova?ve Neurone?cs, Restora?ve Therapies, Zynex Medical, Argo Medical, AbleNet, ClevMed Devices, EGI
Rehab Solutions:
Functional Electrical Stimulation
What is FES?
Func*onal Electrical S*mula*on (FES) is the applica&on of electrical
s&mula&on to restore func&on. FES can be applied for therapeu&c
purposes or for replacement of lost func&on.
Rehab Solutions:
Functional Electrical Stimulation
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5. Enabling technology: External
• EMG
• Surface S*mula*on
• Percutaneous Nerve S*mula*on
Rehab Solutions:
Functional Electrical Stimulation
Enabling technology: Implanted
• Implanted S*mulator‐
Telemeter (IST)
• 12 ‐ 16 s*mulus channels
• up to 2 biosignal sensing
(EMG) channels
• Electrodes
– Intramuscular electrode
– Mul*contact spiral cuffs
• Universal External Control
Unit (UECU)
Rehab Solutions:
Functional Electrical Stimulation
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6. Enabling technology: Future
• Network Neural Prosthesis
Rehab Solutions:
Functional Electrical Stimulation
Clinical Research Applica*ons
•
•
•
•
•
•
Cough Restora&on
Upper Extremity Hand Grasp
Pressure Sore Preven&on
Trunk & Posture Control
Standing
Stepping
Rehab Solutions:
Functional Electrical Stimulation
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7. Cough Restora*on
Objectives:
 Implement a more natural cough
 Provide a system that can be
independently operated by the user
 Customizable stimulation
parameters
 Reduce the need for caregiver to
provide secretion clearance
 Reduce the incidence of
respiratory complications and
associated illness and death
Rehab Solutions:
Functional Electrical Stimulation
Cough Restora*on
Candidates:
Individuals with cervical or high
thoracic level SCI or ineffec&ve
cough due to paralysis of
expiratory muscles
Principal Inves&gator: Dr. Anthony DiMarco, MD
Clinical Contact: Dana Hromyak, BS, RRT
info@fescenter.org
Rehab Solutions:
Functional Electrical Stimulation
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8. Upper Extremity
Purpose: Provide hand grasp
func&on for a variety of
ADLs including:
–
–
–
–
–
Ea&ng
Wri&ng
Brushing teeth
Opening a wallet
Using a cell phone
Rehab Solutions:
Functional Electrical Stimulation
Upper Extremity
User controlled system contrac&ng muscles
in the shoulder, elbow and wrist
Principal Inves&gator: Drs. Kevin Kilgore& P. Hunter Peckham
info@fescenter.org
Rehab Solutions:
Functional Electrical Stimulation
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9. Pressure Sore Preven*on
• NMES provides at‐risk
individuals with a method for
achieving an independent
pressure relief regime
• Dynamic alterna&ng bilateral
s&mula&on (le[/right)
provides weight‐shi[ing
• Used daily for a long period
(over 6 months)
Rehab Solutions:
Functional Electrical Stimulation
Pressure Sore Preven*on
Principal Inves&gator: Dr. Kath Bogie
info@fescenter.org
Rehab Solutions:
Functional Electrical Stimulation
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10. Trunk Control & Posture
•
•
•
Compensatory strategies
Unimanual vs. bimanual
Belts, straps, constraints
•
Independent forward & lateral bending
•
Turning in bed & transfer maneuver
•
Reaching & comple&on of ADL
•
•
Spinal alignment
Pressure sore preven&on
Rehab Solutions:
Functional Electrical Stimulation
Trunk Control & Posture
• Targeted Muscles
•
•
•
•
Erector spinae
Quadratus Lumborum
Gluteus Maximus
Adductor Magnus
• Erector spinae provides
more natural lumbar
curve & anterior pelvic
&lt (Δ = 20o)
• Workspace shi[s
forward & upward
(Δ = 7cm)
Rehab Solutions:
Functional Electrical Stimulation
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11. Trunk Control & Posture
With FES
No FES
No FES
With FES
Principal Inves&gator: Dr. Ronald Triolo
Clinical Contact: Barbara Seitz, RN
info@fescenter.org
Rehab Solutions:
Functional Electrical Stimulation
Standing & Transfers
• Targeted Muscles
• Erector spinae
• Gluteus Maximus
• Gluteus Medius
• Adductor Magnus
• Semimembranosus
• Gastroenemius
• Tibialis Anterior
• Femoral Nerve
Rehab Solutions:
Functional Electrical Stimulation
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12. Standing & Transfers
Benefits
– Transfers to higher surfaces
– Reaching for objects
overhead
– Addi&onal environmental
access
– Psychological benefits
– Physiological benefits
Limita*ons
– Standing dura&on
– No control for balance
– Requires some upper
extremity support
– Invasive surgical
procedure
Rehab Solutions:
Functional Electrical Stimulation
Standing & Transfers
Principal Inves&gator: Dr. Ronald Triolo
Clinical Contact: Lisa Lombardo MPT
info@fescenter.org
Rehab Solutions:
Functional Electrical Stimulation
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13. Stepping
Incomplete SCI
• Largest segment of SCI
popula*on
• Few channels
Complica*ng Issues
• Inter‐subject variability
• Coordina*on with voluntary
movements
Func*onal Goal
• Non/Physiological ambulators
→ Household/community
ambulators
Rehab Solutions:
Functional Electrical Stimulation
EMG vs. switch
• EMG control is more consistent
• Stance &mes, symmetry &
speed improved
• Dynamic stability to be
determined
Principal Inves&gator: Dr. Ronald Triolo
Clinical Contact: Lisa Lombardo, MPT
info@fescenter.org
Rehab Solutions:
Functional Electrical Stimulation
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14. Considera*ons to Par*cipa*ng in any
FES program
• Not all programs are appropriate for all popula&ons
• Implanted vs. external
• Commitments of self, family/caregiver
• Time
• Out of pocket cost and/or reimbursement
• Poten&ally dangerous if not used properly use
• Peripheral nerve damage or skin damage
• Infec&ons
• Over‐stress or fa&gue the s&mulated muscles
Rehab Solutions:
Functional Electrical Stimulation
Quality of Life Impact
Rehab Solutions:
Functional Electrical Stimulation
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15. Acknowledgements
www.FEScenter.org
Rehab Solutions:
Functional Electrical Stimulation
Resources
www.FEScenter.org
www.NeurotechNetwork.org
www.ClinicalTrials.gov
Rehab Solutions:
Functional Electrical Stimulation
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