1. Functional Electrical Stimulation ZAIN SULTAN EE-01083-020 NAEEM HUSSAIN EE-01083-039

2. 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.

3. 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.

5. 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.

6. Stroke: Overview “Brain Attack” Damage due to lack of oxygen or blood Types of Stroke –Hemorrhagic –Ischemic 6

7. 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” 7

8. Gait Deficits Post-Stroke: “Drop-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 8 Figure from: (Kelly, 1981)

9. 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 9

10. 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 10

11. 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 11

12. 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 12 http://www.spinalinjury.net/html/_spinal_cord_101.html

13. 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.

14. 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.

15. 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

16. 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

17. 17 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:/

18. 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.