Source: https://tbirehabilitation.wordpress.com/tag/fes/
Timestamp: 2019-04-18 19:06:09+00:00

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FES is a technique that utilizes patterned electrical stimulation of neural tissue with the purpose of restoring or enhancing a lost or diminished function. It produces contractions in paralysed muscles by the application of small pulses of electrical stimulation to nerves that supply the paralysed muscle. The stimulation is controlled in such a way that the movement produced provides useful function.
FES is used as a tool to assist walking and also as a means of practicing various functional movements for therapeutic benefit. FES may be used to replace the natural electrical signals from the brain, helping the weak or paralyzed limbs move again. With continued stimulation over time, the brain may even be able to recapture and relearn this movement without the stimulation.
This novel treatment is useful for all type of UMN disorders like hemiplegia (Cerebro Vascular Accident, Head Injury, Traumatic Brain injury, Brain tumor ), multiple scerosis, cerebral palsy, incomplete paraplegia etc.
contact “FES Center India” to buy FES System.
Combo video including patients participating in contralaterally controlled FES therapy followed by a patient performing a grasp-release test before CCFES therapy and the same patient performing the same test after 12 weeks of CCFES therapy. All patients were participating in research studies at MetroHealth Medical Center in Cleveland.
PhysioFunction are recognised as international experts in the use of Functional Electrical Stimulation (FES). We ensure our clients receive the most clinically correct rehabilitation technology suited to their needs. Jon Graham, Clinical Director at PhysioFunction talks about Foot Drop and Functional Electrical Stimulation.
Functional electrical stimulation is a biophysical technology that have seen increased use in the management of neurological disorders. This talk will discuss principles of use with specific therapeutic cases and would be of primary interest to occupational and physical therapists. The participant will develop skills necessary to choose appropriately and apply electrotherapy in the rehabilitation setting. Various new technologies using electrotherapy will also be demonstrated.
Functional electrical stimulation (FES) is capable of activating muscles that are under-recruited in neurological diseases, such as stroke. Therefore, FES provides a promising technology for assisting upper-limb motor functions in rehabilitation following stroke. However, the full benefits of FES may be limited due to lack of a systematic approach to formulate the pattern of stimulation. Our preliminary work demonstrated that it is feasible to use muscle synergy to guide the generation of FES patterns.In this paper, we present a methodology of formulating FES patterns based on muscle synergies of a normal subject using a programmable multi-channel FES device. The effectiveness of the synergy-based FES was tested in two sets of experiments. In experiment one, the instantaneous effects of FES to improve movement kinematics were tested in three patients post ischemic stroke. Patients performed frontal reaching and lateral reaching tasks, which involved coordinated movements in the elbow and shoulder joints. The FES pattern was adjusted in amplitude and time profile for each subject in each task. In experiment two, a 5-day session of intervention using synergy-based FES was delivered to another three patients, in which patients performed task-oriented training in the same reaching movements in one-hour-per-day dose. The outcome of the short-term intervention was measured by changes in Fugl–Meyer scores and movement kinematics. Results on instantaneous effects showed that FES assistance was effective to increase the peak hand velocity in both or one of the tasks. In short-term intervention, evaluations prior to and post intervention showed improvements in both Fugl–Meyer scores and movement kinematics. The muscle synergy of patients also tended to evolve towards that of the normal subject. These results provide promising evidence of benefits using synergy-based FES for upper-limb rehabilitation following stroke. This is the first step towards a clinical protocol of applying FES as therapeutic intervention in stroke rehabilitation.
Muscle activation during movement is commonly disrupted due to neural injuries from stroke. A major challenge for stroke rehabilitation is to re-establish the normal ways of muscle activation through a general restoration of motor control, otherwise impairments may be compensated by the motor system through a substitution strategy of task control . In post-stroke intervention, new technologies such as neuromuscular electrical stimulation (NMES) or functional electrical stimulation (FES) offer advantages for non-invasively targeting specific groups of muscles – to restore the pattern of muscle activation. Nevertheless, their effectiveness is limited by lack of a systematic methodology to optimize the stimulation pattern, to implement the optimal strategy in clinical settings, and to design a protocol of training towards the goal of restoring motor functions. This pioneer study addresses these issues in clinical application with a non-invasive FES technology.
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Objective: To study the long-term effectiveness of Theta Burst Stimulation (TBS) or Functional Electrical Stimulation (FES) combined with Physical therapy (PT) as compared to PT alone for improving arm functions in patients with acute stroke.
Design: Single blind randomized controlled trial.
Setting: Outpatient clinics and inpatient wards at tertiary care neurology center.
Subjects: Adult patients with acute middle cerebral artery territory ischemic stroke.
Interventions: 60 patients were randomized into three groups of 20 each: TBS+PT; FES+PT; and PT alone. TBS group received intermittent TBS of ipsilesional hemisphere and continuous TBS of contralesional hemisphere while FES group received FES of paretic limb, both for four weeks. All groups received supervised physical therapy for four weeks followed by home physiotherapy for one year.
Outcome measures: Fugl Meyer Assessment upper limb score (FMA-UL) was primary outcome measure. Patients were evaluated at baseline and subsequently at one, three and six months and one year.
Results: Compared to PT group, mean FMA-UL scores were higher in TBS and FES groups at all follow-ups (P < 0.001). From baseline to one year, mean (SD) FMA-UL scores increased from 14.9(2.1) to 55.55(2.46) in TBS group, 15.5(1.99) to 55.85(2.46) in FES group, and 14.3(2.2) to 43.3(4.22) in PT group indicating an increase of 273%, 260%, and 203% respectively. There was no difference between FES and TBS groups.
Conclusion: A four-week intervention with TBS or FES combined with PT produces better long-term arm functions as compared to PT alone in patients with acute stroke.
Background: Previous studies have demonstrated that post-stroke gait rehabilitation combining functional electrical stimulation applied to the ankle muscles during fast treadmill walking (FastFES) improves gait biomechanics and clinical walking function. However, there is considerable inter-individual variability in response to FastFES. Although FastFES aims to sculpt ankle muscle coordination, whether changes in ankle muscle activity underlie observed gait improvements is unknown. The aim of this study was to investigate three cases illustrating how FastFES modulates ankle muscle recruitment during walking.
Methods: We conducted a preliminary case series study on three individuals (53-70y; 2M; 35-60 months post-stroke; 19-22 lower extremity Fugl-Meyer) who participated in 18 sessions of FastFES (3 sessions/week; ClinicalTrials.gov: NCT01668602). Clinical walking function (speed, six-minute walk test, and Timed-Up-and-Go test), gait biomechanics (paretic propulsion and ankle angle at initial-contact), and plantarflexor (soleus) / dorsiflexor (tibialis anterior) muscle recruitment were assessed pre- and post-FastFES while walking without stimulation.
Results: Two participants (R1, R2) were categorized as responders based on improvements in clinical walking function. Consistent with heterogeneity of clinical and biomechanical changes commonly observed following gait rehabilitation, how muscle activity was altered with FastFES differed between responders.R1 exhibited improved plantarflexor recruitment during stance accompanied by increased paretic propulsion. R2 exhibited improved dorsiflexor recruitment during swing accompanied by improved paretic ankle angle at initial-contact. In contrast, the third participant (NR1), classified as a non-responder, demonstrated increased ankle muscle activity during inappropriate phases of the gait cycle. Across all participants, there was a positive relationship between increased walking speeds after FastFES and reduced SOL/TA muscle coactivation.
Conclusion: Our preliminary case series study is the first to demonstrate that improvements in ankle plantarflexor and dorsiflexor muscle recruitment (muscles targeted by FastFES) accompanied improvements in gait biomechanics and walking function following FastFES in individuals post-stroke. Our results also suggest that inducing more appropriate (i.e., reduced) ankle plantar/dorsi-flexor muscle coactivation may be an important neuromuscular mechanism underlying improvements in gait function after FastFES training, suggesting that pre-treatment ankle muscle status could be used for inclusion into FastFES. The findings of this case-series study, albeit preliminary, provide the rationale and foundations for larger-sample studies using similar methodology.

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