What is functional electrical stimulation (FES)?
- FES is a therapy method where nerves are stimulated with electrical current in order to cause a muscular contraction. The aim is to produce a functional movement.
For which clinical pictures can the training be used?
- Generally applicable in lesions with an intact lower motoneuron
- Spinal Cord Injury
- Traumatic Brain Injury (TBI)
- Multiple Sclerosis
- Guillain-Barre Syndrome
- Parkinson’s Disease
- Chronic Polyarthritis (Rheumatoid Arthritis)
- Cerebral Palsy
- ALS (Amyotrophic Lateral Sclerosis)
- Orthopaedic Diseases
- Muscle weakness due to impaiments of the peripheral nerve
Note: Patient’s individual physical condition or contraindications may forbid an FES application. Please consult your doctor before use!
Which muscle groups can be stimulated?
- Generally every paralysed muscle with an intact lower motoneuron
- The surface of the muscle must be large enough for electrode placement
What are the contraindications for FES therapy?
FES and the RehaMove should not be used by a few people:
- Who use cardiac pacemakers
- with unhealed fractures in lower extremities if the legs shall be trained; in upper extremities, the area of the shoulder girdle and upper ribs if the arms shall be trained
- with damages of the rotator cuff or the potential luxation of the shoulder joint, if the arms shall be trained
- with epilepsy
- with known allergies to electrode gel
- with metal implants underneath or near the muscle groups which are to be stimulated
- pregnant women should desist from using stimulation because the possible adverse effects are unknown and have not yet been rigorously investigated
Which training duration is recommended?
- depending on the patient, the clinical picture, and the training aim
- patient should be able to get used to the therapy
- training start: 5-10 minutes as the muscles are untrained and fatigue quickly
- up to 1 hour training per day is possible when training regularly
- higher therapeutic effect when training 3-4 times per week for 30 minutes
How does the stimulation work?
- Electrical pulses activate the peripheral motor nerves leading to the corresponding muscles
- Pulses pass between two electrodes and thus activate the nerves between the electrodes
- Each nerve has a particular threshold (all-or-nothing principle) triggering an action potential
- Activation can take place when stimulation intensity is high enough (increase pulse width or current) in order to exceed this threshold
How many muscles/channels can be stimulated simultaneously?
- Up to 8 stimulation channels/ 8 muscles
Which electrode size is used for which application?
- in general: the bigger the electrode the better (more comfortable for the user due to a lower current density)
- electrode size depends on the area of the muscle to be stimulated: for small muscles it’s recommended to use small electrodes and the other way around
- electrode forms: oval or rectangular
Where adhesive electrodes have to be placed?
- centrally on the muscle belly
- for a higher therapeutic effect, electrodes have to be placed with a handbreadth between them
- shave if necessary to improve electrode adhesion and skin contact
Is it possible to use different electrodes?
- due to guarantee and warranty claims we recommend the use of HASOMED electrodes
- adhesive electrodes of the company HASOMED can be used for up to 15 applications
- application note: adhesive electrodes should not be used on skin where e.g. body lotion has been applied
In which way is the movement synchronised with the stimulator?
- stimulator and MOTOmed communicate via data cable
- data exchange of all relevant parameters (angle or position of the crank arm, rpm adn rotational direction, symmetry, gear, time, distance)
- stimulation sequences of controlled channels are triggered by angle-based MOTOmed data; thus, the stimulator “knows” when to stimulate which muscle
How endurance and strenght can be trained?
- for strength training higher frequencies are necessary (starting with 30 Hz)
- for endurance training only lower frequencies are used (up to 30 Hz)
What is the ramp for?
Is it possible to adapt the current with increasing training duration?
- depends on the patients adapting threshold and sensitivity
- during training, current can be adjusted for each channel; frequency and pulse width can be adjusted for all channels
With which motion trainer can the RehaStim2 be used?
- only use the RehaStim2 with the MOTOmed Viva 2 (without light version) as arm and leg trainer
When is the adaptive training used?
- in general: therapist decides on the patient group to be treated
- adaptive training: adapts automatically to the patient’s performance
- stimulation is adapted to the residual muscle function of the patient
- mostly used in incomplete and central paralysis: stroke, TBI
- adjustment of a maximum and minimum pulse width:when a certain speed is reached, stimulation will stop slowly, stimulation starts again below this speed
When is the constant training used?
- in general: therapist decides on the patient group to be treated
- constant training: stimulation intensity remains constant even if the patient pedals faster and more powerful
- mostly used in complete paraplegia
How does the sequence training work?
- RehaStim can be used without MOTOmed as a stand-alone device
- cyclical movements of arms and legs can be trained (e.g. grasping, flexion)
When is sequence training used?
- for activation or movement od single muscles
- in order to increase training intensity, e.g. alternating activation of quadriceps muscle
- Sequence training is used where the RehaMove cannot be applies, e.g. when reinitiating complex motion sequences like grasping
- RehaStim includes templates for the most common applications e.g. FES walking, crawling, sit-to-stand or shoulder stabilization
How can I get the sequence training?
- can be activated via additional licenses for present stimulators
What is the difference between percent and second mode in sequence training?
- percent sequence training includes all templates for gait training/FES walking in percentage according to the natural gait phases in a complete gait cycle
- second squence training includes templates in seconds (start + duration of each single muscle in seconds)
What effect has the button “Period” in the percentage-sequence training?
- duration of the complete sequence is adjusted
- periods are adjustable in seconds
What effect has the button “Interval” in the second-sequence training?
- there is always a break between single sequences
- break times can be selected in steps of one second
Which trigger types are available?
- Sequence training offers a manual or automatic triggering
- an additional external trigger software with external single or double trigger is available