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Functional Electrical Stimulation

Functional Electrical Stimulation. Applications to Stroke and Spinal Cord Injury Rehabilitation Amy Heitkamp & Jen Mullett HSS 409 – December 7, 2005. Picture from http://fescenter.case.edu/Resources_Info/fes_guide.htm. Main Topics. FES overview Stroke overview

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Functional Electrical Stimulation

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  1. Functional Electrical Stimulation Applications to Stroke and Spinal Cord Injury Rehabilitation Amy Heitkamp & Jen Mullett HSS 409 – December 7, 2005 Picture from http://fescenter.case.edu/Resources_Info/fes_guide.htm

  2. Main Topics • FES overview • Stroke overview • FES: applications to stroke rehabilitation • Current Research: FES & Stroke • SCI overview • FES: applications to SCI rehabilitation • Current Research: FES & SCI • Conclusion HSS 409

  3. Functional Electrical Stimulation (FES) • active muscle contraction • computer or therapist sequenced activation • produces functional movement • implanted or surface electrodes (FES Resource Guide, 2004) HSS 409

  4. Stroke: Overview • “Brain Attack” • Damage due to lack of oxygen or blood • Types of Stroke • Hemorrhagic • Ischemic • “Stroke is the leading cause of adult disability in the United States” (NSA, 2005) HSS 409

  5. Stroke: Damage & Resulting Disability • Dependent upon location & extent of damage • Examples: (Cleveland Clinic, 2003) • Inability to move parts of the body • Paralysis (hemiplesia or total) • Weakness in parts of the body • Persistent gait deficits(Daly, 2001) • Swing phase • Midsupport phase • “Drop foot” HSS 409

  6. Biomechanics in the Gait Cycle (Dhaher, 2005) photo: http://www.sportsci.com/adi2001/Adi/services/support/tutorials/gait/chapter1/1.1.asp) Support Phase Swing Phase |------------------------------------------|-------------------------------| Swing Foot strike Toe-off Deceleration Midsupport Forward Swing HSS 409

  7. 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 (Pritchett, 2005) Figure from: (Kelly, 1981) HSS 409

  8. Gait Deficits Post-Stroke:Problem Areas (Dhaher, 2005) photo: http://www.sportsci.com/adi2001/Adi/services/support/tutorials/gait/chapter1/1.1.asp) Support Phase Swing Phase |------------------------------------------|-------------------------------| Swing Foot strike Toe-off Deceleration Midsupport Forward Swing HSS 409

  9. FES: Clinical Applications to Stroke Rehabilitation • Dropped-Foot rehabilitation (ODFS) • Improve functional mobility (during walking) – FNS-IM • Others not applicable to this presentation • Main Goals – Improve coordination the different phases of gait • Restoration of motor control • Prevent debilitating falls (Daly, 2003; Daly 2004; “FES Resource Guide,” 2004) HSS 409

  10. FES: Odsock Dropped-Foot Stimulator (ODFS) Figure from: www.salisburyfes.com/ infoms.htm Figure courtesy of Salisbury District Hospital http://fescenter.case.edu/Start_Here/Patients/ Stroke/stroke_programs.htm HSS 409

  11. FES: Functional Neuromuscular Stimulation – IntraMuscular (FNS-IM) • Implanted electrodes • Individualized stimulator on Belt • Comfort • Better Control (Daly, 2004) Figure from www.rehabpub.com/ features/32003/6.asp HSS 409

  12. Current Research on FES usage in Stroke Patients • Daly, JJ. et al. (2004) • Purpose: preclude post-stroke outcomes of gait deficits using FES during rehabilitation • Methods: • (E) Experimental group – therapy & FES (FNS-IM) • (C) Control group - therapy • Subjects: 16 stroke patients HSS 409

  13. Current Research on FES usage in Stroke Patients • Daly, JJ. et al. (2004) • Results: • Peak swing flexion – no significant difference • Peak swing knee flexion – significant gains in E group • Mid-Swing ankle dorsiflexion – significant gains in E group • Conclusions: • Improvements were maintained for 6 months post-study • FES (FNS-IM) is an effective tool for stroke rehabilitation HSS 409

  14. 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 HSS 409

  15. Current Research on FES usage in Stroke Patients *** See Attached Summary Table HSS 409

  16. 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 HSS 409

  17. 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 HSS 409

  18. 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 HSS 409 http://www.spinalinjury.net/html/_spinal_cord_101.html

  19. Prevalence and Death • Approx. 450,000 people live with SCI in the US • About 10,000 new cases every year • 82% involve males between ages 16-30 • motor vehicle accidents • violence • from falls • Quadriplegia is slightly more common than paraplegia • 85% of SCI patients who survive the first 24 hrs are alive after 10 years • Most common cause of death is diseases of the respiratory system such as pneumonia • Second leading cause is nonischemic heart disease • Third leading cause is suicides and/or homicides HSS 409

  20. Christopher Reeves • SCI recovery is thought to occur in the first 6 months-2 years • 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 • Aquatherapy • Treadmill training HSS 409

  21. FES Bicycle • Allows a person with little or no voluntary leg movement to pedal a stationary leg-cycle (ergometer) • Cost approximately $15,000 • Some health clinics have the bikes • Increase muscle mass and cardiopulmonary function HSS 409 http://www.musclepower.com/

  22. Physiology • Normally, electric signals travel from the brain down through the spinal cord to the corresponding muscles or organs • When damage occurs to the spinal cord, these signals cannot reach there intended destination • Applying a small electrical current to the nerve or muscle, the desired function can be triggered HSS 409

  23. FES: Clinical Applications to SCI Rehabilitation • Standing and Transfer FES System • Jen • C6-C7 incomplete injury in 1998 • FES Walking System • Don • Incomplete paraplegic since 1983 • FES System for Gripping and Releasing • Annette • Incomplete C5-C6 Quadriplegic due to car accident in 2002 • Jim • Activities of Daily Living http://toronto-fes.ibme.utoronto.ca/publications/ Neuroprostheses_Popovic_Thrasher.pdf HSS 409

  24. Current Research on FES usage in SCI Patients HAND (Peckham, 2001) • 51 quadriplegic adults with C5 or C6 SCI • Assessed participants: 1) ability to grasp, move, and release standardized objects 2) degree of assistance required to perform ADLs 3) user satisfaction • Results: became more independent in ADLs and high user satisfaction HSS 409

  25. Current Research on FES usage in SCI Patients RESPIRATION (Lin, 2001) • 8 men with quadriplegia • Measured values were evaluated after a 4 week period of using FMS • Results • Expiratory Lung Volumes and Lung Capacities greatly increased • 4 week protocol of FMS, improved voluntary expiratory muscles significantly HSS 409

  26. Current Research on FES usage in SCI Patients • Standing (Hesse, 1998) • 17 patients with SCI • 4 quadriplegic patients • 10 paraplegic patients • 3 patients with incomplete cervical lesion, able to walk short distances before treatment • Results: standing duration and walking distances were dependent on the severity of SCI HSS 409

  27. Future Outlook • Researchers at Sweden’s Karolinska Institute snipped the spinal cords of laboratory rats • Bridged the gap using transplanted nerves • The graft restored function to the rats previously motionless hindlimbs • After a few months, they could flex their joints and partially support their body weight • (US News and World Report, 1996) HSS 409

  28. 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. HSS 409

  29. Bolded * = significant improvement NS= not significant E = experimental group C= control HSS 409

  30. Questions? HSS 409

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