What is FES primarily used for?
to facilitate or improve purposeful movement; produces a functionally useful movement
What are the goals for FES?
- Muscle reeducation
- Address disuse atrophy
- Address impaired ROM
- Decrease muscle spasm
- Manage spasticity
- Act as an alternative for or a supplement to orthotics
- Maintain postural alignment until recovery occurs
(the above are examples of impairments)
What are the 2 motor control theories that are used in FES?
sensorimotor integration theory, dynamical systems theory
FES is a technique where ___ level e-stim is used to enhance functional ability. This is unlike Russian where the goal is strength.
low
What are the 4 documented conditions to use FES for?
- UE and hand function in CVA and SCI patients
- Controlling the LE in CVA and SCI patients for drop foot, locomotion, standing
- scoliosis
- reduced spasticity
What are the assumptions of Dynamical Systems Theory?
- A dynamical system is one that changes over time
- A developmental organism is multidimensional
- Movement develops as a result of many subsystems
- Movements are performed and may be preferred, but are not obligatory and can be changed.
- Movement changes from one form to another without stable intermediate states
- Therapists attempt to influence movement patterns
What are the MC main protocols for FES?
The MC patient conditions for tx are:
- SCI
- CVA (stroke)
- multiple sclerosis
- cerebral palsy
- TBI
Others include:
- Shoulder subluxation due to CVA
- Dorsiflexion assist in gait training & other gait protocols
What are the 5 indications for FES?
- orthotic substitution
- bracing in idiopathic scoliosis
- gait re-education
- UMN/LMN to assist with impaired body fx
- shoulder subluxation due to flaccid paralysis s/p CVA
What are the contraindications for FES?
- where active motion is contraindicated
- over metal implants
- malignancies
- first trimester of pregnancy
- over anesthetic skin whenever possible
- extreme edema
- thick scarring or adipose tissue
- over laryngeal of pharyngeal muscles or carotid sinus
- avoid open wounds and active bleeding
- disorientated patients (patients should be able to provide feedback)
- avoid areas of PVD such as DVT
- Do not use with patients who have uncontrolled hyper/hypotension
- Do no use in regions of pacemakers, spinal cord stimulators, near the bladder or phrenic nerve
What types of weakness and what muscles are affected with patients with CVA?
initial weakness or flaccid paralysis of m. supporting the GH joint, especially supraspinatus and posterior deltoid
What are the effects of gravity on the shoulder after a patient has CVA?
the unsupported extremity tends to stretch the ligamentous structures surrounding the GH joint that results in severe pain and decrease UE function
What is the wave form and modulation of FES?
wave form: asymmetrical biphasic square or biphasic rectangular
modulation: interrupted
What are the parameters of FES (waveform, rate, pulse width, ramp time, cycling)?
waveform: asymmetrical biphasic square or symmetrical biphasic rectangular
rate: 25 pps
pulse width: 300 micro sec
ramp time: 2 sec
cycling: synchronous
What is the electrode placement for shoulder subluxation using FES?
bipolar, electrodes on supraspinatus and posterior deltoid
What are the treatment parameters (amplitude, pulse rate, duration of tx, on/off ratio starting & progression, and times
- amplitude: tetanic m. contraction to patient’s tolerance (turn it up high, unlike IFC to pt’s comfort). This is a MOTOR response (IFC was sensory response).
- Pulse rate:12-25 pps
- Duration of tx: 15-30 min
- on/off ratio: 1:3 (2 sec : 6 sec) progressing to 12 : 1 (24 sec : 2 sec)
- 15-30 min (three times/day)
What are the 2 muscles that prevent inferior humeral head subluxation?
supraspinatus & posterior deltoid
What are the 2 disadvantages in using slings to prevent shoulder subluxation?
- most slings are not effective for subluxation prevention
2. the slings that do prevent subluxation, promote nonuse of the arm & may result in contracture
If the supraspinatus and posterior deltoid cannot be stimulated, which muscle would you try next?
middle deltoid; it can be useful in preventing shoulder subluxation
FES for the GH joint subluxation should be used for ______ a day.
3 times a day for a total of 4-7 hours; this means the patient or caregiver(s) need to be educated in the use of FES
In FES electrode placement ___ electrodes are placed over small muscles and ___ electrodes are placed to stimulate titanic contraction of large muscle.
small (1.5 inch), large (3 inch or bigger)
What do patients with hemiplegia sometimes exhibit?
paralyzed dorsiflexor and evertor muscles
How does FES control foot drop?
by facilitating dorsiflexors and evertors during swing phase
What are the ES characteristics (wave form, pulse duration, modulation) for dorsiflexion assist using FES?
wave form: asymmetric biphasic square
pulse duration: 20-250 micro seconds
modulation: interrupted by foot switch
What is the electrode placement for dorsiflexion assist in FES?
peroneal (fibular) nerve near head of fibula or anterior tibialis muscle.
