Rehab Solutions: FES Technology & Paralysis

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Rehab Solutions: Functional Electrical Stimulation

Jennifer French, MBA Executive Director

Neurotech Network Active FES User


Advancing Technology, Enhancing Life

Developing technology that improves the quality of life of individuals with disabilities through the use of Functional Electrical Stimulation and enabling the transfer of the technology into clinical deployment.

Helping people regain life thru neurotechnology

Focusing on education of and advocacy to access neurotechnology devices, therapies and treatments for people living with impairments, their care-givers and medical professionals.

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Objec&ves


WhatisNeurotechnology?

Poten&alHealthandEconomicImpact: Reducedlongtermcarecosts Increasedindependence Acceleraterehabilita&on Improvequalityoflife Moreself‐reliance Decreasedhealthmanagementcosts

Impactvariesdependingondevice,therapyortreatmentandspecificusercircumstances.

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ArrayofApplica&ons


CategoriesofNeurotechnology

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ExamplesofNeurotechnologyNeuromodula*on DeepBrainS*mula*on SacralNerveS*mula*on SpinalCordS*mula*on

NeuralProsthesis: Hand&wrists*mula*on DiaphragmPacingSystem DropFootS*mula*on

NeuralRehabilita&on: FESCycling NeuralRe‐Educa&onSystem Robo&cAssistedWalking

NeuroSensing&NeuroDiagnos&cs EMGCommunica&on EMGMonitoring EEGInterfacing

Photoscourtesyof:St.JudeMedical,Medtronic,SynapseMedical,Bioness,Innova?veNeurone?cs,Restora?veTherapies,ZynexMedical,ArgoMedical,AbleNet,ClevMedDevices,EGI


Func*onalElectricalS*mula*on(FES)istheapplica&onofelectricals&mula&ontorestorefunc&on.FEScanbeappliedfortherapeu&cpurposesorforreplacementoflostfunc&on.

WhatisFES?

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Enablingtechnology:External•  EMG•  SurfaceS*mula*on•  PercutaneousNerveS*mula*on


Enablingtechnology:Implanted•  ImplantedS*mulator‐Telemeter(IST)

•  12‐16s*muluschannels•  upto2biosignalsensing(EMG)channels

•  Electrodes–  Intramuscularelectrode–  Mul*contactspiralcuffs

•  UniversalExternalControlUnit(UECU)

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Enablingtechnology:Future

•  NetworkNeuralProsthesis


ClinicalResearchApplica*ons

•  CoughRestora&on•  UpperExtremityHandGrasp•  PressureSorePreven&on•  Trunk&PostureControl•  Standing•  Stepping

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CoughRestora*on

Objectives:   Implement a more natural cough   Provide a system that can be

independently operated by the user   Customizable stimulation

parameters   Reduce the need for caregiver to

provide secretion clearance   Reduce the incidence of

respiratory complications and associated illness and death


CoughRestora*on

Candidates:

IndividualswithcervicalorhighthoraciclevelSCIorineffec&vecoughduetoparalysisofexpiratorymuscles

PrincipalInves&gator:Dr.AnthonyDiMarco,MDClinicalContact:DanaHromyak,BS,RRT

[email protected]

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UpperExtremityPurpose:Providehandgraspfunc&onforavarietyofADLsincluding:–  Ea&ng–  Wri&ng

–  Brushingteeth–  Openingawallet–  Usingacellphone


UpperExtremity

PrincipalInves&gator:Drs.KevinKilgore&[email protected]

Usercontrolledsystemcontrac&ngmusclesintheshoulder,elbowandwrist

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PressureSorePreven*on

•  NMESprovidesat‐riskindividualswithamethodforachievinganindependentpressurereliefregime

•  Dynamicalterna&ngbilaterals&mula&on(le[/right)providesweight‐shi[ing

•  Useddailyforalongperiod(over6months)


PressureSorePreven*on

PrincipalInves&gator:[email protected]

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TrunkControl&Posture

•  Compensatorystrategies•  Unimanualvs.bimanual•  Belts,straps,constraints

•  Independentforward&lateralbending

•  Turninginbed&transfermaneuver

•  Reaching&comple&onofADL

•  Spinalalignment

•  Pressuresorepreven&on


TrunkControl&Posture•  TargetedMuscles

•  Erectorspinae

•  QuadratusLumborum

•  GluteusMaximus

•  AdductorMagnus

•  Erectorspinaeprovidesmorenaturallumbarcurve&anteriorpelvic&lt(Δ=20o)

•  Workspaceshi[sforward&upward(Δ=7cm)

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TrunkControl&Posture

PrincipalInves&gator:Dr.RonaldTrioloClinicalContact:BarbaraSeitz,RN

[email protected]

NoFESWithFES NoFESWithFES


Standing&Transfers

•  TargetedMuscles

•  Erectorspinae•  GluteusMaximus

•  GluteusMedius•  AdductorMagnus

•  Semimembranosus

•  Gastroenemius•  TibialisAnterior•  FemoralNerve

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Standing&Transfers

Benefits–  Transferstohighersurfaces–  Reachingforobjectsoverhead

–  Addi&onalenvironmentalaccess

–  Psychologicalbenefits–  Physiologicalbenefits

Limita*ons–  Standingdura&on–  Nocontrolforbalance–  Requiressomeupperextremitysupport

–  Invasivesurgicalprocedure


Standing&Transfers

PrincipalInves&gator:Dr.RonaldTrioloClinicalContact:LisaLombardoMPT

[email protected]

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SteppingIncompleteSCI•  LargestsegmentofSCI

popula*on•  FewchannelsComplica*ngIssues•  Inter‐subjectvariability•  Coordina*onwithvoluntary

movementsFunc*onalGoal•  Non/Physiologicalambulators

→Household/communityambulators


EMGvs.switch

•  EMGcontrolismoreconsistent

•  Stance&mes,symmetry&speedimproved

•  Dynamicstabilitytobedetermined

PrincipalInves&gator:Dr.RonaldTrioloClinicalContact:LisaLombardo,MPT

[email protected]

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Considera*onstoPar*cipa*nginanyFESprogram

•  Notallprogramsareappropriateforallpopula&ons

•  Implantedvs.external•  Commitmentsofself,family/caregiver

•  Time

•  Outofpocketcostand/orreimbursement•  Poten&allydangerousifnotusedproperlyuse

•  Peripheralnervedamageorskindamage•  Infec&ons•  Over‐stressorfa&guethes&mulatedmuscles


QualityofLifeImpact

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Acknowledgements

www.FEScenter.org


Resources

www.FEScenter.org

www.ClinicalTrials.govwww.NeurotechNetwork.org

Rehab Solutions: FES Technology & Paralysis

Technology

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