enhancing recovery from critical care with fes
DESCRIPTION
Post-intensive care syndrome is now recognised as a spectrum of physical, cognitive and emotional problems that can stem from even reletively shorts stays in critical care units. Over 100,000 patients will be treated in critical care units each year in England and Wales alone. Most are discharged to home but a significant percentage will have persistent problems. This presentation by Derek Jones describes how motion therapy combined with a form of FES Cycling (Letto2 with FES) can help boost vital signs in even unconcious patients. The FES enhanced exercise preserves muscle mass and improves the speed and quality of rehabilitation.TRANSCRIPT
Enhancing Recovery from Critical Care
Combining Movement Therapy and Functional Electrical Stimulation
Derek Jones PhD, MBADirector, Anatomical Concepts (UK) Ltd
Rehabilitation after critical illness
• Approx 110,000 in critical care each year in England & Wales
• Significant percentage have long-term problems
• Recognised issues - weakness, muscle loss, PTS, anxiety, depression, cognitive disfunction
• Patients at risk - start rehabilitation as early as clinically possible
NICE Guidelines - CG83
When can Rehabilitation Start?
Early!
Exercise is a therapeutic agentFirst recognised over a
thousand years ago
Exercise is Medicine
Movement therapy - machines that move the limbs
through a range of motion
Early Exercise in Critically Ill Patients Enhances Short-Term Functional RecoveryChris Burtin et al, Crit Care Med. 2009;37(9):2499-2505.
Motion Therapy
Functional Electrical
Stimulation
Bringing together
two technologiesActive Exercise by..Creating more
What Can We Expect
Improved vital signsPreserved muscle massReduced risk of Post-Intensive care syndrome & ICU-AW?Reduced risk of pressure sores
Combining Movement and Functional Electrical
Stimulation (FES)
Faster Rehabilitation
FES Cycling - used by clinics and individuals at home all
over the world
Cardiovascular fitnessMuscle tissue bulk
Bone density improvement
Activate Paralysed Musclevia Intact Lower Motor
Neurons
Application of FES• Absolute
contraindications
• Unhealed fractures in the limbs to be stimulated
• Pregnancy
• Relative Contraindications
• Denervated muscle
• Severe spasticity
• Limited range of hip/knee joint motion
• Severe osteoporosis
• Open wounds in current path
Movementcombined with FES to activate muscle -
even with an unconscious patient
FES unit
Letto2
Func
tiona
l Elec
trical
Stim
ulatio
n
FES is a tried and tested technology
Principles discovered in
the 18th Century
Sequence of precise pulses Functional & useful timingTimed to pedal movement
Adjustable intensitySafe and effective
FrequencyPulse widthCurrent
FES Controller
Feedback of..Pedal position - Speed - Power Generated
Muscle Contraction in response to FES
Some of the ways we use FES..
Create new opportunities for rehabilitation
Spinal cord injury - complete and incomplete
Stroke
Parkinson’s disease
MS
Transverse myelitis
Spinal Cord Injured client - complete lesion T8/T9
Knee flexion and extension muscles activated with “triggered” FES to enhance exercise
Trunk extension, core strength development exercises - C4 complete spinal cord injury
FES makesmovement active
safely and effectively
How could it be used?
• 3 to 4 days after admission to critical care
• Electrodes on Quads & Hamstrings, Gastronemius, Gluteals
• Stimulation intensity individually determined
• Sessions 5 times per week - up to an hour per day
Images on Page 2 - David Graham, “No Diving” ISBN 978-0-9557465-1-2
Anatomical Concepts (UK) Ltd8-10 Dunrobin Court
Clydebank Business ParkClydebankG81 2QP
T: 0141-952-2323E: [email protected]
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