rehab solutions: fes technology & paralysis
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Rehab Solutions: Functional Electrical Stimulation
Jennifer French, MBA Executive Director
Neurotech Network Active FES User
Rehab Solutions: Functional Electrical Stimulation
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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Rehab Solutions: Functional Electrical Stimulation
Objec&ves
Rehab Solutions: Functional Electrical Stimulation
WhatisNeurotechnology?
Poten&alHealthandEconomicImpact: Reducedlongtermcarecosts Increasedindependence Acceleraterehabilita&on Improvequalityoflife Moreself‐reliance Decreasedhealthmanagementcosts
Impactvariesdependingondevice,therapyortreatmentandspecificusercircumstances.
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Rehab Solutions: Functional Electrical Stimulation
ArrayofApplica&ons
Rehab Solutions: Functional Electrical Stimulation
CategoriesofNeurotechnology
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Rehab Solutions: Functional Electrical Stimulation
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
Rehab Solutions: Functional Electrical Stimulation
Func*onalElectricalS*mula*on(FES)istheapplica&onofelectricals&mula&ontorestorefunc&on.FEScanbeappliedfortherapeu&cpurposesorforreplacementoflostfunc&on.
WhatisFES?
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Rehab Solutions: Functional Electrical Stimulation
Enablingtechnology:External• EMG• SurfaceS*mula*on• PercutaneousNerveS*mula*on
Rehab Solutions: Functional Electrical Stimulation
Enablingtechnology:Implanted• ImplantedS*mulator‐Telemeter(IST)
• 12‐16s*muluschannels• upto2biosignalsensing(EMG)channels
• Electrodes– Intramuscularelectrode– Mul*contactspiralcuffs
• UniversalExternalControlUnit(UECU)
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Rehab Solutions: Functional Electrical Stimulation
Enablingtechnology:Future
• NetworkNeuralProsthesis
Rehab Solutions: Functional Electrical Stimulation
ClinicalResearchApplica*ons
• CoughRestora&on• UpperExtremityHandGrasp• PressureSorePreven&on• Trunk&PostureControl• Standing• Stepping
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Rehab Solutions: Functional Electrical Stimulation
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
Rehab Solutions: Functional Electrical Stimulation
CoughRestora*on
Candidates:
IndividualswithcervicalorhighthoraciclevelSCIorineffec&vecoughduetoparalysisofexpiratorymuscles
PrincipalInves&gator:Dr.AnthonyDiMarco,MDClinicalContact:DanaHromyak,BS,RRT
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Rehab Solutions: Functional Electrical Stimulation
UpperExtremityPurpose:Providehandgraspfunc&onforavarietyofADLsincluding:– Ea&ng– Wri&ng
– Brushingteeth– Openingawallet– Usingacellphone
Rehab Solutions: Functional Electrical Stimulation
UpperExtremity
PrincipalInves&gator:Drs.KevinKilgore&[email protected]
Usercontrolledsystemcontrac&ngmusclesintheshoulder,elbowandwrist
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Rehab Solutions: Functional Electrical Stimulation
PressureSorePreven*on
• NMESprovidesat‐riskindividualswithamethodforachievinganindependentpressurereliefregime
• Dynamicalterna&ngbilaterals&mula&on(le[/right)providesweight‐shi[ing
• Useddailyforalongperiod(over6months)
Rehab Solutions: Functional Electrical Stimulation
PressureSorePreven*on
PrincipalInves&gator:[email protected]
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Rehab Solutions: Functional Electrical Stimulation
TrunkControl&Posture
• Compensatorystrategies• Unimanualvs.bimanual• Belts,straps,constraints
• Independentforward&lateralbending
• Turninginbed&transfermaneuver
• Reaching&comple&onofADL
• Spinalalignment
• Pressuresorepreven&on
Rehab Solutions: Functional Electrical Stimulation
TrunkControl&Posture• TargetedMuscles
• Erectorspinae
• QuadratusLumborum
• GluteusMaximus
• AdductorMagnus
• Erectorspinaeprovidesmorenaturallumbarcurve&anteriorpelvic<(Δ=20o)
• Workspaceshi[sforward&upward(Δ=7cm)
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Rehab Solutions: Functional Electrical Stimulation
TrunkControl&Posture
PrincipalInves&gator:Dr.RonaldTrioloClinicalContact:BarbaraSeitz,RN
NoFESWithFES NoFESWithFES
Rehab Solutions: Functional Electrical Stimulation
Standing&Transfers
• TargetedMuscles
• Erectorspinae• GluteusMaximus
• GluteusMedius• AdductorMagnus
• Semimembranosus
• Gastroenemius• TibialisAnterior• FemoralNerve
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Rehab Solutions: Functional Electrical Stimulation
Standing&Transfers
Benefits– Transferstohighersurfaces– Reachingforobjectsoverhead
– Addi&onalenvironmentalaccess
– Psychologicalbenefits– Physiologicalbenefits
Limita*ons– Standingdura&on– Nocontrolforbalance– Requiressomeupperextremitysupport
– Invasivesurgicalprocedure
Rehab Solutions: Functional Electrical Stimulation
Standing&Transfers
PrincipalInves&gator:Dr.RonaldTrioloClinicalContact:LisaLombardoMPT
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Rehab Solutions: Functional Electrical Stimulation
SteppingIncompleteSCI• LargestsegmentofSCI
popula*on• FewchannelsComplica*ngIssues• Inter‐subjectvariability• Coordina*onwithvoluntary
movementsFunc*onalGoal• Non/Physiologicalambulators
→Household/communityambulators
Rehab Solutions: Functional Electrical Stimulation
EMGvs.switch
• EMGcontrolismoreconsistent
• Stance&mes,symmetry&speedimproved
• Dynamicstabilitytobedetermined
PrincipalInves&gator:Dr.RonaldTrioloClinicalContact:LisaLombardo,MPT
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Rehab Solutions: Functional Electrical Stimulation
Considera*onstoPar*cipa*nginanyFESprogram
• Notallprogramsareappropriateforallpopula&ons
• Implantedvs.external• Commitmentsofself,family/caregiver
• Time
• Outofpocketcostand/orreimbursement• Poten&allydangerousifnotusedproperlyuse
• Peripheralnervedamageorskindamage• Infec&ons• Over‐stressorfa&guethes&mulatedmuscles
Rehab Solutions: Functional Electrical Stimulation
QualityofLifeImpact
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Rehab Solutions: Functional Electrical Stimulation
Acknowledgements
www.FEScenter.org
Rehab Solutions: Functional Electrical Stimulation
Resources
www.FEScenter.org
www.ClinicalTrials.govwww.NeurotechNetwork.org