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Functional Electrical Stimulation Therapy: Recovery of Function Following Spinal Cord Injury and Stroke

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Abstract

Functional electrical stimulation (FES) is a technology one can use to artificially generate body movements in individuals who have paralyzed muscles due to injury to the central nervous system. More specifically, FES can be used to generate functions such as grasping and walking in individuals with spinal cord injury (SCI), stroke, traumatic brain injury and other neurological disorders that do not affect lower motor neurons. This technology was originally used to develop neuroprostheses that were implemented to permanently substitute impaired functions such as bladder voiding, grasping, and walking. In other words, a consumer would use the device each time he/she wanted to generate a desired function. In recent years, FES technology has been used to deliver, therapies to retrain voluntary motor functions such as grasping, reaching and walking. In this application, FES is used as a short-term therapy, the objective of which is restoration of voluntary function and not lifelong dependence on the FES device, hence the name FES therapy or FET. The FET is used as a short-term intervention to help the central nervous system of the consumer to relearn how to execute impaired functions. In this chapter, we introduce recent findings and advances in the field of FET.

The findings to date clearly show that FET for reaching and grasping is a therapeutic modality that should be implemented in every rehabilitation institution that is treating patients with stroke and SCI. The results obtained in a number of randomized control trials to date clearly demonstrate that FET for upper limb should not be ignored any longer. There is also considerable evidence to support the use of FET as a therapeutic modality to treat drop foot problem in both stroke and incomplete SCI populations. Several commercial FES systems are available that can be used to deliver FET for drop foot and grasping, and physiotherapists and occupational therapists should take advantage of this technology.

Presently, few teams in the world are investigating the use of more complex FES systems (6–16 channels FES systems that stimulate muscles in one or both legs in a physiologically appropriate manner) for retraining voluntary walking function in stroke and incomplete SCI populations. Although comprehensive randomized control trials have not been completed yet with either patient population, preliminary findings are very encouraging.

As surface FES technology is continuously improving and delivery methods for FET are evolving due to system miniaturization, better stimulation electrodes, and better stimulation protocols, it is foreseeable that, in the next 10–15 years, FET will become one of the dominant interventions for upper and lower limb rehabilitation. Many neuroprostheses are already commercialized and many more are near in the process of being developed and/or commercialized. Thus, we feel very confident that FET field is only beginning to evolve, and that, in the future, it may become one of the key therapeutic interventions not only for patients with stroke and SCI but also for patients with other neuromuscular disorders.

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Authors and Affiliations

  1. Institute of Biomterials and Biomedical Engineering, University of Toronto, 164 College St., Room 407, M5S 3G9, Toronto, ON, Canada

    Milos R. Popovic

  2. Lyndhurst Centre, Toronto Rehabilitation Institute, 520 Sutherland Drive, M4G 3V9, Toronto, ON, Canada

    Kei Masani

  3. Neuroprosthesis Control Group, Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology, Physikstrasse 3, 8092, Zurich, Switzerland

    Silvestro Micera

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  1. Milos R. Popovic
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  2. Kei Masani
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  3. Silvestro Micera
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Correspondence to Milos R. Popovic .

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Editors and Affiliations

  1. Uniklinik Balgrist, Forchstr. 340, Zürich, 8008, Switzerland

    Volker Dietz

  2. , ARTORG Center for Biomedical Engineering, Universität Bern, Murtenstrasse 21, Bern, CH-3010, Switzerland

    Tobias Nef

  3. Rehabilitation Institute of Chicago, Illinois, 60611, USA

    William Zev Rymer

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Popovic, M.R., Masani, K., Micera, S. (2012). Functional Electrical Stimulation Therapy: Recovery of Function Following Spinal Cord Injury and Stroke. In: Dietz, V., Nef, T., Rymer, W. (eds) Neurorehabilitation Technology. Springer, London. https://doi.org/10.1007/978-1-4471-2277-7_7

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