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FES Lecture Notes

The document outlines a series of lectures on Functional Electrical Stimulation (FES), detailing its theory, indications, parameters, and anatomical considerations for upper and lower extremity functions. FES is effective for patients with intact peripheral nerves, particularly in improving motor function and reducing impairment, while contraindications include conditions like pacemakers and seizures. Key parameters for FES application include waveform, frequency, pulse duration, and electrode placement, emphasizing the importance of motor points for effective stimulation.

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Sarah Chiu
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27 views2 pages

FES Lecture Notes

The document outlines a series of lectures on Functional Electrical Stimulation (FES), detailing its theory, indications, parameters, and anatomical considerations for upper and lower extremity functions. FES is effective for patients with intact peripheral nerves, particularly in improving motor function and reducing impairment, while contraindications include conditions like pacemakers and seizures. Key parameters for FES application include waveform, frequency, pulse duration, and electrode placement, emphasizing the importance of motor points for effective stimulation.

Uploaded by

Sarah Chiu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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January 28, 2025

Functional Electrical Stimulation (FES) Lectures


FES Lecture 1- Theory and Indications
- NMES (non- specific term, applies to any ES intervention)
- FES (specific for ES used for functional tasks)
- FES appropriate for patients with intact peripheral nerve usually upper
motor neuron such as MS, stroke, complete SCI above
T10-T11/incomplete SCI  not appropriate for Guillain Barre, ALS,
Peripheral nerve injury and complete SCI below T11
- FES evidence is strong! (in early or late after 6 months  in reducing
motor impairment and improve function
- 1) direct current, 2) *alternating current*, 3) pulsatile current
- Website for electrode placements  Axelgaard - Educational Resources
- Moving electrodes further apart increase current density into deeper
tissue, closer current is more superficial
- Smaller fibers first then larger ones are recruited  synchronous which
tend to be fatiguing
- Applications  strengthening (muscle contractions), endurance
training, spasticity reduction (stimulate the antagonist, stimulate the
agonist), function (motor learning)
- Voluntary movement + FES produces greater brain activation seen on
MRI than FES alone
- Contraindications  pacemakers, unstable arrhythmias (cardiac hx),
over carotid sinuses, near areas of venous/arterial thrombosis or over
hematoma, seizures, impaired sensation (precaution)

FES Lecture 2- Parameters


- Waveforms  symmetrical for larger muscles, may be more
comfortable; asymmetrical useful for smaller muscles and not all
machines have asymmetrical
- Frequency  generally 30Hz or more is required for a response
- Pulse duration  300 us is most comfortable
- On/Off time  strengthening is generally 1:5 (needs more rest),
endurance starts with 1:1
- Ramp up/ramp down  ramp up to mimic muscle contraction, ramp
down is mimic muscle relaxation
- Amplitude/intensity  usually 15-16
- Electrodes closer together  current is more superficial; electrodes
farther apart  current is deeper
- ‘active’ electrode placed over motor point of muscle, ‘indifferent’
placed over tendon portion of muscle
January 28, 2025

- ** To increase strength of contraction, you can increase frequency,


pulse duration and amplitude

FES Lecture 3- Anatomy Review Reach & Grasp (Upper extremity


function)
- Neural reorganization and neuroplasticity  FES improved motor
recruitment and motor/sensory expression
- UE movements are complex  requires precise timing of many
muscles
- Proximal stability is important  scapula control
- Graded progression is key  closed chain then modified closed chain
then functional then eccentric control
- Serratus is important for scapular control
- Motor point  area on the skin that overlies a concentration of motor
nerve branches typically in the middle of the muscle belly
- Radial nerve  innervates the ‘openers’, wrist and finger extension to
reduce flexors tone
- Median nerve  innervates the ‘closers’ palmar surface of forearm for
flexion
- Ulnar nerve  activates intrinsics in the hand

FES Lecture 4- Step & Touch (Lower extremity function)


- Motor point is key for FES electrode placement

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