Functional Electrical Stimulation (FES) for Spinal Cord Injury

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WHAT IS FUNCTIONAL ELECTRICAL STIMULATION (FES)? Functional electrical stimulation (FES) is the application of low-level electrical impulses to nerves or muscles to improve or restore muscle function in people with spinal cord injuries. These impulses usually trigger the desired function, like contracting muscles to move a foot or lift an arm.  FES is also applied […] Read More

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Functional Electrical Stimulation (FES) for Spinal Cord Injury

What is Functional Electrical Stimulation (FES) for Spinal Cord Injury?

Functional electrical stimulation (FES) is the application of low-level electrical impulses to nerves or muscles to improve or restore muscle function in people with spinal cord injuries. These impulses usually trigger the desired function, like contracting muscles to move a foot or lift an arm. 

FES is also applied to block pain signals and improve or restore bodily functions, such as bowel and bladder control.

The spinal cord is a bundle of nerve fibers and nerve cells that are enclosed in the spine. Electric signals are carried from the brain by the spinal nerves to muscles of the skeleton and internal organs via the spinal cord. 

In like manner, the spinal nerves carry sensory information, such as touch, pressure, warmth, cold, pain, and other sensations from the skin muscles, joints, and internal organs to the brain to the lower back. The brain and spinal cord, together, make up the central nervous system, which controls most of the body’s functions.

What is a Spinal Cord Injury?

It is damage to any part of the spinal cord or nerves at the end of the spinal cord. It is a serious type of physical trauma that is likely to have a lasting and significant impact on most aspects of daily life. 

The spinal cord is the body’s messenger, carrying messages from the brain to all parts of the body; and also from parts of the body to the brain. The message is in the form of impulses or sensations. When the spinal cord sustains an injury, these impulses or sensations cannot go through it. There occurs a break in transmission. 

A spinal cord injury is often the result of unpredictable accidents or violent events. Common symptoms of spinal cord injury are loss of mobility, paralysis, and loss of bowel and bladder control.

Damage can range from significant, long-term paralysis to less severe spinal cord injuries that can heal over time. Any loss of function takes place below the level of the injury, so the higher the site of the injury along the spinal cord, the greater the possible loss of voluntary control over muscle and body functions.

Uses of Functional Electrical Stimulation for Spinal Cord Injury

FES helps people with spinal cord injuries by:

  • Using small electrical impulses to activate specific muscles and nerves, such as contracting muscles to move a foot or lift an arm.
  • Electrical impulses can be used to block signals that send messages about pain and improve body functions, such as bowel and bladder controls.
  • Restoring muscle movement to perform activities like:
  • Move hand to grasp and release objects.
  • Hold a pen to write.
  • Stand and walk short distances.
  • Sit upright and improve posture.
  • Regain the sensations of pressure, touch, and temperature.
  • Restoring breathing by stimulating the diaphragm, thus stopping the use of ventilators.
  • Making male erection and ejaculation possible.
  • Regaining bowel and bladder control.
  • Reducing pain by stopping signals of pain messages.
  • Stimulating gluteus muscles to prevent pressure sores due to sitting.
  • Building muscle mass to decrease the risk of fractures.
  • Increasing blood circulation.
  • Helping to manage weight through the ability to exercise.

Functional electrical stimulation can also be used for paraplegia or stroke patients.

Functional Electrical Stimulation (FES) for Spinal Cord Injury
Picture courtesy: Gaylord Specialty Healthcare

Non-candidates for Functional Electrical Stimulation (FES)

Those with:

  • Cancer.
  • Epilepsy.
  • Osteoporosis.
  • Osteomyelitis.
  • A current pregnancy.
  • Other implanted electrical devices.
  • History of thrombosis or hemorrhage.
  • Severe muscle spasticity or contractures.

Functional Electrical Stimulation (FES) Equipment

The FES equipment comes in shapes and different sizes. Typically, the location of the spinal cord injury and your desired functions determine the type of equipment. 

Most functional electrical stimulation devices include:

  • An electrode, to which the wires from the box are attached.
  • Wires that lead from the box and carry the electrical impulses.
  • An external small electrical box called the neuromuscular electrical stimulator unit.

The electrode stimulates (as it touches) the targeted muscles or nerves. Electrodes can be:

  • Attached to the surfaces of the skin with sticky pads.
  • Placed directly under the skin (percutaneous placement).
  • Fully embedded deep into the muscle (implanted) or the area surrounding the targeted nerve. This involves a surgical procedure.

Surface and percutaneous electrode placements are used for short-term treatments, while implanted electrode involves long-term treatment. 

Electrical muscle stimulation systems range from $4,000 to $14,000 and are not covered by insurance.

Functional Electrical Stimulation (FES) for Spinal Cord Injury
Picture courtesy: Freepik

Specialty

  • Neurologist.
  • Physical therapist.
  • Neuromuscular rehabilitation therapist.

Risks of Functional Electrical Stimulation (FES) for Spinal Cord Injury

  • Broken wires.
  • Electrodes that move after placement.
  • Irritation at the site of electrode placement.
  • Infections at the site of electrode placement.
  • Encapsulation (scar tissue formation around the electrode).
  • The risk of inability to MRI in any future health problems, because of the wire and other metal components used in FES systems.

Benefits of Functional Electrical Stimulation

  • FES uses computer technology to send low-level electrical impulses to specific muscles in your body (legs, arms, hands, or other areas), to activate them.
  • The electrical stimulation can cause your muscles to contract, which may promote increased muscle bulk or muscle control.
  • It prevents muscle atrophy.
  • The muscle activity may help reduce muscle spasms.
  • It can lead to improved bladder and bowel functions.
  • FES activates the muscles of people with spinal cord injury, so they may be able to move and function independently.

Conclusion

Many people including stroke patients treated for spinal cord injury using functional electrical stimulation regain or improve function. They may sit up, stand, walk some meters, use their hands again, and have some bodily functions restored. 

Follow up with your neuromuscular rehabilitation therapist, over time, to adjust the position of the electrodes or the strength of stimulation. This is necessary as your muscle gets stronger and your nerves react to the levels of stimulation. 

The prognosis of FES is good, and many have experienced better quality of life.

FAQ

What is functional electrical stimulation (FES) shock?

Functional electrical stimulation (FES) delivers a shock to your affected muscle, activating nerves and making the muscle move. You relax your hand then contract the wrist extensor muscle to cause movement. This movement triggers an electric shock, which causes greater movement of the hand. 

How much does a functional electrical stimulation (FES) system cost?

An FES system costs between $4,000 and $14,000 and is typically not covered by insurance. The manufacturers have yet to convince Medicare to pay for the device.

What does functional electrical stimulation (FES) feel like?

FES usually starts at a very low level, causing a tingling “pins and needles” feeling on the skin. The current is then slowly increased until it is strong enough to make the muscle contract. This level (the smallest current needed to make the muscle contract) will be used for the treatment.

Can functional electrical stimulation (FES) cause pain?

FES is a non-invasive treatment option that does not cause any pain, but it does produce tingling sensations on the skin. The electrical current is supplied by a small unit which is a similar size to a mobile phone.

What does a functional electrical stimulation (FES) do?

FES applies small electrical pulses to paralyzed muscles to restore or improve their functions. FES is commonly used for exercise, but also to assist with breathing, grasping, transferring, standing, and walking. It can also lead to improved bladder and bowel functions.