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Stimulating Steps

Reprinted from PN/Paraplegia News September 2013

Functional electrical stimulation is powering a host of health benefits for people with SCI.

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Almost everyone has that one striking summer beach day worth remembering, but for Chris Wynn, a beach day 20 years ago represents a different type of memory. Wynn was paralyzed in a January 1993 accident when he sustained a C4-5 spinal-cord injury (SCI).

“I was with my friends doing front flips into the water when one flip I didn’t land on my feet, I landed on my head,” says Wynn.

Wynn was 22 at the time.

Fortunately for Wynn, that day at the beach wouldn’t represent the only big change in his life. About eight months after his SCI, Wynn was recruited for a project involving functional electrical stimulation (FES) at the Cleveland FES Center. Little did he know, but FES would play a huge role in the way he lived life with quadriplegia.

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Restoring Control

FES is the use of low-level electrical stimulation to restore or improve function due to neurological condition or injury.

It’s designed to produce useful movements or functions from paralyzed muscles that mimic voluntary movements. The treatment also reportedly increases overall health and helps with complications that arise from paralysis.  

FES benefits patients by restoring control over things such as coughing, breathing, or voiding the bladder. The stimulation also increases blood flow, decreasing the chance of cardiovascular disease or diabetes. Additionally, it can increase muscle bulk that creates padding in certain areas of the body, which can prevent pressure ulcers.

“There’s a really wide spectrum of benefits they get from using FES,” says Robert Kirsch, PhD, executive director of the Cleveland FES Center. “The independence they get from it is good psychologically, financially, and physically.”

The treatment can be used via a surgically implanted device or through surface stimulation. Wynn had a hand-grasp system called Freehand surgically implanted in his left hand in 1996.


Following a stroke, veteran David Soriano uses FES technology daily.

“Sometimes surface stimulation can work great, but there are also times when a consumer requires a much more intimate system, and the FES implants offer a little bit more precision and control,” says Hunter Peckham, PhD, who works with Wynn.

 The Freehand drastically changed Wynn’s outlook.

“It’s a little bit closer to me being me prior to the injury,” says Wynn. 

A Spark in Cleveland

Wynn owes much of his success to the Cleveland FES Center, which performs basic research and clinical trials.

The center is a consortium of three institutional partners: Cleveland Veterans Affairs (VA) Medical Center, Case Western Reserve University and MetroHealth Medical Center. 

It works with companies to market FES products, but unfortunately, few businesses currently make them. That’s because the business model for FES products is difficult to sustain. The company that commercialized the device Wynn uses shut down in 2001 due to financial problems. 

To try and change this limitation, the Cleveland FES Center created an extension to itself called the Institute for Functional Restoration, which is working hard to nurture the market for FES devices.

The center is working on the approval of a device commonly referred to as “Omnistim,” which will perform the functions of several different FES devices all in one.

The Possibilities

Several companies provide FES surface stimulation as an orthotic or for therapy.

Bioness (bioness.com) produces FES surface stimulation products that aid with normal, functional movement. They have systems such as the L300 that helps some users walk and the H200 that assists others with hand function.

Bioness Vice President of Marketing Keith McBride says there hasn’t been a lot of technology for rehabilitation in the last 20 years. He says these products have made a big difference by providing a much higher level of benefit than traditional technologies.

David Soriano, a Vietnam veteran, had a stroke in 2003 leaving the right side of his body virtually nonfunctional. Soriano learned about FES technology through a TV commercial for Bioness. 

Soriano intially tried out the company’s L300. On his first day of trying it, he was able to walk up and down stairs, walk on grass, carpet and concrete, and walk up and down an incline. 

“My mind was racing, and all I could think was what are the possibilities with this,” Soriano says about that first day.

Soriano now uses Bioness products daily. He’s able to go up and down ladders, cut the grass, brush his teeth, feed himself, do push ups and much more. 

“My family always knew after my stroke I wasn’t going to just lie down and take it,” says Soriano. “But I would never have been able to be here without FES.”

Acitivity-Based Rehab

Another company is Restorative Therapies (restorative-therapies.com), which provides FES surface stimulation products.

CEO Andrew Barriskill says the products can be used to prepare for other types of FES treatments or just to increase overall health.

Restorative Therapies produces several different cycling exercise systems that work the legs and arms. 

A misconception is that exercise for people who can’t voluntarily move their muscles has no benefit, but research confirms that “activity-based” rehab for paralyzed patients does offer many benefits.

“The fact is that the musculature and lower extremities are a big part of your overall metabolism,” says Barriskill. “It’s actually very important to maintain muscles even when you have no volition over them as part of maintaining your general health.” 

Even though the rehab process is slow to change, it is, in fact, changing. 

“In the past, therapists told those affected by paralysis they had to learn to live with their injury,” says Barriskill. “Now there’s a lot more hope and expectation from the patients to really see improvement of life.”

Quality of Life

Even though these products cost thousands of dollars, there are many financing options.

VA paid for all of Soriano’s FES devices and helped Wynn pay for his hospital stay during the implant surgery. Medicare covers FES to a certain extent. Private insurance is also relatively cooperative as well. A third of Bioness patients receive payment from private insurance companies.  

“FES is about health, independence and quality of life,” says Peckham. “That’s the advantage of FES, and there’s nothing else that can provide that to people that exists.”

For more information, talk with your physician or rehabilitation therapist or visit the Cleveland FES Center at fescenter.org.

PVA and PN do not endorse products or services. Those mentioned in this article are for information only.

 

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Stimulating Steps

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