What FES might people need?

David Rushton

King’s College Hospital, Denmark Hill, London SE5 8AZ, UK.

david.rushton@kingsch.nhs.uk

People with disabilities have a range of priorities for improving their health and quality of life, and these change with time.

When an FES technique moves from the narrow research arena into the open clinical field, promising to help people with disabilities, it comes into competition with all the other ways of spending public and private funds toward similar ends.

It therefore has to be justified, and this may be more easily done if the various potential benefits can be distinguished, analysed and evaluated separately.

Early in the rehabilitation process the person is still a patient, and their focus, and that of their therapy team, is largely towards two goals: optimising biological recovery processes; and restoring independent living. Both of these goals, of course, are relatively generic.

There are intriguing hints that FES may develop clinical therapeutic roles at this stage, influencing neurological recovery for the good; but the mechanisms are still largely undefined, so ways of optimising them are as yet unknown. FES in this context is sometimes termed ‘Therapeutic Electrical Stimulation’ (TES).

Strictly-functional FES is not often applied at this early stage, partly because the clinical condition is still evolving relatively quickly, and partly because there are other competing rehabilitation priorities active.

Later on, the focus of interest often shifts towards two new goals. Firstly, the person becomes more interested in ways of overcoming outstanding areas of disability. These are more specific to the individual’s particular interests and way of life.

Secondly, the person may feel the need to undertake an exercise programme to prevent some of the complications and degenerative changes associated with their disability, and the altered and reduced levels of physical activity that this may entail.

The first of these purposes is the target of FES as originally defined, which could be described as serving as an electrical orthosis. This must be tailored precisely to the neurological impairments and activity needs of the individual.

The second can be termed ‘Exercise FES’. The goals vary, but include improved cardiopulmonary fitness, muscle bulk and cosmesis, increased bone density, improved skin health, autonomic function and normalised body mass index.

In paraplegia, exercise methods for the trunk and lower limbs, such as FES cycling or rowing, are useful for this purpose, because they can bring a large amount of paralysed muscle into play.