Functional Electrical Stimulation



FES - Kids' Physiotherapy Ltd


What is Functional Electrical Stimulation (FES)?

Functional Electrical Stimulation (FES) uses small electrical impulses to activate muscles by exciting the nerves leading to the muscles. Two self adhesive patches (electrodes) are usually placed on the skin close to the nerve supplying the muscle and over the centre of the muscle. Leads connect the electrodes to a stimulator that produces the impulses.
Functional electrical stimulation is very often used to describe both the stimulation that a child may use during walking, to act as an orthotic or stimulation for exercise, to help strengthen muscles.
Electrical stimulation may be used as part of a therapy exercise programme in order to help strengthen muscle, assist in maintaining range of movement or allow the practice of a movement pattern. This is sometimes referred to as exercise stimulation.
Electrical stimulation may also be used to help a child with standing or walking and used in this way is termed Functional Electrical Stimulation.


Who may benefit from using Functional Electrical Stimulation (FES)?

Functional Electrical Stimulation can be used with children that have Cerebral Palsy or a child that has difficulty moving due to any other condition or damage to their brain or spinal cord.


How can Functional Electrical Stimulation (FES) help walking?

A child may benefit from use of exercise stimulation to help strengthen muscle, which may in turn help with their walking. Some children only use exercise stimulation and others may progress on to using the stimulation in a more functional way.
The most common problem treated by Functional Electrical Stimulation (FES) is called dropped foot. This is an inability to lift the foot and toes when swinging the leg during walking, causing the toes to catch or the foot to drag on the ground. Dropped foot is caused by weakness of the muscles that lift the foot and excessive tightness (spasticity) in the muscles of the calf. Stimulation is given to the muscles at the front of the leg. It activates the muscles that lift the foot during walking. A switch worn in the shoe triggers the stimulation and the electrical signals reach the muscles through electrodes stuck to the skin on the side of the leg, just below the knee. The stimulator is about the size of a pack of cards and can be worn at the waist on a belt or in a pocket. Some muscle stimulators can be worn around the lower leg and do not need a switch attached in the shoe. Electrical stimulation can help children to walk faster, with less effort and with more confidence.
Some children may benefit from Functional Electrical Stimulation applied to the muscles in the top of their thigh (quadriceps) or on the bottom (gluteals) to help them with their walking.

How can Functional Electrical Stimulation (FES) be used to improve arm and hand function?

Functional Electrical Stimulation (FES) may be used in a variety of different ways to help a child with their arms and hands.

This may be to help improve their shoulder position and reduce pain, to help strengthen weak muscles through the arm and hand or to relax tight ones.

There are a number of different devices available that are able to either stimulate one group of muscles (e.g. to move the wrist) or to stimulate groups of muscles to allow movement practice of the whole arm (e.g. reaching for an object).


What does Functional Electrical Stimulation (FES) treatment involve?

An assessment takes about an hour, during which a muscle stimulator will be trialled. If the trial is successful then a machine can be loaned to further trial at home. Sometimes a child may take a little time to get used to the stimulation. Further appointments are made so that progress can be measured and adjustments made to the stimulator or exercise programme. Some patients use stimulation independently everyday as a functional aid, others use it as part of their physiotherapy treatment. Some patients continue to use Functional Electrical Stimulation (FES) for many years, others only for a period of a few months.


Are there any risks or side effects from the treatment?

Stimulation causes a tingling "pins and needles" sensation on the skin, although most people do not find it uncomfortable, a few do and for this reason do not use it. Sometimes, even though patients are carefully assessed, the treatment has not helped them or patients are not able to use the stimulator effectively. In these cases stimulation will be stopped. Very occasionally patients find that the electrodes irritate their skin. Using hypo-allergenic electrodes or changing the type of stimulation used can often solve this problem. Very rarely stimulation increases muscle tightness (spasticity) and in these cases treatment will be stopped. A few patients have found Functional Electrical Stimulation (FES) ineffective because they have difficulty positioning the electrodes in the right place.


What are the benefits of treatment?

Clinical trials for exercise stimulation have shown improvements in muscle strength, ability to activate their own muscles and control of their movement
Clinical trials and measurements taken with patients who have used Functional Electrical Stimulation (FES) to help their walking have also shown beneficial results. These include an ability to walk faster, with less effort and with more confidence when they use the stimulator. Sometimes muscle tightness (spasticity) is reduced. Some patients find that after using the stimulator for a few months their walking is sufficiently improved that they no longer need to use it. The majority of research in this area continues to be with adult patients, however, FES is becoming increasingly topical within children’s services.


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