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Thread: The science and practice of exercise fraud - the bell is ringing for FES

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    The science and practice of exercise fraud - the bell is ringing for FES

    THE FOLLOWING ESSAY IS BEING CONSIDERED FOR PUBLICATION ON ANOTHER WEBSITE DEVOTED TO DISABILITY STUDIES. THE FIRST REVIEWER SUCCINCTLY SUMMARIZED IT HAS "ELECTRICAL STIMULATION - FRAUD AT ITS FINEST."

    THE SHAME OF REHABILITATION

    The field of rehabilitative medicine is maculated with claims by purveyors and vendors about the efficacy of devices purported to have a positive affect on motor functioning, on muscle restoration, on circulation. In the field of electrical medicine, especially, is the clamor of the sales pitch, accompanied by the sight of a muscle in a powerful state of contraction, so convincing that even the field of sports medicine is drawn into the shadow world of electrical stimulation. The understanding of electricity and its affects on the body is still more a matter of superstition than research, with images of Mary Shelley's Frankenstein, and of electroshock treatments frying neural circuitry and stopping hearts, still common amongst those who should know better. The claims have staying power despite the fact that NASA and no professional or olympic athlete uses electrical stimulation to build muscle. This staying power is perpetuated by people in the medical community using their status and positions to give weight to the claims that, yes, electrical stimulation does build muscle, but very inefficiently, so inefficiently, it seems, that it used only on the handicapped. [http://www.galvanism.org/Orthopaedic...d%20muscle.htm ] So has arisen a drain on the resources and insurance of the disabled who, in the attempt to supplement the meager recoveries of rehabilitative medicine's primitive infatuation with resistance exercises, fall prey to the barking of the promoters of the very electrical stimulation that has a centuries long history of ineffectiveness at building muscle.
    The FDA, in its policies with regard to 'powered muscle stimulators,' states straightaway that it has no way of investigating the effectiveness of such devices, which go by various names (e.g., functional electrical stimulation, electrical muscle stimulation, e-stim). This is an open admission that the field is without guidance from the medical community as to what is effective, so there is no yardstick to judge. Yet FDA approval is taken by many as evidence of the very effectiveness that the FDA refuses to vouch for. Insurance companies are besieged by the handicapped armed only with anecdote and the prescriptions of their physicians who give in easily since in most cases nothing can be done for the sufferer anyway.
    In the 1940s, in what is now known as the Veterans Administration, experimentation was done with what was called 'galvanic exercise.' The experimentation was done by a team of doctors (Guttman, Melville, Wehrmacher, and Hines), one of whom, Hines, later had a VA hospital outside of Chicago named after him. The exercise involved stimulation of the atrophic hands of those who had recently had an ulnar nerve lesion repaired by surgery. It was found in this bit of experimentation, that the muscles of the hand were restored in mass and functioning far more rapidly than those of the control group that had just resistance exercise rehabilitation alone. That was the end of it. In the next decade Guttman stated that electrical stimulation had no effect on slowing the advance and reversing of atrophy. The earlier findings were relegated to obscurity (see Sydney Licht's essay"The History of Electrotherapy" in a book he edited in 1969, Therapeutic Electricity and Ultraviolet Radiation, for a short mention of the WWII research)
    Why the WWII researchers got the results they did, results later abjured by one of the physicians involved, turns on a very key point of physics. It is this same point that holds that in principal alone all forms of powered muscle stimulators approved by the FDA to build muscle will not have any affect on muscle atrophy. This point concerns the nature of the waveform used to trigger muscle contractions, and how FDA regulations prohibit use of this very waveform. This prohibition is a vestige of the ignorance surrounding electricity's effects on the body that can be dated to 1855 when Guillaume DuChenne, the father of electrotherapy, pronounced AC superior to DC for electrical stimulation. DuChenne's reasons for this recommendation could not possibly, at that time, have been made with full knowledge of what electricity was. Instead his reasons were based upon ease of use by the therapist (not effectiveness), and avoidance of the 'warming affect'. The warming affect was the blistering and pitting of the skin caused by direct current.
    The galvanic exercise of the WWII researchers involved the use of direct current, in the form of a mono-phasic pulse, that is, one in which the poles were not switched back and forth with each pulse. This meant that electrical charge was passed, with electrons being introduced at the anode, and withdrawn from the body at the cathode. This is required for electrochemistry. In the late 18th century Luigi Galvani called it 'animal electricity.' And in 1800 Alessandro Volta announced the battery and discredited Galvani's animal electricity as nothing more than the electricity of chemical interaction, certainly not any sort of vis viva. Over two centuries later the FDA, in its requirements for powered muscle stimulators, forbids the passing of electrical charge except in such small amounts that electrochemistry is highly unlikely.
    People who work with electrotherapy sense there is some difference between AC and DC. They note that the AC can be left on and the muscle will continue to contract. This was why Thomas Edison said it was dangerous to have around the house. He preferred DC because it would make a muscle contract and then the muscle would relax even if the current ran on. The current had to be pulsed on and off to elicit repeated contractions, and this was the reason DuChenne and the therapists of his time found it troublesome to use. In order to keep triggering muscle contraction the therapist had to remain at the patient's side and to use the skills of a telegrapher, repeatedly stopping and starting the current with a switch to get the all-important contractions that were thought to be indispensable to muscle strengthening. With AC one couldn't let go of a hot wire, fist clenched; but with DC there wasn't that problem. Edison lost to Tesla who pushed AC as a power source to business and cities. The deadliness of AC, demonstrated by Edison in the electrocution of dogs, was taken up by grisly authorities who saw its value as a device for execution. The effects of high voltage AC on the body are akin to an extremely painful and burning strangulation, a form of barbarity that caught on as scientific for many decades, only to be replaced by the presumably more humane lethal injections in doling out death.
    AC, the waveform preferred by Tesla, is used for the transduction of mechanical energy from the site of its generation over long distances to the site of its use. Over distances of more than 20 or 30 feet the power losses incurred with the use of DC prohibit it from being used for the long range delivery of mechanical energy. This mechanical energy is tapped as heat and light in an electro-mechanical version of friction. AC causes powerful muscle contractions, but not because of anything approaching the way the body does it. This is the difference between electro-mechanics and electrochemistry. The latter is possible only with DC, and is the way the body works. The electrocution strangling of the convicted and the unfortunate with AC is a result of the transduced mechanical energy sending all muscle into a state of tetany or clenching, accompanied by burning.
    Those who market powered muscle stimulators that use DC, in order to get FDA approval, limit the pulse widths to microseconds, change polarity with each pulse in what is called a bi-phasic current, and limit frequencies of pulses to less than 200 herz. This guarantees that no current is passed, and electrochemistry is ruled out. Since the building of muscle involves biochemical changes such as the synthesis of proteins, no form of electrotherapy unable to affect the body's chemistry can have the slightest affect on muscle building. One of the more expensive forms of electrotherapy, called functional electrical stimulation, is heralded by people even in the handicapped community (e.g., Christopher Reeve) as a way to build muscle without affecting the chemical activity of any of the cells that make up the muscle. Using the same ineffective bi-phasic current that has been the standard in the field for a century and a half, the creators of functional electrical stimulation, engineers, thought that by introducing computers and having the elicited contractions pump a bicycle, bi-phasic current would be rendered effective at building muscle. They did not understand that by introducing computer controls to the delivery of voltage, and that by embellishing electrotherapy with technologically-advanced circuitry, they did not make bi-phasic current any more effective at building muscle.
    It has been known since at least 1976, when Dr. Sudhansu Chokroverty published his transmission electron microscopic studies in the Archives of Neurology, that disuse atrophy was the loss of cross-sectional area of the type II muscle fiber. Research done in 1993 on the effects of functional electrical stimulation on type II muscle fiber cross-sectional area by Greve et al. and published in Paraplegia (31:764-70) showed that FES had no effect on this cross sectional area. Rather than return to the drawing board, the engineers disregarded the research and continued to sell the product, making the same claims about positive effects on muscle atrophy, and more, in an increasingly lucrative market for the health care dollar. The targets of the marketing were the gullible and desperate for whom traditional rehabilitation could do nothing beyond resistance exercises and an occasional fling at electrical stimulation, despite its sad history of inconsequence.
    The clinical ineffectiveness of traditional therapeutic methods emphasizing resistance exercises to build muscle, has been joined by a class of charlatans who have FDA approval. This is not so much a bit of quackery as it is capitalism filling a niche, the providing of an expensive placebo to those who have the wherewithal or the insurance to pay for it. Many handicapped believe so strongly in it that they will defend their ignorant judgment with claims that it is backed by scientific research, though they cannot specify where this research can be found. Since they were never told by the vendor how to tell if it was working or not, they are convinced that it works even though their muscles never seem to regain any functioning. They cannot say how they are able to know if it is not working. Instead they attribute continued weakness and paralysis to the severity of the injury rather than the ineffectiveness of FES. What they see is powerful muscle contractions on exceedingly weak, atrophic, and paralyzed muscles, and, like Luigi Galvani seeing the frog's leg twitch, they believe that any contractions of the muscle, even spastic contraction, will help maintain and strengthen the muscle. They don't understand that the muscle must be made to contract because of a simulation of nervous system trophism, that is, because of electrical charge delivered to the neuromuscular junction, that is, electrochemistry, something ruled out by the FDA. And this is not possible using a bi-phasic current applied transcutaneously to the muscle surface. The body doesn't work this way, and that is why FES, or anything approved by the FDA, has no affect on muscle disuse atrophy.
    On the other hand mono-phasic, direct current stimulation, being a simulation of the way the body works, triggers weak contractions on weak muscle and strong contractions on healthy muscles. The blistering and pitting of the skin, easily avoided, is the consequence of what makes such a waveform effective in triggering the anabolism and protein synthesis necessary for muscle building. Over time the contractions grow stronger at the same power setting, and this is an indication of the restoration of the muscle. In contrast bi-phasic current, which is not a form of bio-electricity, triggers strong contractions on weak muscle as well as healthy muscle, and has no effect on muscle structure. It is good only for the transduction of mechanical energy. That this information is not yet commonly known, especially after a century and a half or more of research involving the use of electrotherapy, is truly a shame and a scandal, and a black mark on the field of neuroscience. This bit of benightedness is responsible for the appearance of a class of charlatanry that preys on the credulity of the handicapped, willing participants in their own fleecing, victims of the continued archaic resistance exercises the field of rehabilitation foists upon those disabled by stroke and concussive nervous system trauma.
    THE FOLLOWING ESSAY IS BEING CONSIDERED FOR PUBLICATION ON ANOTHER WEBSITE DEVOTED TO DISABILITY STUDIES. THE FIRST REVIEWER SUCCINCTLY SUMMARIZED IT HAS "ELECTRICAL STIMULATION - FRAUD AT ITS FINEST."

    THE SHAME OF REHABILITATION

    The field of rehabilitative medicine is maculated with claims by purveyors and vendors about the efficacy of devices purported to have a positive affect on motor functioning, on muscle restoration, on circulation. In the field of electrical medicine, especially, is the clamor of the sales pitch, accompanied by the sight of a muscle in a powerful state of contraction, so convincing that even the field of sports medicine is drawn into the shadow world of electrical stimulation. The understanding of electricity and its affects on the body is still more a matter of superstition than research, with images of Mary Shelley's Frankenstein, and of electroshock treatments frying neural circuitry and stopping hearts, still common amongst those who should know better. The claims have staying power despite the fact that NASA and no professional or olympic athlete uses electrical stimulation to build muscle. This staying power is perpetuated by people in the medical community using their status and positions to give weight to the claims that, yes, electrical stimulation does build muscle, but very inefficiently, so inefficiently, it seems, that it used only on the handicapped. [http://www.galvanism.org/Orthopaedic...d%20muscle.htm ] So has arisen a drain on the resources and insurance of the disabled who, in the attempt to supplement the meager recoveries of rehabilitative medicine's primitive infatuation with resistance exercises, fall prey to the barking of the promoters of the very electrical stimulation that has a centuries long history of ineffectiveness at building muscle.
    The FDA, in its policies with regard to 'powered muscle stimulators,' states straightaway that it has no way of investigating the effectiveness of such devices, which go by various names (e.g., functional electrical stimulation, electrical muscle stimulation, e-stim). This is an open admission that the field is without guidance from the medical community as to what is effective, so there is no yardstick to judge. Yet FDA approval is taken by many as evidence of the very effectiveness that the FDA refuses to vouch for. Insurance companies are besieged by the handicapped armed only with anecdote and the prescriptions of their physicians who give in easily since in most cases nothing can be done for the sufferer anyway.
    In the 1940s, in what is now known as the Veterans Administration, experimentation was done with what was called 'galvanic exercise.' The experimentation was done by a team of doctors (Guttman, Melville, Wehrmacher, and Hines), one of whom, Hines, later had a VA hospital outside of Chicago named after him. The exercise involved stimulation of the atrophic hands of those who had recently had an ulnar nerve lesion repaired by surgery. It was found in this bit of experimentation, that the muscles of the hand were restored in mass and functioning far more rapidly than those of the control group that had just resistance exercise rehabilitation alone. That was the end of it. In the next decade Guttman stated that electrical stimulation had no effect on slowing the advance and reversing of atrophy. The earlier findings were relegated to obscurity (see Sydney Licht's essay"The History of Electrotherapy" in a book he edited in 1969, Therapeutic Electricity and Ultraviolet Radiation, for a short mention of the WWII research)
    Why the WWII researchers got the results they did, results later abjured by one of the physicians involved, turns on a very key point of physics. It is this same point that holds that in principal alone all forms of powered muscle stimulators approved by the FDA to build muscle will not have any affect on muscle atrophy. This point concerns the nature of the waveform used to trigger muscle contractions, and how FDA regulations prohibit use of this very waveform. This prohibition is a vestige of the ignorance surrounding electricity's effects on the body that can be dated to 1855 when Guillaume DuChenne, the father of electrotherapy, pronounced AC superior to DC for electrical stimulation. DuChenne's reasons for this recommendation could not possibly, at that time, have been made with full knowledge of what electricity was. Instead his reasons were based upon ease of use by the therapist (not effectiveness), and avoidance of the 'warming affect'. The warming affect was the blistering and pitting of the skin caused by direct current.
    The galvanic exercise of the WWII researchers involved the use of direct current, in the form of a mono-phasic pulse, that is, one in which the poles were not switched back and forth with each pulse. This meant that electrical charge was passed, with electrons being introduced at the anode, and withdrawn from the body at the cathode. This is required for electrochemistry. In the late 18th century Luigi Galvani called it 'animal electricity.' And in 1800 Alessandro Volta announced the battery and discredited Galvani's animal electricity as nothing more than the electricity of chemical interaction, certainly not any sort of vis viva. Over two centuries later the FDA, in its requirements for powered muscle stimulators, forbids the passing of electrical charge except in such small amounts that electrochemistry is highly unlikely.
    People who work with electrotherapy sense there is some difference between AC and DC. They note that the AC can be left on and the muscle will continue to contract. This was why Thomas Edison said it was dangerous to have around the house. He preferred DC because it would make a muscle contract and then the muscle would relax even if the current ran on. The current had to be pulsed on and off to elicit repeated contractions, and this was the reason DuChenne and the therapists of his time found it troublesome to use. In order to keep triggering muscle contraction the therapist had to remain at the patient's side and to use the skills of a telegrapher, repeatedly stopping and starting the current with a switch to get the all-important contractions that were thought to be indispensable to muscle strengthening. With AC one couldn't let go of a hot wire, fist clenched; but with DC there wasn't that problem. Edison lost to Tesla who pushed AC as a power source to business and cities. The deadliness of AC, demonstrated by Edison in the electrocution of dogs, was taken up by grisly authorities who saw its value as a device for execution. The effects of high voltage AC on the body are akin to an extremely painful and burning strangulation, a form of barbarity that caught on as scientific for many decades, only to be replaced by the presumably more humane lethal injections in doling out death.
    AC, the waveform preferred by Tesla, is used for the transduction of mechanical energy from the site of its generation over long distances to the site of its use. Over distances of more than 20 or 30 feet the power losses incurred with the use of DC prohibit it from being used for the long range delivery of mechanical energy. This mechanical energy is tapped as heat and light in an electro-mechanical version of friction. AC causes powerful muscle contractions, but not because of anything approaching the way the body does it. This is the difference between electro-mechanics and electrochemistry. The latter is possible only with DC, and is the way the body works. The electrocution strangling of the convicted and the unfortunate with AC is a result of the transduced mechanical energy sending all muscle into a state of tetany or clenching, accompanied by burning.
    Those who market powered muscle stimulators that use DC, in order to get FDA approval, limit the pulse widths to microseconds, change polarity with each pulse in what is called a bi-phasic current, and limit frequencies of pulses to less than 200 herz. This guarantees that no current is passed, and electrochemistry is ruled out. Since the building of muscle involves biochemical changes such as the synthesis of proteins, no form of electrotherapy unable to affect the body's chemistry can have the slightest affect on muscle building. One of the more expensive forms of electrotherapy, called functional electrical stimulation, is heralded by people even in the handicapped community (e.g., Christopher Reeve) as a way to build muscle without affecting the chemical activity of any of the cells that make up the muscle. Using the same ineffective bi-phasic current that has been the standard in the field for a century and a half, the creators of functional electrical stimulation, engineers, thought that by introducing computers and having the elicited contractions pump a bicycle, bi-phasic current would be rendered effective at building muscle. They did not understand that by introducing computer controls to the delivery of voltage, and that by embellishing electrotherapy with technologically-advanced circuitry, they did not make bi-phasic current any more effective at building muscle.
    It has been known since at least 1976, when Dr. Sudhansu Chokroverty published his transmission electron microscopic studies in the Archives of Neurology, that disuse atrophy was the loss of cross-sectional area of the type II muscle fiber. Research done in 1993 on the effects of functional electrical stimulation on type II muscle fiber cross-sectional area by Greve et al. and published in Paraplegia (31:764-70) showed that FES had no effect on this cross sectional area. Rather than return to the drawing board, the engineers disregarded the research and continued to sell the product, making the same claims about positive effects on muscle atrophy, and more, in an increasingly lucrative market for the health care dollar. The targets of the marketing were the gullible and desperate for whom traditional rehabilitation could do nothing beyond resistance exercises and an occasional fling at electrical stimulation, despite its sad history of inconsequence.
    The clinical ineffectiveness of traditional therapeutic methods emphasizing resistance exercises to build muscle, has been joined by a class of charlatans who have FDA approval. This is not so much a bit of quackery as it is capitalism filling a niche, the providing of an expensive placebo to those who have the wherewithal or the insurance to pay for it. Many handicapped believe so strongly in it that they will defend their ignorant judgment with claims that it is backed by scientific research, though they cannot specify where this research can be found. Since they were never told by the vendor how to tell if it was working or not, they are convinced that it works even though their muscles never seem to regain any functioning. They cannot say how they are able to know if it is not working. Instead they attribute continued weakness and paralysis to the severity of the injury rather than the ineffectiveness of FES. What they see is powerful muscle contractions on exceedingly weak, atrophic, and paralyzed muscles, and, like Luigi Galvani seeing the frog's leg twitch, they believe that any contractions of the muscle, even spastic contraction, will help maintain and strengthen the muscle. They don't understand that the muscle must be made to contract because of a simulation of nervous system trophism, that is, because of electrical charge delivered to the neuromuscular junction, that is, electrochemistry, something ruled out by the FDA. And this is not possible using a bi-phasic current applied transcutaneously to the muscle surface. The body doesn't work this way, and that is why FES, or anything approved by the FDA, has no affect on muscle disuse atrophy.
    On the other hand mono-phasic, direct current stimulation, being a simulation of the way the body works, triggers weak contractions on weak muscle and strong contractions on healthy muscles. The blistering and pitting of the skin, easily avoided, is the consequence of what makes such a waveform effective in triggering the anabolism and protein synthesis necessary for muscle building. Over time the contractions grow stronger at the same power setting, and this is an indication of the restoration of the muscle. In contrast bi-phasic current, which is not a form of bio-electricity, triggers strong contractions on weak muscle as well as healthy muscle, and has no effect on muscle structure. It is good only for the transduction of mechanical energy. That this information is not yet commonly known, especially after a century and a half or more of research involving the use of electrotherapy, is truly a shame and a scandal, and a black mark on the field of neuroscience. This bit of benightedness is responsible for the appearance of a class of charlatanry that preys on the credulity of the handicapped, willing participants in their own fleecing, victims of the continued archaic resistance exercises the field of rehabilitation foists upon those disabled by stroke and concussive nervous system trauma.

  2. #2
    I did not even read this long post, it gives me a headache. Why is it such of a mission for you to try and discredit FES Greg?

  3. #3
    Senior Member jefftwalker80's Avatar
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    "THE FOLLOWING ESSAY IS BEING CONSIDERED FOR PUBLICATION ON ANOTHER WEBSITE DEVOTED TO DISABILITY STUDIES."

    You should post your "essay" on another website if tha5ts the crap you want to write.

  4. #4
    Senior Member jefftwalker80's Avatar
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    I read some of your other posts and you sound like a miserable person. It takes more energy to be a d*ck. Somethin' to think about.

  5. #5
    DQ, you need a hobby besides slamming FES.

    What do you hope to accomplish by posting all of this negativity?

  6. #6
    "A little less talk and a lot more action" If your stuff is really better, then prove it. You are not going to convince anyone with your posts of "technical wisdom". We actually need to see a product and not just read about how great it is. If this is better then FES lets see it. Quit talking and make it happen.

  7. #7
    Senior Member Jeff's Avatar
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    Jul 2001
    Location
    Argao, Cebu, Philippines
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    6,864
    I finally understand, I think Don Quixote is a lot like .... well ... Don Quixote. He's on his adventure to vanquish the big bad FES. But knights of his stature are all but gone in this day of true cardiovascular exercise for SCI persons. So he toughs it out ... in his own little world .... while more and more paralyzed people are garnering the benefits of FES. And simply scratching their heads at Don Quixote.

    ~See you at the SCIWire-used-to-be-paralyzed Reunion ~

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