Stimulating Approach: Many Patients Rediscover Movement Through a New Technology

August 1, 2007

Contact: Larry Bowie (404-350-7708)

ATLANTA - Garry Samples shuffles slowly into the therapy room of Shepherd Pathways, his left arm resting in a sling, his right hand clutching a walking cane. He is about to do something that he can’t do anywhere else – open his left hand and extend the fingers.
After taking a seat, Garry releases his arm from the sling to reveal a balled fist. With the help of Pathways therapist Cheri Baumgartner, he is fitted with a splint-like plastic device that wraps around his wrist and hand. This simple device holds the key to Garry’s accomplishment for the day. It is a functional electrical stimulation (FES) system, made by the company Bioness, and it sends electrical impulses that cause Garry’s fist to unclench and his fingers to straighten.
In September 2006, Garry, an electrician at Southwire Co., suffered a stroke, which affected his left side. He comes to Pathways from Carrollton, Ga., three times a week for three-hour sessions, during which the FES system electrically stimulates his muscles through a series of exercises programmed uniquely for him.
After opening and closing his hands, Garry proceeds to a series of weight-bearing exercises that are prompted by a green light on the system, telling him the stimulation is running and when to apply pressure. Then he practices moving his arm back and forth as if wiping off a counter, again with the green light dictating his action. Finally, he works on “grasp and release,” in which Baumgartner places a ball in Garry’s hand and guides it to a basket into which he drops the ball.
The device may be doing most or all the work for Garry initially, but it’s not without benefit: After three weeks with the FES system, Garry has experienced increased sensation in his arm and hand. And the pain in his arm has lessened.
A New Take on an Old Therapy
The technology behind the FES system is not new. In fact, electrical stimulation has been used in therapy for years. But the Bioness FES system is unique in the number and configuration of electrodes. They’re built into the splint for the upper-extremity device, and the box that controls the lower-extremity device is wireless.
“Traditional versions have just two electrodes with wires that feed into a box,” explains Kathy Farris, OTR/L, an occupational therapy clinical educator in Shepherd’s Acquired Brain Injury (ABI) Program. “But the six electrodes built into this splint give us the ability to train coordinated movements of the hand while performing normal movements at the shoulder and elbow used for functional activities in daily life.”
Shepherd has both forearm and leg splint models of the FES system. Both are used across the therapy continuum with stroke, brain injury and spinal cord injury patients.
“Anyone who has muscle weakness resulting from a brain or spinal cord injury is a good candidate for this therapy,” says Dr. Darryl Kaelin, the medical director of ABI services at Shepherd. “It’s used to increase strength and help re-educate the muscles.”
Because FES works on functional movements, therapists have started to incorporate it earlier in treatment. “As a result, we’re seeing motor recovery at an earlier phase of therapy, as well as an increase in sensation and awareness,” Farris says.
Assisted Walking
Duane Morrow sustained a spinal cord injury while playing rugby three and a half years ago; it left him a quadriplegic. He was told the chances of walking again were slim. He received inpatient and outpatient treatment at Shepherd, and last year started working out in Shepherd’s Beyond Therapy program, which extends treatment beyond the originally prescribed regimen. Today, Duane walks with the aid of a cane and a brace on his foot, a remarkable turnaround owed partly to the electrical stimulation that’s been used to strengthen his lower extremities so he no longer needs a wheelchair for mobility.
While in therapy, he wears the FES system on his leg; it provides stimulation to his muscles and allows him to lift his toes to facilitate walking. “The brace helps me to walk because it keeps my toes flexed,” he says. “But the FES system actually stimulates the muscles and strengthens them. That’s something the brace can’t do.”
With a spinal cord injury like Duane’s, neural transmissions from the brain to the nerve are blocked. In this case, electrical stimulation allows muscles to contract and relax, which they can’t do on their own because of the injury. Thus, the FES system can help a patient throw a tennis ball, perform grasp-and-release exercises, and allow the hand to bear weight. It also can stimulate toes and signal the appropriate muscles that lift the foot during the “swing phase” of a gait.
Beyond Therapy therapist Candy Tefertiller, MSPT, ATP, says the FES system allows her to provide patients with motor and sensory stimulation during motor-patterned activity. “It’s very beneficial to be able to stimulate muscles that aren’t working in hopes of strengthening them, rather than simply putting them in a brace, which holds the muscles but doesn’t retrain them,” she says.
Those who can walk use the lower extremity device to assist with over-ground walking speed, efficiency and safety, she adds. This same lower-extremity device also can be used in therapy in combination with different types of locomotor training, including robotically assisted or manually assisted treadmill training.
“These devices offer individuals the opportunity to regain self-use of the hand or leg over time to become more independent,” Dr. Kaelin says. “We’ve seen excellent results.”
Not for Everybody
A doctor must prescribe therapy with the FES system, and therapists who use it with patients first must complete several days of training on the device. But while the system has been getting impressive results in therapy, it’s not for everybody.
“We test it on each appropriate patient and try to make it part of the treatment plan,” Farris says. “Some have good results, while others can’t tolerate the electrical stimulation, which can feel like burning or sharp pins and needles, and for some people, the sensation is simply too much at first.”
Good spinal cord injury candidates for the FES system are patients who have their peripheral nerve intact and respond well to basic electrical stimulation, Tefertiller says. The overall goal for those who work with FES devices is to help increase functional mobility and independence, two factors that help shape a patient’s quality of life.

About Shepherd Center
Shepherd Center is a private, not-for-profit hospital devoted to the medical care and rehabilitation of people with spinal cord injury and disease, acquired brain injury, multiple sclerosis and other neuromuscular problems. Each year Shepherd Center admits more than 700 patients and conducts thousands of outpatient clinic visits. For more information, visit Shepherd Center online at www.shepherd.org.