Restorative therapy and ‘FES’  

Functional electrical stimulation (FES) is a well-established modality that has been widely used for rehabilitation since the 1960s. The method involves sending low-current electrical pulses via electrodes on paralysed or deconditioned muscles to produce muscle contractions during a purposeful movement, such as stepping, cycling and walking, or reaching and picking an item up. These tasks might not be possible without such stimulation. 

While FES is used in many rehabilitation settings, the FES bike is less commonly available in Singapore and a more specialised piece of equipment available in selected rehabilitation facilities. 

At the SPD Transition to Employment (TTE) programme, the RT300 FES Bike is being used during therapy. It provides patterned and co-ordinated stimulation to multiple groups of muscles in the arms or legs. For example, 

• in the leg cycle option, users can choose to stimulate the glutes, hamstrings, quadriceps, calf muscles; 
• in the hand cycle, users can choose to stimulate shoulder muscles, triceps, biceps, and muscles in the forearm. 

Using FES Bike for Therapy 

Mr Mikail Wong, 44, is a spinal cord injury survivor who has little to no control of his body from his chest down. Injuries to the spinal cord interferes with electrical signals sent from the brain to the muscles in the hands and legs, resulting in paralysis. Mr Wong’s therapists incorporated the use of the FES bike during his therapy sessions to elicit muscle contractions in his legs as part of his fitness and endurance training, as well as to prevent the wasting of the muscles paralysed by his injury.  This also helps in the maintaining of his muscle bulk and flexibility to ensure that his body is ready should suitable restorative procedures, with advancement in science and technology, be possibly made available in future. 

How the FES Bike Works 

The FES bike software monitors, detects and shows the amount of contribution by the user’s own muscles in producing the cycling movement, allowing his therapists to see how responsive his muscles are to the electrical stimulation. With that data, the FES bike activates the corresponding motor support, which ensures that the user is able to perform the purposeful cycling movement successfully even if his muscle contractions are not strong enough to move the foot pedals. 

Mr Wong appreciates how he can train his lower limb muscles with the bike as this is something he is not able to do during his regular exercises without electrical stimulation. This provides him a level of independence, as well as a more purposeful rehabilitation journey. 

Benefits 

The use of the FES bike is an important form of accessible fitness for persons with mobility challenges, such as spinal cord injury survivors like Mr Wong, traumatic brain injury or stroke survivors, and others with cerebral palsy or multiple sclerosis. It helps to improve fitness, prevents muscle wasting from the lack of movement of paralysed muscles and maintains muscle bulk. It also has potential benefits in improving bone density, range of movement in joints and reducing spasms.  

The use of the equipment also reduces the amount of manpower needed and provides clearer statistics on the user’s condition, allowing the professionals in charge to better analyse improvements over time and implement relevant strategies. 

This article was written with inputs from SPD senior physiotherapist Pauline Koh and physiotherapist Dylan Koh. 

References 

https://restorative-therapies.com/for-patients-families/how-ifes-therapy-works/