Course Description:

FES is the application of electrical stimulation to restore or enhance mobility and function of a paralyzed or paretic muscle or group of muscles. FES is used in the rehabilitation of patients with central nervous system (CNS) lesions to achieve a functional or therapeutic goal or benefit. An FES system consists of a stimulator plus an electrode system and might use surface, percutaneous, or implanted electrodes. In the case of implanted systems, the stimulator is also implanted and an external control unit is used to manage the stimulation. Prerequisites for successful use of FES include intact lower motor neurons, healthy neuromuscular junctions, normally contractile muscle tissue, a motivated patient with good support system, adequate sensation in the area of application, and ability of the patient to operate the system, both cognitively and physically. FES has been used most extensively in spinal cord and stroke rehabilitation. Clinical benefits of FES include improvements in upper extremity (e.g., reaching, grasping, moving objects) and lower extremity (e.g., foot placement and clearance, gait speed) function. Improvements in pain and range of motion (ROM) secondary to poststroke shoulder subluxation have been noted. Other therapeutic benefits of FES use include exercise-related increases in cardiorespiratory fitness, muscle strength and contractile function, and psychosocial status. Possible adverse events from the use of surface electrode systems include skin irritation, tissue damage, and elicitation of a pain response. Risks of using percutaneous electrodes include skin irritation, infection, and electrode damage. The latter two are also risks associated with implanted systems.