Regaining Independence: Building Core Strength with FES

Functional electrical stimulation (FES) is an amazing rehabilitation tool designed to help people living with muscle weakness or paralysis caused by neurological injuries or illnesses such as spinal cord injury (SCI), brain injury, Multiple Sclerosis (MS), or stroke. By applying small electrical pulses to weakened or paralyzed muscles, FES can activate these muscles to improve function and support rehabilitation efforts. 

This technique is particularly useful for targeting the muscles in the core and lower back (trunk) that are crucial for maintaining posture and balance, performing daily activities, and even breathing. Strengthening these muscles can significantly enhance the quality of life and independence for people affected by neurological impairments, making exercising the trunk muscles and building core strength with FES an important tool for neurorehabilitation.

Understanding Muscle Weakness and Paralysis in Neurological Conditions

Neurological conditions commonly result in muscle weakness or paralysis, profoundly impacting an individual’s mobility and daily functioning. These conditions disrupt the normal nerve signals between the brain and muscles, leading to a loss of muscle strength and control below the level of injury. 

The core muscles are pivotal for maintaining posture, ensuring balance, and facilitating a range of movements essential for everyday activities like sitting, standing, and walking. When these muscles are weakened or paralyzed, it not only compromises physical stability and posture but also affects a person’s ability to perform basic tasks—this can lead to a significant reduction in independence and quality of life. Impairments in trunk muscle function can also result in impaired breathing, which can lead to serious respiratory conditions like pneumonia. This underlines the critical need for core strengthening exercises for people with disabilities to rehabilitate these key muscle groups and restore functional abilities.

Basics of Functional Electrical Stimulation (FES)

Functional electrical stimulation (FES) devices are active, therapeutic medical devices that use low-energy electrical pulses to activate muscles that are weakened or paralyzed due to neurological injury or illness. FES devices work by mimicking the natural action of the central nervous system, sending electrical signals to the affected muscles below the level of neurological injury. This causes the otherwise paralyzed muscles to contract and perform specific functions, like cycling, standing, or walking. 

FES devices use a system of electrodes, typically placed on the skin over the target muscle groups and connected to a stimulator that generates the electrical pulses. The intensity of these pulses is carefully controlled to ensure safe, effective muscle activation without discomfort. 

Ongoing advancements in consumer electronics, electrode design, and stimulation algorithms have greatly enhanced the safety and efficacy of FES over the past 40+ years, making it a highly reliable tool for neurorehabilitation and core exercise for people with disabilities. Moreover, decades of research have demonstrated significant improvements in the health and quality of life of people living with muscle weakness or paralysis when they include FES as part of their recovery program.

Benefits of FES for Core Muscles

FES effectively strengthens weakened or paralyzed muscles by causing the muscles to contract and do work during a functional activity. Repeated stimulation not only helps in building and maintaining muscle mass but also improves blood circulation and enhances the neuromuscular connection which is crucial for muscle re-education and recovery. Numerous studies and clinical trials have demonstrated the efficacy of FES in core strengthening exercises for people with disabilities to aid rehabilitation. 

Studies of Rebuilding Core Strength with FES and Results

A recent study explored the impact of combining core muscle training with functional electrical stimulation (FES) on people’s motor and balance abilities after stroke [1]. The study involved 120 people within six months of their first stroke, split into two groups: one receiving only core muscle training and the other receiving core muscle training plus FES. After eight weeks, both groups showed improvements in muscle strength. However, the group receiving the combined treatment of core training and FES showed greater improvements. They exhibited better scores in walking, balance, and functional mobility tests compared to the group that only did core muscle training. The results suggest that combining core training with FES could significantly enhance the rehabilitation of lower limb function after stroke. 

An earlier study into the benefits of abdominal FES to improve respiratory function after a spinal cord injury describes how it can increase quality of life and lower health care costs [2]. Electrodes can be placed over the sides of the abdomen to stimulate and strengthen muscles that generate coughing (expiratory muscles). Strengthening these muscles improves lung function and cough effectiveness, preventing respiratory complications that reduce quality of life and increase health care costs—even for people with severe, high-level spinal cord injuries. A key finding of the study is that consistent use of abdominal FES can even improve unassisted respiratory function, meaning that people don’t need to constantly rely on an FES device to breathe better.

Figure 1. Different electrode positions for abdominal FES [4].

In an even earlier study focusing on individuals with a spinal cord injury [3], researchers investigated the effects of FES on seated mobility when applied to the gluteal and lower back muscles. The participants, eight individuals with spinal cord injuries using implanted stimulators, underwent tests with and without muscle stimulation. The tests measured trunk strength, seated stability during simulated rowing, pelvic tilt, shoulder height, and reach ability in various conditions. 

The results were promising. When muscles were stimulated, there was a significant increase in trunk strength and stationary rowing force compared to when the muscles were not stimulated. Improvements were also seen in pelvic tilt and shoulder height during sitting and reaching tasks. Additionally, participants could reach further and found tasks easier to perform with stimulation than without. This study suggests that using FES to stabilize the trunk can enhance seated posture, increase forward reach, and allow exertion of greater force, despite individual differences among people with paralysis.

Figure 2. Person with quadriplegia and their seated posture without (a) and with (b) FES of the hip and trunk extensor muscles [3].

These findings emphasize the role of FES as a powerful tool in restoring core muscle function and improving the quality of life for people with neurological impairments.

Build Core Strength with FES Cycling

FES can be a vital neurorehabilitation tool for people recovering from neurological injury or illness. FES has shown remarkable benefits in several conditions that cause paralysis or limit mobility, including better posture, increased balance, and improvements in daily tasks.

If you’re intrigued by the possibilities of FES and how it can enhance your rehabilitation journey, particularly for core muscles, consider exploring the MyoCycle Home Plus and Pro Plus devices. These advanced systems stand out with their 10 channels of FES, including two specifically dedicated to stimulating the trunk muscles, offering a comprehensive approach to muscle strengthening and functional improvement.

The MyoCycle series is designed not only for ease of use but also for maximized therapeutic benefit, making it an ideal option for both home and professional settings. Whether you’re a patient seeking to improve your own rehabilitation or a healthcare provider looking to add to your therapeutic toolbox, these devices represent the cutting edge of FES technology.

To learn more about how the MyoCycle Home Plus and Pro Plus can fit into your or your patients’ rehabilitation plans, we invite you to request more information for detailed information on the MyoCycle’s features and benefits. A MYOLYN team member will reach out with in-depth product information, user testimonials, and research supporting the effectiveness of FES. For personalized inquiries, don’t hesitate to contact us directly through our website or customer service line. Embrace the future of rehabilitation, and discover how the MyoCycle can transform your recovery experience.

References

1. Li, Z., Guo, J., Ge, R., & Liu, C. Rehabilitation effect of core muscle training combined with functional electrical stimulation on lower limb motor and balance functions. Journal of Back and Musculoskeletal Rehabilitation (2023).
2. McCaughey, E.J., Butler, J.E., McBain, R.A., Boswell-Ruys, C.L., Hudson, A.L., Gandevia, S.C., & Lee, B.B. Abdominal Functional Electrical Stimulation to Augment Respiratory Function in Spinal Cord Injury. Top Spinal Cord Inj Rehabil (2019).
3. Triolo, R.J., Bailey, S.N., Miller, M.E., Lombardo, L.M., & Audu, M.L. Effects of Stimulating Hip and Trunk Muscles on Seated Stability, Posture and Reach after Spinal Cord Injury. Arch Phys Med Rehabil (2013).
4. McCaughey, E.J., Borotkanics, R.J., Gollee, H., Folz, R.J., & McLachlan, A.J. Abdominal functional electrical stimulation to improve respiratory function after spinal cord injury: a systematic review and meta-analysis. Spinal Cord (2016).