Patients with paralysis who ride an FES cycle during inpatient rehabilitation often ride two or three times a week with a therapist at their side. At home there is no clinic schedule, nobody to set the electrodes and, for most patients, no FES bike. October is National Physical Therapy Month, so this post goes through what a family and a therapist each need in place for FES cycling at home.
What is an FES bike for wheelchair users?
An FES bike uses functional electrical stimulation (FES) to make the leg muscles contract in time with the pedals, so people with paralysis can cycle for therapeutic exercise. The MyoCycle is a prescription-only bike for wheelchair users who have paralysis or weakness in the legs, and the MyoCycle Home and Home Plus models are built for use in the home.
What changes when a patient takes an FES bike home from the clinic?
Four things change at once: the equipment, the schedule, the supervision, and the funding. In the clinic, a therapist applies the electrodes, adjusts the stimulation, and writes the note, and the session is already on the calendar. At home, a rider or caregiver does all of that, and nobody is holding a 10 AM slot.
Craig Hospital shows how much structure a good inpatient program builds. A typical referral to its FES program comes within the first week of admission, patients ride two to three times a week, and the program offers 72 FES cycling slots weekly (see our Craig Hospital partner spotlight). Early, regular riding is also what the research on disuse atrophy looks at. In an Ohio State trial, 26 people with spinal cord injury began 4 to 15 weeks after injury and did FES cycling for 30 minutes three times a week for six months, and FES cycling significantly reduced the loss of total body lean mass (Baldi et al., Spinal Cord, 1998). A home program works best when someone plans it before the discharge date.
How much do riders use an FES bike at home?
MyoCycle riders have completed more than 200,000 hours of FES cycling, and the vast majority of those hours were ridden at home, according to MyoPortal usage data. Some riders cover remarkable distances: Stewart Midwinter recently shared that he has finished his second lap around the world, riding from home on his MyoCycle.
What does a patient need for FES cycling at home?
A home program needs five things in place before the first ride:
- A prescription, because the MyoCycle is a prescription-only medical device
- Funding, worked through insurance and alternative sources together
- A MyoCycle Home or Home Plus, both built for use in the home
- Setup, which the family can do with the included instructions or a MYOLYN clinician can do in the home
- A person to call, which for our riders is our clinical specialist, a licensed physical therapist
What does home FES cycling setup involve?
A MyoCycle needs about 35 by 27.5 inches of floor space and weighs 110 pounds. A family can set up a MyoCycle Home or Home Plus using the instructions that come with it, and our team is available by phone or video at no charge for anyone who wants help. Families who’d rather have someone else do it can ask a MYOLYN trained clinician to come to the home, set the MyoCycle up, and train the rider, for a fee.
How does MYOLYN support a rider after the MyoCycle arrives?
Every home purchase includes a 30-day video check-in with our clinical specialist, who goes over electrode placement, stimulation levels, and how to fit sessions into the week. Riders also get weekly progress reports by email, lifetime clinical and technical support from our U.S.-based team, and a 60-day satisfaction guarantee.
Our clinical team also hosts a monthly Zoom group ride, where MyoCycle riders from around the country ride together and bring questions about settings, electrode placement, and scheduling. You can register here and find the next date on the registration page, and if you’re thinking about a MyoCycle, you’re welcome to sit in. A private Facebook community of riders keeps the conversation going between rides.
How can a therapist help before discharge?
Three things make the biggest difference:
- Document each FES cycling session: time, muscle groups stimulated, stimulation levels, average power output, and the patient’s response
- Talk with the patient and family about a home plan before the discharge date is set
- Send us the referral and your session notes
Session notes that show a patient has ridden and responded strengthen the letter of medical necessity and the funding case. Our team prepares the prescription request and the letter for the physician to review, and we work insurance and alternative funding together. Our earlier post, 6 Things You Can Do To Help Your Patient Get a FES Cycle At Home, covers documentation in more detail, and The Future of At-Home Neurorehabilitation covers the wider case for home devices.
How do I get started?
Therapists can refer a patient here. Patients and families can request more information, and our team will go over funding and setup with you. Let us help!
The MyoCycle is a prescription-only medical device.
