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Stationary cycling combined with electrical stimulation applied to the leg muscles (FES-cycling) is commonly used by people with spinal cord injury to maintain good health of their paralyzed limbs. Recent studies have highlighted the fact that FES-cycling is beneficial for people with other neurological disorders, especially stroke and multiple sclerosis (MS). An upcoming post will discuss the benefits for people with stroke, while this post will focus on the benefits for people with MS.

A recent pilot study conducted by Deborah Backus, PhD, PT, and her team at the Shepherd Center assessed the effects of FES-cycling on outcomes for people with MS [1]. Previous studies on the outcomes of FES-cycling training for ambulatory people with MS have demonstrated improvements in strength, walking endurance and speed, and even mental health and quality of life [2]. However, the effects of FES-cycling training for non-ambulatory people with MS haven’t been adequately studied, so Backus and her team set out to do just that.

Fourteen people (8 men and 6 women) with MS participated in the study. Participants ranged from 31 to 70 years old, and had been diagnosed with MS from 3 to 28 years ago. Only non-ambulatory people with MS could participate, meaning that they had to be unable to walk more than 70 feet at a time and has to use a wheelchair outside their homes. Participants completed 12 30-minute FES-cycling sessions over four weeks.

The results of the FES-cycling training indicate that not only is FES-cycling safe for non-ambulatory people with MS, but also that such training provides physical benefits and improved quality of life to people with moderate to severe MS. All the participants were able to increase their cycling time and/or resistance over the course of the training, suggesting that their ability to cycle improved as a result of the FES-cycling training. While the training had little effect on muscle strength or spasticity, the study participants reported that transfers and walking at home were easier after the FES-cycling training, suggesting that the training had functional benefits for the study participants. Perhaps most importantly, the participants reported that the social aspects of their life had improved as a result of the study, suggesting that the FES-cycling training had a positive effect on the participants’ quality of life.

Despite the fact that this was only a 4-week pilot study, the outcomes are promising for people with moderate to severe MS. More in-depth research is needed to learn more about the potential benefits of FES-cycling training for people with MS. To that end, a team of researchers at the University of Illinois at Urbana-Champaign is embarking on a 6 month clinical study to examine the effects of FES-cycling training on walking performance and physiological function among people with severe MS [3]. Based on the pilot data from the Shepherd Center, the results of this longer study are expected to be positive.

While FES-cycling is typically associated with spinal cord injury, its benefits extend to people with other neurological disorders, especially stroke and MS. These benefits include:

  • Improved walking and cycling ability
  • Increased muscle strength
  • Improved physical, mental, and social well-being
  • Better quality of life

Exciting research into the benefits of FES-cycling for people with MS is being conducted at places like the Shepherd Center and the University of Illinois at Urbana-Champaign. If you or someone you love has MS and is interested in FES-cycling, contact us today to learn how the MyoCycle Home can meet your needs!

References

[1] Deborah Backus, Blake Burdett, Laura Hawkins, Christine Manella, Kevin K. McCully, and Mark Sweatman (2016) Pilot Study of Outcomes After Functional Electrical Stimulation Cycle Training in Individuals with Multiple Sclerosis Who Are Nonambulatory. International Journal of MS Care.

[2] John N. Ratchford, Wendy Shore, Edward R. Hammond, Gregory J. Rose, Robert Rifkin, Pingting Nie, Kevin Tan, Megan E. Quigg, Barbara J. de Lateur, and Douglas A. Kerr (2010) A pilot study of functional electrical stimulation cycling in progressive multiple sclerosis. NeuroRehabilitation.

[3] Lara A. Pilutti, Robert W. Motl, Thomas A. Edwards, and Kenneth R. Wilund (2016) Rationale and design of a randomized controlled clinical trial of functional electrical stimulation cycling in persons with severe multiple sclerosis. Contemporary Clinical Trials Communications.

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Electrical stimulation is an incredible technology with the potential to dramatically change the way we restore and enhance the human body. Unfortunately, despite centuries of research on electrical stimulation, we still have yet to see the practical use of electrical stimulation reach its full potential.

Gad Alon, in his lecture at the APTA’s NEXT 2015 conference, said that one barrier to the acceptance of electrical stimulation as a standard of care is the “name game,” or, “the absence of consensus on generic meaningful terminology and the prevailing promotion of erroneous and misleading jargon.”

A quick Google search for electrical stimulation will lead you to discover a lot of names, abbreviations, and acronyms, including:

  1. Electrical muscle stimulation (EMS)
  2. Russian electrical stimulation
  3. Neuromuscular electrical stimulation (NMES)
  4. Functional electrical stimulation (FES)
  5. Transcutaneous electrical nerve stimulation (TENS)
  6. and many more…

All of these names refer to the same basic thing – applying electricity to the body to increase or decrease activity in the nervous system. The different names come from applying the current in different ways, to different parts of the body, or for different reasons. Part of the problem that Gad Alon referred to is the fact that people will say they use a particular kind of electrical stimulation, like Russian electrical stimulation, without ever explaining what it really means.

electrical stimulations

Generally speaking, the different names reflect either the intended use of the electrical stimulation or the characteristics of the stimulation itself. For example, EMS and Russian electrical stimulation are both generally intended for athletic training, but Russian stimulation uses high frequency sinusoidal waveforms, whereas EMS typically uses lower frequency rectangular waveforms. As another example, TENS units are typically used for pain relief, while NMES units are used to retrain muscles after an injury, even though both TENS and NMES use similar stimulation waveforms.

Instead of trying to solve the problem of the name game, this post provides a brief explanation of the most common types of electrical stimulation and how they are used in therapy. Hopefully, this information will help you to avoid the pitfalls of the name game and choose the right therapeutic modality for your purposes.

  • Transcutaneous electrical nerve stimulation (TENS)
    • Intended for temporary pain relief in sore and aching muscles or for symptomatic relief of chronic pain
    • Most pervasive type of electrical stimulation (a search for “TENS units” on Amazon.com brings up over 60,000 results)
    • Typically limited in functionality, but cheap as a result
    • Example: TENS 7000 unit
  • Interferential current (IFC) electrical stimulation
    • Intended for symptomatic relief of acute, chronic, and post-traumatic or post-surgical pain
    • Similar to TENS, but generally more effective and powerful
    • Much less common than TENS, but more functional and more expensive
    • Example: Amrex Z-Stim IF150
  • Electrical muscle stimulation (EMS)
    • Intended for strengthening muscles, increasing muscle size, improving muscular endurance, and accelerating muscle recovery
    • Also similar to TENS, but designed to make the muscles contract strongly
    • Typically used by athletes, especially for muscle recovery
    • Example: Compex Sport Elite
  • Russian stimulation
    • Intended for strengthening muscles, increasing muscle size, improving muscular endurance, and accelerating muscle recovery
    • Similar to EMS, but uses high frequency, sinusoidal stimulation waveforms
    • Popularized in the 1970s when Russian researchers used EMS to enhance the training of Olympic athletes
    • Example: RS 2500 Russian Stimulator
  • Neuromuscular electrical stimulation (NMES)
    • Intended for relaxing muscle spasms, preventing muscle atrophy, increasing blood circulation, maintaining or increasing range of motion, and especially for re-educating the neuromuscular system
    • Essentially the same as EMS, but typically focused on therapeutic use (rehab) instead of athletic use (training)
    • Example: Intelect NMES Digital Unit
  • Functional electrical stimulation (FES)
    • Intended for relaxing muscle spasms, preventing muscle atrophy, increasing blood circulation, maintaining or increasing range of motion, and especially for re-educating the neuromuscular system
    • Essentially the same as NMES, but especially effective for neurological rehabilitation, as the stimulation is automatically controlled to turn muscle contractions into functional movements
    • Usually incorporated into an exercise or bracing device to maximize functionality
    • Example: the MyoCycle Home, MyoCycle Pro, and MyoCycle Mobile

If you’d like to know more about the applications of electrical stimulation or the benefits of FES-cycling, check out earlier blog posts. Have questions about electrical stimulation? Leave a comment below or contact us to learn more!

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Thursday, 05 January 2017 16:10

Make FES a Standard of Care

Less clinical research, more personal care

Should we base the standards of care for physical therapy on clinical research, or do we need a different model to speed adoption of new treatment approaches such as functional electrical stimulation (FES) for physical injuries?
That’s the controversial question posed by Gad Alon, PT, PhD, Emeritus Associate Professor at the University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science.

At the NEXT conference of the American Physical Therapy Association last summer in Nashville, TN, Dr. Alon made a case for adopting FES as a standard of care based on a new model for making standards of care for people with physical limitations.

The controversy stems from the clinical research model that has long been used in clinical practice. The current legacy approach advises physical therapists to only use treatment modalities that have "statistically significant and clinically meaningful findings." However, achieving such results often takes years of academic or clinical research, with many more years of commercial development following before a useful product reaches the market. Still worse, the current model makes it so that product is only used for patients who are like the patients in the original research studies.

Let’s look at an example. Suppose a therapist treats patients who have hemiparesis after a stroke. The clinic also treats patients with multiple sclerosis, traumatic brain injury, and other neurological disorders. In an effort to better treat these patients, the therapist uses the clinical research model by doing some research on treatment options. The therapist finds a lot of research papers about how FES has a statistically significant and clinically meaningful effect on upper extremity function for patients after a stroke, and so the therapist starts using FES with the patients who have had a stroke and need help with upper extremity function. The therapist does not find as many papers about FES for lower extremity function or for other disorder groups, so those patients are never offered FES, even though many of them would probably benefit greatly from FES treatment.

This is the legacy approach that Dr. Alon criticizes, because patients are highly varied in types and levels of impairments and functional limitations. In other words, the functional goals of one patient with a physical impairment may be very different from another person with the same impairment. It doesn’t make sense for both patients to wait for years for a study of a device or regimen to enroll enough participants and reach some predefined outcome over years of testing before they can have access to an intervention that may or may not meet their individual goals.

To counter this limitation of the current model, Dr. Alon advocates adopting a different model for physical rehabilitation based on "personalized rehabilitation programs." He proposes that such a model seeks to address each individual’s functional goals with a focus on determining which treatment approaches are most likely to advance that person’s goals.

He stresses that no single intervention can maximize functional outcomes, and the goal should not be “normal” movement, but “visibly better” performance.

To that end, Dr. Alon advocates for adopting functional electrical stimulation or FES combined with task-specific interventions to reach best possible outcomes as the standard of care for patients who are candidates for FES.

Dr. Alon also pointed to a pair of additional obstacles to the adoption of FES as a standard of care.  One is the difficulty of using the devices by clinicians and the second is the high cost of the technology both for physical therapy clinics and for home use.

Two of MYOLYN’s guiding principles are to make its FES technology easy-to-use and affordable both for in-clinic and home use.

  • The MyoCycle Pro provides patients with a great workout using MYOLYN’s state of the art technology that automatically tailors the electrical stimulation to the individual patient. The result is a device that makes managing patients and patient load easier while providing fun, efficient therapy.
  • The MyoCycle Home automatically customizes muscle stimulation to meet your individual needs. It is easy to use and effective.
  • The MyoCycle Mobile is a one-of-a-kind product that gives people the ability to enjoy a bike ride with their friends and family despite their disability.

Join our waiting list today to be one of the first to experience the benefits of the MyoCycle and contribute to making FES a standard of care.

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The human body is an incredibly complicated machine, with all of its separate parts and pieces sending messages to each other through the electrical wires that are the nerves. Electrical stimulation can be used to tap into the network of messages traveling back and forth through the body, giving us the power to take control of our bodies in a way that seems like science fiction. Here are some of the awesome applications of electrical stimulation.

5. Pain Relief

When you’re in pain, your body is sending a message through your nerves to your brain. Electrical stimulation, when applied correctly, can effectively block the pain signal, so that your brain never gets the message.

Imagine you pulled a muscle in your lower back. The pain receptors in your back say to your brain, “We’ve got a problem down here,” and you interpret that message as a dull ache. Applying electrical stimulation around the pain receptors essentially generates so much noise that your brain can’t hear what the pain receptors are saying. Since you don’t get the message, you don’t feel the pain.

It’s so effective, Icy Hot started adding electrical stimulation to their patches, and it looks like Shaq loves it.

Icy Hot plus transcutaneous electrical stimulation (TENS) makes for some effective pain relief.

4. Sports Performance

Athletes have been using electrical muscle stimulation (EMS) to build muscle, increase strength, and speed recovery since the Russians started incorporating EMS into their training for the Olympics back in the 1950s. EMS can activate all of the muscle fibers in a muscle group at the same time, resulting in significantly stronger contractions than can typically be achieved voluntarily. More loading of the muscle means more adaptation, plus, you can essentially work the muscle out without thinking about it, since the EMS activates the muscles for you. Compex markets a line of electrical stimulators for these purposes. Check out T-Nation’s article on EMS for more thoughts on the subject.

Electrical muscle stimulation (EMS) used to activate the quadriceps during a squat. Photo courtesy of Gciriani (own work).

There is also potential to use EMS to train someone in performing a particular movement. For example, if an athlete isn’t activating their quadriceps properly during a squat, EMS can be used to both aid in the activation and cue the athlete on proper activation.

3. Rehabilitation

The most common use of electrical stimulation is during physical therapy, especially after injury or surgery on a joint like the knee. Muscle atrophy and poor activation are big problems after knee surgery, so physical therapists will typically use an electrical stimulation unit to cause isometric contractions of the quadriceps in an effort to combat atrophy and assist with voluntary contractions. Electrical stimulation also improves blood flow, which speeds up the healing process.

In The Matrix, Neo received a combination of acupuncture and electrical stimulation to rebuild his muscles after his lifelong, machine-induced coma.

Functional electrical stimulation (FES) is also especially useful for aiding in recovery following a stroke, brain injury, or incomplete spinal cord injury, as it can help teach the nervous system how to reach, grasp, or even walk again.

2. Compensating for Paralysis

Beyond rehabilitation, FES can be used as a neuroprosthetic to compensate for paralysis. For example, if your brain and spinal cord can’t communicate with the muscles in your shin, you might experience foot drop when walking. The paralyzed shin muscles are unable to pick your foot up when you walk, so your toe drags on the ground, making walking difficult and unsafe. An FES unit attached to your shin, like the WalkAide or the Bioness L300, can stimulate the paralyzed shin muscles at the right time when you’re walking, causing the foot to lift and eliminating drop foot.

FES can even enable someone who’s completely paralyzed to pedal a bicycle by activating their leg muscles for them. Products like the ERGYS, the RT300, and the MyoCycle Home enable people to do stationary cycling for exercise, and products like the RehaBike, the BerkelBike, and the MyoCycle Mobile enable people to go outside and cycle on the road.

about featured

The MyoCycle Home enables people who are paralyzed to pedal a bicycle again.

Click here if you’d like to join the waiting list for the MyoCycle and be one of the first to get the latest and greatest FES bike ever made, and contact MYOLYN if you’re interested in competing in the world’s first major FES bike race at the Cybathlon!

1. Controlling the Brain

The most incredible application of electrical stimulation is controlling the brain. If the body is controlled by electrical signals, the brain is the control center, and electrical stimulation can be used to hack the brain. Anything the brain controls can be manipulated with electrical stimulation: emotions, cognitive performance, and motor skills. Some companies even sell kits that allow you to stimulate across your forehead to enhance concentration, though they exist in a bit of a gray area with respect to the FDA, and it’s unclear whether they’re safe or not.

The video below is an incredible demonstration of the power of deep brain stimulation, especially in alleviating the symptoms of some terrible diseases like Parkinson’s.

Leave a comment below to let us know what you think about these awesome applications of electrical stimulation!

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Tuesday, 08 March 2016 17:25

Cybathlon Update

The world's first augmented Olympics, the Cybathlon, is still on schedule for October 8, 2016 in Zurich, Switzerland (and tickets are on sale!). The Cybathlon committee recently updated the site with video from last year's rehearsal, and they updated the rules for the events. Most notably, the team pages have been updated, so click here to see a list of all the teams competing in the FES bike race.

MYOLYN is still seeking a qualified pilot (motor complete SCI, T12 or higher) who has a great personal story to tell and an indomitable drive to be the world's best augmented athlete. Contact us today if you or someone you know is interested in competing.

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