Rehabilitation Matters

Spinal Cord Injured Client Using RehaStim to Exercise with a Total Gym

Following spinal cord injury it is essential to exercise and involving the legs is a good way to ensure circulation and fitness are enhanced.  The basic challenge though is that the paralysis that results from injury prevents normal forms of exercise.  We work with the RehaMove FES Cycling system in the UK and this has become very well accepted as an excellent way of exercising at home - using Functional Electrical Stimulation (FES) to power the legs in conjunction with a motorised bike. 

Our competitors like to say that they offer the "world's best" - we leave that for others to judge.  The RehaMove system has flexibility on it's side.  In this short clip our partners at Standing Start in Cambridgeshire are using the RehaStim (FES generator) part of our FES cyling system with sequence mode software. 

  

This powerful software allows the user to programme complex sequences of muscle activation that enables very effective use in situations that cant be matched by less sophisticated units.  In this case, a client with a complete lesion is shown exercising on a Total Gym performing leg squats.  The quadriceps muscles are activated by the RehaStim unit through the electrodes placed on the thighs.  The therapist in the picture is stabilising the thighs to prevent lateral movement but the FES system is being used to make the legs extend.

Thanks to our partners at Standing Start for this clip

 

 

 

Stimulette den2x in action

I have my "tongue in cheek" with this post as it features one of my (previously healthy) business partners trying out the new Stimulette den2x from Austrian company Dr Schuhfried.  Let me explain the background. 

In my last post, I introduced the den2x as an important advance for our clients who have had a spinal cord injury at a level where the lower-motor neurons become damaged. This so called denervation results in loss of limb muscle and increases the risk of pressure sores.

One of our successful products has been the RehaMove system from Hasomed in Germany which is certainly the most flexible and powerful system on the market for allowing exercise and a circulatory boost for spinal cord injured clients.  However, RehaMove can't work effectively with truly denervated clients as the stimulation it delivers is designed to utilise intact lower motor neurons.   The Stimulette den2x on the other hand generates the electrical stimulation in a manner that enables restoration of the structure and bulk of denervated muscle. 

At Anatomical Concepts we are pleased to have an agreement to offer the den2x to UK clients and broaden our offering to the FES rehabilitation market.

You will notice (apart from our giggling childish laughter) that the electrodes are very large and of a custom design.  They utilise electrode gel and are held closely in touch with the skin of the thigh by the broad circumferential wraps.  The electrode design and manner of use is essential for safe and effective practice.  In normal application with a denervated client the system would be used at least 5 times per week.  Electrodes need to be replaced at 3 month intervals.

My colleague was brave to try this as it is at best an "unusual" experience.  Perhaps he trusted us enough to know he was safe.

 

An important advance for SCI clients with denervated muscles

 
Anatomical Concepts (UK) are pleased to offer an exciting new product - Stimulette den2X - an outcome of EU clinical research - that is designed uniquely to address the problem of denervation in leg muscles following specific  spinal cord injuries.  In approximately 30% of those with paraplegia, the lower motor neurons are affected and consequently these individuals can't use a technology such as FES Cycling with our RehaMove system  - the leg muscles simply can't respond to this nerve stimulation form of FES

As you might know, spinal cord injured individuals with conus–cauda lesions, and as a consequence denervation of their lower extremities, suffer from severe atrophy of their lower limb muscles. After some years, much of the muscle tissue is replaced by fat and connective tissue and secondary problems such as decubitus ulcers, dysfunction of wound healing and osteoporosis can occur. Such denervated muscles experience progressive changes that gradually transform them into tissue incapable of excitation by normal FES (functional electrical stimulation) protocols. This unfortunately prevents activities such as FES cycling or standing that can assist overall fitness and well being.

We now offering (Anatomical Concepts (UK) Ltd)  the “Stimulette den2x” manufactured by Dr Schuhfried Medizintechnik GmbH of Austria within the UK and Ireland regions. Pricing is being finalised but we aim to make this widely available.

The Stimulette den2x is a compact, high performance, two-channel electrotherapy device that was developed to be used exclusively for stimulating denervated muscles.

Designed for safe home use, it features the latest microprocessor technology, a graphic LCD display and features simple operation by touch sensors.

In the 1990‘s, stimulating denervated muscle was seen as promising but controversial by some. During the EU Project RISE, a team of scientists and physicians from Austria, Germany, Italy, United Kingdom, Slovenia and Iceland, acquired essential insights into functional electrical stimulation (FES) of denervated muscles. RISE demonstrated that home-based FES of denervated muscle is an effective therapy that results in the rescue of muscle mass and restoration of tetanic contractility - even after many years of denervation. This project and the subsequent product development, are founded on more than 20 years research in Austria.

The stimulators and custom electrodes that evolved were required to deliver high-intensity and long duration impulses (much different from conventional FES applications) that can directly elicit contraction of denervated skeletal fibres in the absence of nerve endings. The product Stimulette den2x embodies this development and includes especially developed electrodes to ensure safe and effective use. Subsequent research has confirmed the positive results of the RISE project and extended them through a two year longitudinal study of 25 patients with complete conus/cauda equina lesions and up to 9 years of denervation.

These interesting studies also suggest that there is a prime “window of opportunity” up to 2 years post-injury to initiate stimulation and avoid the most severe muscle degeneration and infiltration. This suggests that optimal deployment would occur when suitable candidates utilise this electro-therapy during their time with the spinal units and then continue this usage for the long term.

Suggested Direct and indirect benefits of stimulating denervated muscles:

1. Recovery of muscle mass and fibre size
2. Recovery of tetanic contractility
3. Restoration of muscle fibre structure
4. Enhanced cushioning effect for seating
5. Better skin condition
6. Reduced risk of pressure sores
7. Improved cosmetic appearance of lower extremities
8. Increased self-esteem

If standing upright is accomplished: (achieved in 20% in the study by Kern)

1. Improved cardiovascular fitness
2. Unloading of seating surface

If you would like to see the system, or review the literature underpinning this development please contact us and we will send you a copy of the key articles. A highly rated article (impact factor 5.4) by Kern et al  gives a good introduction. We are now in a position to demonstrate, train staff and supply these systems and of course answer any questions that spring to mind.