Rehabilitation Matters

Electrotherapy with "mixed" paraplegia

We have recently had a couple of spinal cord injured clients with a "mixed" paraplegia.  I'll explain what this means in a second.  Let me explain a bit about one case in particular.  He has supposedly a T11/12 complete lesion following a spinal cord injury that he sustained in Nov 2008.

He is using an FES bike (RTI 300) which illicits good contractions in hamstrings and gluteals but he gets absolutely nothing from his quadriceps muscles.  It's really debatable whether he can benefit from a FES bike; probably I wouldn't have offered him our RehaMove FES bike system. 

We did use the Stimulette den2x (specifically designed for denervated muscles) to see if we could obtain a contraction from his quadriceps muscles.

I was able to get good twitch response from his quads using the den2x with some "spill over" into hamstrings and even gastrocnemius with less than 100 mA.  However, trying to illicit a tetanic contraction was less successful as the spill over (using large carbon electrodes/sponge bags) was quite large at even moderate levels of current.

Let's go back to the idea of "mixed paraplegia"

This means, that below the level of his injury there is some intact spinal cord left.  But - as his injury is located in an area in which the spinal nerves = 2nd motoneurons run parallel to the spinal cord for some centimetres - we also find lesions of the 2nd motoneurons of some segments. And because of anatomical reasons this results in denervation of quadriceps and the muscles of the front side of the lower leg and to a spastic paresis of the hamstrings and the calf.  This is a very challenging situation we find sometimes in patients with conus-cauda-lesions.

What we will attempt to do in that situation is stimulate the denervated muscles with the usual den2x programs and accept that there may be a co-contraction of the other muscles. The only thing is, that you have to take care, that the intensity of the stimulation is not too strong for the spastic muscles – their tendons also have to get used to the pulling of their (much stronger than the denervated) muscles!

Very often, after some time the denervated quadriceps gets strong enough for leg extension, but not always – sometimes the strength of the hamstrings stays higher than that of the quads and no leg extension becomes possible.

The “spill over” to the calf is the effect of the intact nerve of the spastic muscles, which “transports” the impulse to its muscles.

As the clients’ legs are very slim, we could try to use smaller electrodes, which should cover the whole quadriceps, but should not reach the dorsal half of the thighs. Sometimes we try to turn them through 90°, so that they lie on the leg longitudinally.

Exploring electrotherapy of denervated muscle

We recently had a vist from Dr Modlin from Vienna who was able to share her experience of using electrotherapy to restore denervated muscle.  She has some 15 years experience in this area which is probably pretty unique world wide.   We have now had a few months working with clients with the Stimulette den2x product, which can be used to restore muscle quality and bulk in denervated muscle. We wanted to short circuit the learning curve a bit and get to learn from a rare expert. 

One of the things that we learned pretty quickly is that the protocols described in the clinical papers are not exactly in line with those used in Dr Modlin's daily practice.  It's not that these are wrong - its just that useful nuggets of information are left out.  Sometimes these subtleties can make a big difference to results.

Lesions that cause denervation are those due to injury to the so called lower motor neuron. This might be due to a peripheral nerve lesion, brachial plexus injury or spinal cord injury at typically T12 or below. Such injuries cause rapid nerve degeneration followed by a cascade of other effects to the detriment of muscle tissue.

With spinal cord injuries, those with so called upper motor neuron lesions can, for example, use "conventional" FES systems.  In these cases, relatively small amounts of electrical energy can be used to trigger stimulation of a leg muscle via the intact nerve structures. 

Those with lower motor neuron damage find that such conventional FES techniques don't work.  The new Stimulette den2x actually aims to directly stimulate the muscle.  The levels and patterns of energy required are significantly different from those normally thought of with FES and protocols, electrodes and approches to use are all very different.

For many years, clinical and research work in Austria has focused on whether electrotherapy can be used to restore denervated muscle.  This idea has been controversial over the years but recent studies have been very positive - for example the RISE multicentre European trial was very successful in rescuing even long-term denervated muscles.  This is quite an important finding if it can promote improved tissue quality and circulation, as well as lower the risk of pressure sores.  Even when there is little or no expectation of reinnervation, preservation of muscle mass and improvement of the trophic situation is very important.

The RISE trial featured home-based training, 6 days per week and care needed to be taken during stimulation due to the energy levels used. 

Ideally with our clients we will work with quadriceps, hamstrings, gluteals and perhaps tibialis anterior and gastrocnemius/soleus, although the emphasis may change with the needs of the individual.

There are two dominant stimulation modes that we might use.  We are pretty much always using biphasic rectangular impulses. The pulse shape may on rare occasions be changed if a client has some sensation and it has been difficult to manage comfort levels.

If possible we want to stimulate a muscle group for approx 30 minutes per day - this is achieved gradually. For the first 3-4 weeks increasing the intensity and duration gradually is in order. The level of stimulation current is also carefully limited.

Stimulation is setup in programmes in the den2x so that the client can access them with a button press. Programmes are set for tetanic and twitch muscle contraction and both would typically be part of a programme.

If tetanic (smooth strong) contaction can be achieved this would be the primary focus of training with stimulation parameters something like this

40 ms impulse duration
20 ms impulse pause
3 secs surge duration (burst of pulses is on)
2 secs surge interval (burst of pulses is off)

With many clients, tetanic contraction is not easily achieved at the beginning and the stimulation is based on seeking "twitch" activation of the muscles.

120 ms impulse duration
400 ms impulse pause
5secs surge duration
2 secs surge interval

Once tetanic contraction is achievable, the aim is to develop muscle hypertrophy by working against a load.

This clearly requires a commitment from the client to work consitently with the programme and this has been one of my primary concerns about the techique. Would clients really be motivated to use the system especially if it took quite a while to see the benefits. So far early signs have been good.

According to research, there is a "window of opportunity" in using this technique.  Starting to use electrotherapy early is likely to preserve muscle tissue - a much better prospect than restoration in long standing denervated clients.

My feeling is that this technique has real value for certain clients with denervated muscles.  What would be ideal is if these persons could start to use electrotherapy early in their rehabilitation - in our case in the UK, whilst they are in the spinal units and then continue to use the system when they go hom

 

 

Arm rehabilitation post-stroke - Separating fact and fiction

Improving arm function post-stroke - Hemiparesis is by far the most common limiting symptom resulting from a stroke, affecting 80 percent of stroke survivors.  Unfortunately, many persons recovering from a stroke find that the health service doesn't really focus on helping them recover arm function.  When I first studied in this area (admittedly a while ago now) it used to be thought that it wasn't possible to recover much function anyway.  Now we know that functional recovery can take place given the right degree of support and the right tools.  Such a tool is the Tailwind product from Encore Path Inc.

We have been working with the Tailwind product in the UK for a couple of years now.  I was quite excited when I learned about it and keen that we should work with it - even if it meant working sometimes against the skeptics.  The Tailwind product was created by Kris Appel in the USA, based on research at the University of Maryland which focused on the concept of a Bilateral Arm Trainer with Rhythmic Auditory Cueing (BATRAC) device.

The investigators carried out controlled scientific studies that showed how their method significantly improved function in stroke patients suffering from the loss of function in one side of the body.  The BATRAC method is specifically aimed at the loss of function in one arm, and tackles the problem by literally retraining the brain. The BATRAC device requires the patient to use both arms to carry out the motion of reaching forward for an object and bringing it in toward the body. The movement is "cued" by a rhythmic auditory signal that apparently entrains the motor cortex of the brain.

In a study published in 2000, the developers of the BATRAC method reported significant improvement in the use of the affected arm with as little as one hour of training per week for six weeks.

This initial study showed improvement from 12 percent to 26 percent on two different motor improvement scales.  The study subjects were also asked to assess their ability for daily use of the affected arm in everyday tasks, and this self-assessment revealed an even higher rate of improvement, up to 43 percent after training.

The BATRAC investigators conducted further studies that compared BATRAC results to a more commonly used method of physical therapy — a technique referred to as dose-matched therapeutic exercises, or DMTE.

In a report published in the Journal of the American Medical Association, functional magnetic resonance imaging scans were gathered from subjects in a study that compared BATRAC and traditional training techniques.  Blood oxygenation-level dependent scans were made of the entire brain as the subjects moved the unaffected arm first, and then the paralyzed one.  The scans were taken before and after training with the two methods.

The investigators noted significant changes in brain activity in most members of the BATRAC group after training, but no changes in brain activity for the DMTE group. In addition, those members of the BATRAC group whose brains showed evidence for rewiring had improved function, while the control group showed significantly less improvement.

It's quite interesting that in the USA few therapists question the validity of the technique whilst we still have many in the UK who are skeptical.  We belive that Tailwind has shown itself to be an effective tool for stroke rehabilitation - what we need now in the UK is the correct, timely input from therapists

The Truth of the Quiet Box

A few weeks ago a friend was fund raising for charity by paticipating in the Iron Man Wales event.  My wife and I went to see him off - from a safe distance.  It's quite a challenge starting with a 3.8 km swim, followed by a 180k bike ride and finished off with a 42.1 km run. Not exactly something to take casually. 

Andy had just finished the bike section and was starting the run when he heard the PA system announce ".. And here comes the oldest competitor!" 

Just for a second Andy thought the announcer was referring to him but then as he looked back he saw right behind him was indeed the oldest competitor - a 75 year old man. 

I think most of us would think that a 75 year old doing Iron Man Wales was beyond belief.  After all we have evidence all around us that suggests such a feat would be impossible.

Isn't that the trouble with beliefs. We all hold them - and yet they have an often silent and unconscious grip on our lives.  My one time mentor, Michael Breen used to say something like, "If you are going to have beliefs - make sure you choose useful ones".  Sadly most of us don't.  We don't even know how strongly our lives are shaped by the beliefs we hold.  Our beliefs can be like stealthy parasites that steal our lives and infect those around us.

Working in rehabilitation I am very interested in my client's beliefs about what they can achieve in their lives as they recover from their injuries.  I meet many spinal cord injured people who would like to believe that they might walk again some day.  The challenge is that all around these people are others that want them to stay "realistic" - to accept that they will never walk again.  So often well meaning observers manage to "kill hope" rather than nurture realism.  Certainly this world requires that we take action in the moment; we can't neglect that.  However, the purpose with which we act shapes the way our world becomes.  Without mankind stretching what is possible and believable we would still be living in caves.

Here is a nice story from Kensho Furuya (Kodo - Ancient Ways)

The Master said, "Think about this.  I have here two small wooden boxes of the same size."  Holding up the boxes one at a time he told his students, "Listen. When I knock on this one, a loud sound resonates around the room.  When I knock on this other one, there is hardly any sound at all."

"Now tell me, from our experience of such things, what do we already know about the loud-sounding box?" asked the Master.  The students understood that the box was empty.

"And what do you make of the quiet box?" asked the Master again.  The students recognised that this box was full of something.

So the Master posed a question.  "Tell me, with human enterprise in mind, do we use the lessons of the wooden boxes?"

A student answered at once, "We certainly do not, Master.  We only take notice of who makes the loudest noise.  We don't pay attention to the quiet one."

A second student spoke up.  "I can see what you are suggesting but in our democracy the majority rules.  What the majority believes is desireable is supported and will grow in influence as a result."

"I agree," replied the Master.  "But keep in mind that the value of an idea or of a belief is is not determined by how many people believe it or choose to follow it."

In times gone by the majority may have believed that the world were flat or that the sun moved around the Earth.  The majority idea it didn't make it a fact.

There may be a deeper truth that is separate from the ideas of majority and minority.  If this truth exists it will lie within each of us awaiting cultivation.

Using Tailwind when the User has Limited Arm Movement post-Stroke

Tailwind is an arm rehabilitation training device that stroke survivors can use at home to recover gross arm function.  I've wrote about this product before as we have been enthusiastic about working with it in the UK.  Despite the product having an excellent evidence base, we still do come across clinicians who are skeptical.  All too often, rather than study the evidence, clinicians speak from their past experience and manage to kill the hope and belief of patients before they even get started.

Tailwind is not a silver bullet of course. It needs to be set up and used correctly and with consistency.  In the USA where the device is manufactured, their experience is that every single user can report positive gains after using Tailind for two weeks. This  is entirely consistent – in two weeks, users will see changes—such as being able to lift the arm overhead which they never did before, putting a coat on, being able to swing the arm at the side naturally while walking.

It's important to get off to a good start using Tailwind and for many users this means dealing with a weak wrist that can prevent many users initially from using Tailwind effectively.

Here are some some guidelines for this situation

1. Hand/wrist support. Most of these users will require at least the hand strap in order to hold onto the handle, and some may also require a soft splint in order to keep their wrists from buckling. A soft wrist splint is suggested, and the user should be reminded not to become dependent on it. It should only be used for a short time.  Avoid moderate and firm wrist supports. Use the soft to mild support to make the wrist align with forward movement, but not to weaken overall wrist muscles.

2. Elbow support. It may be necessary for the therapist or caregiver to gently guide the elbow of the user for the first few weeks of exercise, until the user can do the movement on their own. Gently supporting the wrist by placing the caregiver’s hand under the wrist may also be necessary, at first.

3. Length of movement along the track. Some individuals may only be able to move the handle ½“ to 1" along the track. Do not be discouraged by this – the goal is to learn the exercise and practice it repeatedly.  Start low and go slow.  It may be best to start off with this small movement only, with just the affected arm.  After the user is comfortable with this movement, then the other arm may be added, then the metronome.  Trying to do the complete movement in the beginning may be very challenging for some users – just focus on the affected arm, then add the other arm, and build up to using the metronome. Proper posture and movement is important.

4. Other suggestions
• Make sure the user’s chair is high enough so that the arms and wrists clear the pod
• Make sure the user is not too high which can cause downward weight on tracks
• Have users do mild arm stretching for a few minutes prior to using the device
• Have the user change their grip from the top of the T-bar to the side of the handles. This will
allow a lower grip to extend arms outward

After a few sessions, the user should be able to move farther along the track, and eventually do the
exercise without the wrist support. Users with even a small amount of movement can be helped by the Tailwind.

 

 

Visit to Pace Rehab - An Excellent UK Prosthetic Rehab Centre

Too often I see that we do not give rehabilitation the attention it deserves in the UK.  Most of us have no idea of what such services could or should do for us until we have a personal need.  Even then, when we have the need we do not truly know what is possible.  We trust our clinicians to guide us but what are the beliefs that underly that guidance?  As we recover from amputation, stroke or other condition we are likely to have many years of life ahead of us; we would all prefer these years to deliver a decent quality of life but too often that's not the case. 

The fact is that NHS can't live up to our expectations for rehabilitation - the resources are not there - and increasingly clients who are able will find alternative ways of not only meeting their needs but exceeding their expectations.

Im just back from spending the day with PACE Rehabilitation in Cheadle near Manchester.  Their ethos in delivering prosthetic rehabilitation is about providing benefits to clients rather than just meeting their needs.  There is a vast difference between simply meeting peoples needs and equiping them for a full and happy life.  They work with clients to understand their hopes and dreams and work with them mentally, physically and technically to bring about great results.

PACE was started by an old friend and prosthetist Toby Carlsson along with Consultant in Rehabilitation Medicine, Earnest Van Ross.  They are very passionate about what they do and it shows.  Toby describes the work they do as "a priviledge".

At yesterday's referrers meeting we saw demonstrations and presentations to showcase the work done by PACE.  In addition to hearing from Toby and Earnest, we had presentations from Sue Turner on the counselling and the "buddy scheme" aspects of their work.  Howard Wolley demonstrated prosthetic cast taking and limb alignment whilst physiotherapist Carolyn Hirons involved us all in demonstrations of physiotherapy techniques for gait and improved function.

Colin Lynch, Paracycling World Champion, gave a very interesting presenation and demonstration that described how PACE had worked with him to imporve his cycling prosthesis. Taking him from top 10 to number one in the world.  Alan Roberts, a bilateral amputee following military trauma shared his rehab experiences with us to complete the day.

I have no vested interest in PACE - and I highly recommend them.

Young Transverse Myelitis Client Responds Well to FES Cycling

These notes refer to very pleasing progress with an FES Cycling Client - a 4 year old little boy with a neurological condition affecting motor function in his lower limbs.  It has a similar aetiology as transverse myelitis (TM). TM is a rare disease of the central nervous system involving inflammation of the spinal cord. This inflammation causes swelling which can block the nerve impulses that travel along the spinal cord.  It can also cause damage to the myelin sheath surrounding the axons in the spinal cord.

With this client not all muscle groups are affected and the weakest measles are his glutes and hamstrings.  He is able to mobilise independently holding onto furniture or walls for support. He has some spasms in his quads but are not problematic, sensory function is preserved.  The Client was supplied a RehaMove FES Cycling system, based on the Gracile model which is appropriately sized for children. The text here was originally produced by Andy Galbraith and edited by me.

Initial Setup visit
Starting Parameters: for RehaMove Gracile (Paediatric version of the RehaMove FES Cycling System)

• Motomed bike set to “direct” from “motivation”
• Initial gear start-up set to 1
• Passive cycling speed - default set at 20rpm
• Torque power set to 10

Stimulation Parameters:
All programmes set at 5mins warm up - 20mins stimulation - 5mins cool down
As client has preserved sensory function we set the stimulation to constant.

Programme 1 Ramp 5 Freq 20Hz Pulse width 150us (increased to 160us)
Involving quads and hamstrings of both legs
Ch1 - 35mA, Ch2 - 35mA, Ch5 - 35mA, Ch6 - 35mA

Programme 2 Ramp 5 Freq 20Hz Pulse width 150us (decreased to 130us)
Involving quads, hamstrings and gluteal muscles of both legs
Ch1 - 35mA, Ch2 - 35mA, Ch3 - 30mA, Ch5 - 35mA, Ch6 - 35mA, Ch7 - 30mA

Programme 3 Ramp 5 Freq 20Hz Pulse width 150us (decreased to 130us)
Involving quads, hamstrings, pretibial muscles and gastrocs of both legs
Ch1 - 35mA, Ch2 - 35mA, Ch3 - 25mA, Ch4 - 25mA, Ch5 - 35mA, Ch6 - 35mA, Ch7 - 20mA, Ch8 - 20mA

On muscle testing: all muscles reacted to stimulation, strongest contractions being felt in the quads, Client gave very good feedback for his age on the testing and we were also able to see contractions in the glutes, pre tibial and calf muscles, we reduced the current levels in response to his feedback being careful not to associate any discomfort with the stimulation.

Of course client attention span was limited, a diversionary video was playing which helped. When the client was paying attention and trying he was actively cycling well, this was limited to short bursts of approx. 15 to 20 seconds before "finding nemo" would be more important.

We belived that client will respond really well to the stimulation providing it is kept at low levels given his preserved sensation.  Reviewing in 6 weeks time, quick start with web support and fitness principles literature was left with mother.

Notes at FES Cycling 6 week follow up
Clients mother advised that Client has been using the FES Gracile system fairly regularly.  Apart from a family holiday for two weeks in August they have used the system for 20mins every other day, mostly on programmes 2 and 3. Client enjoys the sessions (providing he can watch TV) and remains motivated to use it.  It is believed the client has full sensation in his lower limbs and he has said the stimulation has been too painful from time to time, Mother has been reducing the Pulse width (down to 130us) to accommodate this, but this is not every time. At present the client does not tolerate any other physio intervention.

Checked Starting Parameters:

• Initial gear start-up 1
• Passive cycling speed - default at 20rpm
• Torque power at 10

Stimulation Parameters: at 6 weeks
All programmes set at 5mins warm up - 20mins stimulation - 5mins cool down, Mother feels 20mins is probably the maximum length of time the Client will tolerate the sessions at present.

As the Client has preserved sensory function we set the stimulation to constant and discussed with Mother the possibility of changing to adaptive stimulation protocols at a later stage. We have reduced the Frequency by 5Hz and planned to slightly increase the current and pulse widths to make the stimulation more tolerable.  The majority of the session was teaching Mother how to make the changes to the stimulator and reviewed position advice.

Programme 1 Ramp 5 Freq 15Hz Pulse width 150us
Ch1 - 35mA, Ch2 - 35mA, Ch5 - 35mA, Ch6 - 35mA

Programme 2 Ramp 5 Freq 15Hz Pulse width 150us
Ch1 - 35mA, Ch2 - 35mA, Ch3 - 30mA, Ch5 - 35mA, Ch6 - 35mA, Ch7 - 30mA

Programme 3 Ramp 5 Freq 15Hz Pulse width 150us
Ch1 - 35mA, Ch2 - 35mA, Ch3 - 25mA, Ch4 - 25mA, Ch5 - 35mA, Ch6 - 35mA, Ch7 - 20mA, Ch8 - 20mA

Good seating position was easily achieved with the use of a small wooden chair this time with a small cushion supporting Clients hips and lower back.  Much improved from the video clip viewed last week. As they had recently had a 2 week break from the set up procedure I think it was just down to them being a bit rusty and a bit of coaching was required with positioning.

Client's quadriceps muscle are his strongest muscles, he also has strong gastrocnemius muscles that spasm when he is excited or generally rushing (quite a lot of the time for a (now) 5year old) causing him to walk on his toes.  At present the client prefers to do this as he feels taller when he is doing it and should be able to modify this as he gets older which will have a positive impact on his gait . Mother informs me he can walk with his heels down when he is less excited. I did not see this when I was there but did note planter grade being achieved when using the bike.

Have constructed the following programme to accommodate Glutes, Hamstings pretibial and gastroc muscles.

Programme 4 Ramp 5 Freq 15Hz Pulse width 150us

Ch1 - 30mA Right Gluteus Maximus Start Angle 120 Stop Angle 210
Ch2 - 35mA Right Hamstring Start Angle 220 Stop Angle 360
Ch3 - 25mA Right Tibialis Anterior Start Angle 330 Stop Angle 90
Ch4 - 25mA Right Gastrocnemius Start Angle 180 Stop Angle 280
Ch5 - 30mA Left Gluteus Maximus Start Angle 300 Stop Angle 30
Ch6 - 40mA Left Hamstring Start Angle 40 Stop Angle 180
Ch7 - 25mA Left Tibialis Anterior Start Angle 150 Stop Angle 270
Ch8 - 25mA Left Gastrocnemius Start Angle 0 Stop Angle 100

On muscle testing: all muscles reacted to stimulation Client gave very good feedback again and we were also able to see good contractions in the glutes and hamstrings with slightly reduced, softer contractions in the pre tibial and calf muscles.  Client was able to actively cycle and with the reduced frequency level did not report any discomfort.  Mother is now happy to change current and pulsewidth and will adjust over the coming weeks to get the optimum levels for the Client.

I have discussed with Mother the importance of not neglecting the quads and to monitor their strength in relation to his other muscles.  Client can actively cycle (20reps) in gear 1 using predominantly quads, Mother is constantly working on his exercise tolerance with this activity.

Since he has started using the Gracile and stimulator Client can now independently cycle his regular push bike with stabilisers to the park (approx. 400m) and back. He used to get very frustrated at not being able push over the top of the pedals. He proudly showed me his cycling today with no assistance, Mother did not think she would ever hear herself shout “that’s enough - not too far ahead” it was very impressive. Mother feels the Client has made great progress in a short period of time.

Sequence mode was successfully loaded onto the stimulator, demonstrated with Mother and explained set up. Not sure if the Client will tolerated the sequence mode at present as he needs the distraction of the bike or TV or even both when stimulation is on. I do feel Clients’s Gluteus medius will benefit most from sequence mode and have discussed this with Mother today.

Mother's Update at 10 Weeks
Client is continuing to make good progress with FES cycling. When we started, he could barely pedal it at all without the motor assistance.  The last 3 sessions, he has managed 8 minutes without the motor.  Speed  continues to be his aim so he is managing to get further each time. He was managing 0.7km last week in his 8 mins without the motor but over the weekend, it was 1.5 km without the motor in the same time period.  And I am quietly increasing the resistance levels too. We are up to level 6.

His legs are slowly starting to plump up, particularly at the tops. And his standing balance is much improved from 8 weeks ago. Walking is still poor but it's early days.
 All in all, a big success so far from our point of view. So thanks to you and Andy for your assistance.

Standing Start Showcase - A Great Success

This weekend's Standing Start Showcase in Cambridge focused on "Getting Fit for Life" following a spinal cord injury.  A mixture of presentation and demonstrations were used to successfully highlight the exercise techniques used at Standing Start. We also explored how FES Cycling and FES enhanced exercise could work to improve long term health for clients.

 

The format was quite novel as clients Mike and Harvey demonstrated the exercises with guidance from Standing Start staff Andy Galbraith and Natalie Dodson.  Moving around the room to observe different exercises definitely brought some variety from the usual "death by Powerpoint" scenario.  The remarkable thing was just how challenging some of the exercises were - and well beyond the expected abilities of persons with these levels of injury.

It clearly takes a leap of faith for many new clients to commit to these exercises. The likelyhood is that they have to be willing to work at developing some new abilities that they almost certainly they did not believe they could achieve.

After an introduction by myself and Peter Carr (Founder of Standing Start) the day kicked off with a contribution from Daniel Kuhn of the Bergamannstrost Kliniken Halle, Germany.  Daniel works with electrotherapy in the rehabilitation of spinal cord injured persons and in particular has a great deal of experience working with the RehaMove FES Cycling system manufactured in Germany by Hasomed GmbH and represented in the UK by Anatomical Concepts.  Daniel is currently working toward his PhD and looking at the clinical effectiveness of FES Cycling in the rehabilitation process.

I demonstrated the RehaMove FES Cycling system with the assistance of Katrin Bombitzki, Export Manager from Hasomed.  Katrin was able to give a brief overview of the many countries of the world nw using the RehaMove system and what to expect in the future.  I also showed the Stimulette den2x electrotherapy system for denervated muscles produced in Austria and now offered by Anatomical Concepts (UK) Ltd.

Left to right Natalie Dodson, "MJ" Perrier, Peter Carr (sitting), Daniel Kuhn, Katrin Bombitzki and Andrew "Iron Man" Galbraith.  (I hate having my picture taken so im behind the camera)

The final presentation or the day was from Marie-Josee Perrier.  MJ is a PhD student in Health and Sport Psychology at Queen's University in Kingston, Canada.  She talked about her research interests include the relationships between self-identity as an athlete and exercise/sport behaviour, motivation and planning for sport.  She is spending the next three months with Brett Smith at Loughborough University to learn a little more about qualitative research in the context of health and spinal cord injuries.

Join us in September

Want to get fitter following a spinal cord injury?  We are hosting an event for persons who wish . It's to be held at Standing Start on Saturday September 24th.

The focus is "Exercising to Change Lives" - A one day workshop on getting fit for life following a spinal cord injury. Good speakers - good practical guidance - a chance for one-to-one advice.

More details and registration opportunities can be found at fessport.com or you can view a leaflet about the event right here.  The cost is just £10 with all going to Standing Start.

Open publication - Free publishing - More fes cycling

Client Daniel Eley Heads Back to Columbia

Our client Daniel Eley, 33, was working with disadvantaged children and teenagers living on the streets in Colombia when he broke his neck on New Year's Day 2010.  It was the internet that came to Mr Eley's aid in the wake of his accident, as more than 8,000 people from around the world joined a Facebook appeal group to help him.  We wrote about him here at the time.

Undaunted by his accident, Dan now has an ambition to forge ahead with a new charity to continue his humanitarian efforts.

I've posted a short clip of an interview with Daniel by the BBC, last week.  It does show him using our RehaMove FES Cycle.  Despite his spinal cord injury Dan is off to Colombia and on his return, in November, he will be doing a sponsored "ride" around Great Britain to raise funds for the Spinal Research Institute.