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Functional Electrical Stimulation

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(FES)

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Resource Guide

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for Persons with Spinal Cord Injury or Multiple Sclerosis

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by

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Jeanne O'Malley Teeter

Carole Kantor

Denise L. Brown

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Published by

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FES Information Center

Cleveland, Ohio

Functional Electrical Stimulation (FES) Resource Guide for Persons with Spinal Cord Injury or Multiple

Sclerosis

by JO Teeter, C Kantor, DL Brown

Copyright 1995 by FES Information Center

All rights reserved. No reproduction or transmission of any part of this work is permitted without the

written permission of the publisher.

ISBN 1-888470-03-8

Published by:

FES Information Center, 11000 Cedar Avenue, Cleveland, Ohio 44106-3052; Phone: (216)231-3257;

FAX (216)231-3258. The FES Information Center is part of the Cleveland FES Center, a consortium on

functional electrical stimulation including the Cleveland VA Medical Center, Case Western Reserve

Univeristy, MetroHealth Medical Center, and the Edison BioTechnology Center.

While every effort has been made to ensure the reliability of the information presented in this publication,

the FES Information Center neither guarantees the accuracy of the data contained herein nor assumes

any responsibility for errors, omissions, or discrepancies. The FES Information Center accepts no

payment for listing; and inclusion in the publication of any organization, agency institution, publication,

service or individual does not imply endorsement by the authors or publisher. Errors brought to the

attention of the publisher and verified to the satisfaction of the publisher will be corrected in future editions.

CONTENTS
Acknowledgments .............................................................................................................................................. i

Introduction ........................................................................................................................................................ ii

PART 1. LEARNING ABOUT FES ...................................................................................... 1

WHAT IS FES? ................................................................................................................................................... 1

THE NERVOUS SYSTEM ................................................................,.....................................................................

WHY DOES PARALYSIS OCCUR? .......................................................................................................................... 2

How DOES FES OVERCOME PARALYSIS AND ITS RELATED PROBLEMS? ................................................................ 2

HOW IS FES APPLIED TO THE HUMAN BODY? ............................................................................................. 5

How DOES FES TECHNOLOGY WORK? ............................................................................................................... 5

WHAT FES SYSTEMS ARE AVAILABLE? ................. ,',."., ................... ,...... ,........................................................... 7

WHAT FES APPLICATIONS CAN BENEFIT PEOPLE WITH SPINAL CORD INJURY? ............................... 11

SCI-1. FES systems for cardiovascular exercise .......................................................................................... 11

SCI-2. FES systems for breathing assistance ............................: .................................................................. 14

SCI-3. FES systems for cough assistance .. .................................................................................................. 16

SCI-4. FES systems for grasping and reaching ............................................................................................ 17

SCI-5. FES systems for bladder and bowel control, ................................................................................ ,..... 21

SCI-6. FES systems for transfers and standing ............................................................................................ 24

SCI-7. FES systems for stepping and walking .................................... :......................................................... 26

SCI-8. FES for erection and electroejaculation ............................................................................................. 30

SCI-9. FES for improving circulation ............................................................................................................. 32

SCI-10. FES for preventing pressure sores .................................................................................................. 34

SCI-11. FES for treating pressure sores ....................................................................................................... 35

SCI-12. FES for controlling spasticity ............................................................................................................ 36

SCI-13. FES for preventing or treating contractures ..................................................................................... 38

SCI-14. FES for preventing or treating osteoporosis..... ................................................................................ 39

SCI-15. FES for treating weak, atrophied muscles ....................................................................................... 41

SCI-16. FES for controlling tremor ................................................................................................................ 43

SCI-17. FES for sensation ............................................................................................................................. 43

SCI-18. FES for regaining voluntary function ................................................................................................ 44

WHAT FES APPLICATIONS CAN BENEFIT PEOPLE WITH MULTIPLE SCLEROSIS? ............................. .46

MS-1. FES systems for cardiovascular exercise ........................................................................................... 47

MS-2. FES systems for breathing assistance ............................................................................................... 47

MS-3. FES systems for cough assistance... .................................................................................................. 47

MS-4. FES systems for grasping and reaching............................................................................................. 47

MS-5. FES systems for bladder and bowel control ....................................................................................... 48

MS-6. FES systems for transfers and standing ............................................................................................. 50

MS-7. FES systems for stepping and walking ............................................................................................... 50

MS-8. FES for erection and electroejaculation .............................................................................................. 52

MS-9. FES for improving circulation ............................................ ,................................................................. 53

MS-10. FES for preventing pressure sores ................................................................................................... 53

MS-11. FES for treating pressure sores ........................................................................................................ 54

MS-12. FES for controlling spasticity............................................................................................................. 55

MS-13. FES for preventing or treating contractures ...................................................................................... 58

MS-14. FES for preventing or treating osteoporosis ..................................................................................... 59

MS-15. FES for treating weak, atrophied muscles ........................................................................................ 60

-MS-16. FES for controlling tremor .................................................................................................................62

MS-17. FES for sensation .............................................................................................................................. 63

MS-1B. FES systems for improving control of movement... ........................................................................... 63


WHAT SHOULD I KNOW WHEN CHOOSING AN FES PRODUCT OR SERVICE?.......................................64

How WILL PARTICIPATION IN AN

FES PROGRAM AFFECT ME? ............................................................................. 64

WHAT QUESTIONS SHOULD I ASK? .....................................................................................................................65

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PART 2. WHERE TO GET FES ....................................................................67

UNITED STATES LISTINGS ................................................................................................................................67

OTHER COUNTRIES ........................................................................................................................................ 130

Argentina, Australia, Austria, Brazil, Canada, Denmark. France. Germany, Iceland. Israel. Italy.

Japan, Netherlands. Poland. Portugal, Slovenia, Spain. United Kingdom.

PART 3. MORE RESOURCES ON FES .......................................................175

SUGGESTED READING ON FES ...................................................................................................................... 175

INFORMATION AND REFERRAL CENTERS ......................................................................................................... 180

EQUiPMENT .......................................................................... 185

PROFESSIONAL ORGANIZATIONS .................................................................................................................... 183


MANUFACTURERS OF ELECTRICAL STIMULATION

PART 4. GLOSSARY .......................................................................................................191

PART 5. INDEX ..............................................................................................199

TOPICAL INDEX ............................................................................................................................................................ 199

ORGANIZATIONAL INDEX ............................................................................................................................................

204

RESPONSE FO"RM ........................................................................................................................... LAST PAGE

Photograph and Illustration Acknowledgments


Photographs and illustrations reproduced with the permission of: Cleveland FES Center, p. 4;
Cleveland FES Center, MetroHealth Medical Center. Ron Hart, Illustrator. pp. 2. 6; ElectroLogic of
America, Inc., p. 15; The Dobelle Institute, Inc. p. 15; University of Alberta, pp. 18(left), 27(1eft);
Team Rehab Report, July 1995 Issue. p. 18(right); Cleveland FES Center, Cleveland VA Medical
Center, p. 27 (right); and Empi, Inc. p. 41.

iACknOWledgments

The authors wish to extend thanks: to lynn (Phillips) Bryant, Director of ABlEDATA, for her advice
and editorial assistance; to the National Spinal Cord Injury Association for their assistance with the
consumer evaluation of this publication; to our Technical Review Committee for their
knowledgeable review of the text; to our Community Advisory Committee for their guidance
throughout the project; and to the Buckeye Chapter, Paralyzed Veterans of America (PVA) and the
PVA Spinal Cord Injury Education and Training Foundation for their financial support of this project.

Technical Review Committee


Paul Berns, MD and Roy Douglas, Peers Program
Bernard S. Brucker, PhD, University of Miami
Joyce Campbell, PhD, California State University
Rory Cooper, PhD, University of Pittsburgh
Graham Creasey, MD, MetroHealth Medical Center
Janis Jacobs Daly, MS, PT, Cleveland VA Medical
Center
Ross Davis, MD, Neural Engineering Clinic
Suzanne Diffley, RN, Paralyzed Veterans of America
Anthony DiMarco, MD, MetroHealth Medical Center
Jerry Dugan, Paralyzed Veterans of America
John Elefteriades, MD, Yale University Medical
School
Peter Gorman, MD, Baltimore VA Medical Center
Robert Jaeger, PhD, Illinois Institute ofTechnology
Rosemary Jones, PhD, Bristol Oncology Center
Daniel Kelly, PT, Cleveland Clinic Foundation
Donald Leslie, MD, Shepherd Center
Simon Levine, PhD, University of Michigan
Ronald Lew, MD, Cleveland VA Medical Center
Steven Linder, MD, Palo Alto VA Medical Center
Mark Malagodi, MS, University of Pittsburgh

E. Byron Marsolais, MD, PhD, Cleveland VA Medical


Center
Dana Ohl, MD, University of Michigan
Inder Perkash, MD, Palo Alto VA Medical Center
Jerrold Petrofsky, PhD, Petrofsky Center for
Rehabilitation Research
Dejan Popovic', PhD, University of Miami
Arthur Prochazka, PhD, University of Alberta
Mary Rodgers, PT, PhD University of Maryland
Stephen WJ Seager, DVM, National Rehabilitation
Hospital
Diane Shaddock, Services for Independent Living,
Inc.
Aneta Stefanovska, PhD, Slovenia Rehabilitation
Institute
Clayton Van Doren, PhD, MetroHealth Medical
Center
James Walter, PhD, Hines VA Hospital
Robert Waters, MD, Rancho Los Amigos Medical
Center
Marguerite Wieler, PT, University of Alberta

Community Advisory Committee


P. Hunter Peckham, PhD, Chairperson, Cleveland FES Center, Cleveland VA Medical Center, Case Western Reserve
University
Lynn Bryant, ABLEDATA
Frederick Frost, MD, MetroHealth Medical Center
Betty Lou Graves, Parent of FES Consumer, Pennsylvania
Linda Herson, The Institute for Rehabilitation Research
Janna Jacobs, CRC, National Spinal Cord Injury Association
Jim Jatich, FES Consumer, Ohio
Sam Khawam, FES Consumer, Washington
Carolyn P. Konnert, LSW, Nat!. MlIltipte Sclerosis Society
Margaret Meyer, Services for Independent Living
Diane Shaddock, Services for Independent Living
Paul Sonye, Buckeye Chapter Paralyzed Veterans of America
Kathy Stroh Wuolle, OTR, MetroHeaHh Medical Center
Ronald J. Triolo, PhD, Cleveland VA Medical Center
Cynthia Wederich, MS, RPT
Frank Zeiss, Sigmedics, Inc.

ii

ilntroduction
This book has been written for persons with spinal cord injury or multiple sclerosis, their families,
and the health care professionals who work with them. The book contains information on the use of
functional electrical stimulation (FES) to maximize health and function for people with these spinal
cord dysfunctions.

Although this book is specifically for people living in the United States, residents of other
countries will likely find it useful because the information was gathered from medical and
rehabilitation experts across the world. The material is current as of spring 1995. We expect to
provide supplements periodically as new developments occur. See the order form on the last page.

How to use this book


This book is divided into five parts. The tabbed divider between each part provides information
about how to use the part.
If you don't know much about FES and need to learn about how it works, what the options
are, and how to select a treatment to explore, start with Part 1. Learning about FES. This section
provides an overview of FES and then describes each type of application or treatment that is
currently available. Focus on SCI-1 through SCI-18 if you have a spinal cord injury, or MS-1
through MS-18 if you have multiple sclerosis. The guidelines (page 64) for selecting FES programs
at specific clinics or with a specific health care provider may also be useful. The glossary should
help you with any unfamiliar terms used in the book. Terms appearing in bold type are explained in
the glossary starting on page 191.
If you already know quite a bit about FES, but need to know where you can go to get
treatment, start with Part 2. Where to get FES. These descriptions of FES programs are listed by
location so that you can identify the options in your local area* . If you want to look for a particular
type of FES program, then use the index at the end of the book. It will direct you to any programs in
Part 2 that match your criteria. Before making any decisions, you may want to review the selection
guidelines at the end of Part 1 on page 64.
If you can't find all the information you need in Parts 1 or 2, turn to Part 3. More resources
on FES. This section includes a bibliography for additional reading, a directory of some FES
product manufacturers, and listings of other organizations that may be helpful in your search for
information about FES.
You can always use the index in Part 5 to find appropriate information in any section of the
book. Don't forget to use the glossary in Part 4 - sometimes your definitions of terms may be
somewhat different from those used in the book. Even professionals who work with FES may use
words differently since they have been trained in different fields - for example, neurosurgery,
physical therapy, biomedical engineering. There is no standard terminology today in the FES field.
Remember - electrical stimulation is a medical technology that should be undertaken only
under the guidance and supervision of a trained health care professional!
"This information is provided solely as a guide. The FES Information Center does not endorse, warrant, or guarantee any
FES product or service. The FES Information Center and its affiliates assume no responsibility for the effectiveness,
safety or quality of any product or service.

PART 1. LEARNING ABOUT FES

This part provides information on the following topics:

What is FES?

How is FES applied to the human body?

What FES applications can benefit people with spinal cord injury (SCI)?

What FES applications can benefit people with multiple sclerosis (MS)?

and

What should I know when choosing an FES product or service?

How to use these two sections:


These sections describe 18 different FES applications or treatments. Each
description discusses the purpose of the treatment, non-FES alternatives, how the
FES system works, the status of the treatment, who is medically eligible, how long
the treatment takes, what the treatment costs, and what you can expect from the
treatment. (The cost information is current as of May, 1995). Some treatments also
include information on what may be available in the future.
Use the Contents to get to the exact page number for a given application description.
Each treatment is numbered to correspond with the picture on page 4 and the large
table on page 10. Some treatments are only available for persons with SCI; others
are only available for persons with MS. The small table that occurs in each treatment
description indicates the status of the treatment and refers to the United States
unless otherwise noted. See the key on page 9 for an explanation of the status
table's terminology.
These sections provide an up-to-date, general description for any given application
or treatment. You may be able to locate specific information about where a particular
treatment is available and other details in Part 2. WHERE TO GET FES. Since the
information in Part 2 is supplied to the FES Information Center on a voluntary basis,
not every method described in these sections will appear in Part 2. More details on
particular treatment may also be available from the resources listed in Part 3. MORE
RESOURCES ON FES.

PART 1. LEARNING ABOUT FES


IWhat is FES?

Spinal cord injury (SCI) or multiple sclerosis (MS) can produce total or partial paralysis. The person
who has one of these conditions may be unable to move parts of his or her body. Breathing, blood
circulation, bladder and bowel function may also be affected. In the last 30 years, medical scientists
and engineers have invented methods and devices to assist with these problems. One technique is
called functional electrical stimulation (FES) (pronounced "ef-ee-es".) Because FES can be
applied to many different physical problems, any person with SCI or MS may want to investigate
FES as a treatment option.
FES is a method of applying low level electrical currents to the body to restore or improve
function. A heart pacemaker is one example of an FES system. Other types of FES may restore
lost abilities such as standing or grasping. Also, FES may assist with some secondary problems of
paralysis such as poor blood circulation or slow wound healing. When used in these ways, the
treatment may simply be called electrical stimulation or ES.
It is important to understand that FES is not a cure for spinal cord injury or multiple
sclerosis. FES is an assistive device. For people with a complete spinal lesion, FES provides
benefits only when the system is operating. When the system is turned off, the benefits will
disappear. People with an incomplete spinal lesion or multiple sclerosis may be able to use FES
to recall some amount of voluntary muscle function, so that when the FES system is turned off. the
user may still receive benefits. This is a therapeutic benefit of FES. FES itself does not reverse
paralysis. Finally. people with certain types of nerve damage cannot be helped by FES. Despite
the limitations. one of the exciting things about FES is that improvements in function are possible
for people of any age and any duration, level, or completeness of injury. Many FES techniques are
still experimental. Yet. they hold real promise for helping people with paralysis. For some
individuals. FES can improve physical and emotional health in ways that cannot be achieved with
other methods available today.

The nervous system


Movement and feeling in the human body depend on natural electrical currents that flow through
nerves connecting the brain with the limbs. At the bottom of the skull. the brain joins a long bundle
of nerves called the spinal cord. Along the spine, smaller nerve bundles branch out from the spinal
cord to the head. arms, trunk, and legs. We call the brain and spinal cord the central nervous
system. We call the branching nerves that supply the arms. legs, and other parts of the body the
peripheral nervous system. We call the nerve bundles branching out from the spinal cord spinal
nerve roots.
The natural electricity in the body carries signals back and forth between the central and
peripheral nervous systems. When we decide to make a movement, signals start in the brain and
travel to the limbs. The signals carry the electrical commands that cause voluntary muscles to
contract. We call these commands motor signals. Other signals go in the opposite direction. They
start at a limb, the trunk, or the head and carry electrical messages about touch, pressure or pain
back to the brain. We call these sensory signals.

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FES RESOURCE GUIDE

Why does paralysis occur?


Injury or disease in the nervous system can interrupt the normal communication between the
central and peripheral nervous systems. The result may be muscle weakness or paralysis. This can
happen when there is damage at any point between the brain and a muscle. Such damage points
may be in
the brain itself
the spinal cord
the spinal nerve root (a bundle of nerves that branch out from the spinal cord)
the peripheral nerve
the muscle.
Injury or disease in the nervous system harms nerve cells. The central nervous system
may be affected -- brain cells or spinal cord cells are damaged. Or, the peripheral nervous system
may be affected -- spinal nerve roots or peripheral nerves are damaged. Peripheral nerve
damage is called denervation. Often an injury to the spinal cord (central nervous system) can also
affect the peripheral nerves that lead out from the cord. The picture below shows the difference
between the upper motor neurons and lower motor neurons of the nervous system. Most types
of FES are not beneficial when the lower motor neuron is damaged. A clinician can perform simple
tests of muscle function to check for lower motor neuron damage or denervation.

The Nervous System

Brain - __
Upper Motor Neuron
Lower Motor Neuron
Spinal Cord

Muscle

How does FES overcome paralysis and its related problems?


When there is damage only to the central nervous system, the muscle and its nerve supply
remain healthy_ The reason they donit work is that they are cut off from the command signals
coming from the brain. FES applied near the muscle or nerve can substitute artificial electrical
signals for the missing normal motor signals. The artificial impulses make the muscle contract.
Things are different when there is also denervation. When that happens, the nerve-muscle
connection is broken. Stimulating the nerve with FES pulses will not make the muscle contract.

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LEARNING ABOUT FES

Electrical pulses applied to the nerve or muscle will face the same barrier faced by the normal
signals from the brain. This happens in peripheral nerve disorders or injuries, in diseases of the
nerve-muscle junction, and in muscle diseases. Recently, researchers have started to design
special stimulation equipment to activate denervated muscle directly and bypass the damaged
peripheral nerve. The biggest problem is that the muscle fatigues and gets weak very quickly.
Multiple sclerosis (MS) also produces problems in transmission of nerve signals. While
SCI is caused by a physical insult, MS is caused by degrading of the natural insulation on nerves.
Depending on where this happens, the symptoms can vary from weakness and numbness to eye
problems and dizziness.
The ideal solution to neurological problems such as these is regeneration. It involves
causing the central nervous system to grow new neurons to replace the ones that are injured or
sick. Scientists who are working on this problem are doing basic research about how cells and
nerves grow. They are studying cells and animals to learn more about nerve cell growth in humans.
Some experiments are looking at the possible benefits of electrical stimulation applied very shortly
after injury to the spinal cord. We all hope that someday FES won't be needed anymore because
regeneration will have solved the problem of paralysis. But, that day is many years in the future.
Today, we have more than a dozen applications of FES to improve health and function,
such as for improving circulation, and for moving muscles. When FES is used to move parts of the
body, it may also be called FNS or functional neuromuscular stimulation. Such FES/FNS
applications include:
cardiovascular exercise
breathing assist
grasping and reaching
transfers and standing
stepping and walking
bladder and bowel function.
Sometimes the primary purpose of FES does not involve moving muscles. Then, it may be
called simply electrical stimulation (ES), TENS (transcutaneous electrical nerve stimulation) or
electrotherapy. In such cases, the primary purpose may be to prevent or treat problems that arise
because of SCI or MS. These problems are called secondary complications and they include:
male sexual dysfunction (inability to have an erection or ejaculate)
blood clots (deep venous thrombosis)
pressure sores
spasticity (uncontrolled contraction of muscles that causes stiff awkward movement)
contractu res Ooints that cannot open fully)
loss of bone mineral (osteoporosis)
weakening and shrinking of muscles due to inactivity (atrophy)
tremor (shaking that occurs continuously or whenever a voluntary movement is made).
When FES is used for these problems, two effects can occur. One is muscle contraction and the
second is electrical current in the affected tissues, without muscle contraction. These effects are
sometimes called therapeutic electrical stimulation.
Together with heart pacemakers, electrical stimulation (ES) devices for pain control are the
most widely available ES devices. Because so much information is already available, this book
does not deal specifically with ES for pain. Neurologists, doctors who specialize in the nervous
system, often prescribe ES for pain that cannot be treated otherwise. Pain control may include
many other treatment methods such as medication, psychological therapy, and acupuncture. See
Part 3. MORE RESOURCES ON FES for information on ES for treating pain.

Inn

FES RESOURCE GUIDE

The picture below shows 18 different ways that FES can be used to help someone with a
spinal cord dysfunction.

FES Applications in Spinal Cord Dysfunction

18. Regaining Voluntary


Function I Improving
Movement Control

1. Cardiovascular Exercise
,

,
I

2. Breathing Assistance
17. Restoring Sensation

3. Cough Assistance

16. Controlling Tremor

4. Grasping &
Reaching

15. Treating Weak


Muscles

5. Bladder & Bowel


Control

4. Preventing I Treating
~. Osteoporosis

13. Preventing I Treating


Contractures
/

7. Stepping and walking

/
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, 12. Controlling Spasticity

8. Erection &
Electroejaculation
11. Treating Pressure Sores
9. Improving Circulation

10. Preventing Pressure Sores

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LEARNING ABOUT FES

IHow is FES Applied to the Human Body?

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How does FES technology work?
The main components of an FES system are the electrodes, the stimulator, and sensors or
switches. When FES is being used to move muscles, current pulses in the electrodes cause the
weakened or paralyzed muscles to contract. In other applications, currents in the electrodes may
simply produce electrical currents in the tissues without moving any muscles. The stimulator
controls the strength and timing of the low-level pulses that flow to the electrodes. The sensors or
switches control the starting and stopping of the pulses supplied by the stimulator.
Electrodes
Electrodes may be applied to the skin daily or they may be implanted in the body. Skin surface
electrodes are made of a flexible material such as rubber that conducts electricity. Tiny electrical
currents are sent through the electrode to the skin and the tissues beneath the skin. Some surface
electrodes are applied with a conductive gel. Others are self adhesive. Both types may be
reusable. Surface electrodes are widely used in therapeutic electrical stimulation for rehabilitation of
injury or weakness. It is convenient to simply apply electrodes to the skin surface. But, daily
application of the electrodes can be time consuming. Stretchable garments with electrodes already
mounted in appropriate locations have been developed by several manufacturers to simplify the
process.
Surface electrodes have some drawbacks. Because they are separated by skin and fat from
the underlying muscles and nerves, surface electrodes cannot make individual muscles active.
Instead, they stimUlate groups of muscles. Therefore the desired action may be more difficult to
achieve. Also, the muscle stimulation may vary from day to day because of differences in
placement of the electrodes. Sometimes, the skin may be irritated or burned by the electrode gel or
the electrical current itself. In people who retain feeling, there is a possibility of discomfort because
the stimUlation may accidentally activate pain nerve fibers. Researchers are developing new
stimulation equipment that avoids pain nerve activation.
Implanted electrodes are located inside the body and avoid the need for daily application.
They provide selective stimulation of particular muscles with lower current levels. But, a drawback
is the need for surgery to place the electrodes or replace them if necessary. They are also more
expensive to produce. Implanted electrodes may be fine wire coils inserted in muscles
(intramuscular electrodes), flat metal foils placed against the spinal cord or muscle surfaces
(epimysiaI electrodes), or soft cuffs of rubber and metal foil that surround nerves (nerve
electrodes).
Leads, Stimulators and Sensors
Electrodes are connected to a stimulator by insulated wires called leads. The stimulator sends
electrical pulses through the leads and to the electrodes where the electrical charge is delivered to
the nerve, muscle or other tissue. Most stimUlators are external units that can be as small as a
calculator or as large as a computer workstation. Usually, a stimulator has a computer controller
built into it. Each stimulation channel sends pulses to one or more electrodes.

FES RESOURCE GUIDE

A Basic Electrical Stimulation System

Electrodes

:.-:.
~

Leads

Instructions

OFF

Controller

Stimulator

[)::::::::J---'
-ryPulse

Stimulation Unit

More advanced systems have implanted electrodes and also may have implanted
stimulators. Implanted electrodes and their leads can be completely inside the body or the leads
may pass through the skin (percutaneous leads) and connect to an external stimulator. The
surgery for implanting an FES stimulator is similar to that used in implanting a heart pacemaker.
The electrodes are connected to the stimulator inside the body. The stimulator has a built-in radio
receiver that receives command signals from an external control unit. See the pictures on pages
12, 15, 18, 27, and 41 for examples of different FES system components.
Sensors are electronic or mechanical devices that measure some feature of the
environment and send information about it back to the stimulator-controller. The controller uses the
information to adjust the stimulation. Sensors include the switches that the FES user operates to
start and stop the system. Some systems also have switches that allow the user to select from a
menu of choices. Some sensors are built into braces or shoes to detect the angle at a joint or the
pressure when weight transfers onto a foot. These are all man-made, or artificial, sensors.
Researchers are also working on using natural sensors by recording signals from the sensory
nerves in the body.
One of the important senses we use in movement and posture is proprioception. This
means knowing where the parts of our bodies are. For example, natural sensors in the area of the
knee joint tell you the position of your leg even when you cannot see it. In complete SCI, the
sensory nerve pathways are interrupted and cannot convey information about limb position to the
brain. Some FES systems use an angle sensor to get information on limb position. This electronic
device is strapped to the limb, it measures joint angle, and sends that information to the controller.
The controller then adjusts the stimulation levels according to the desired task.
To be truly practical, an FES system needs to correct for changes in the environment and
day-to-day changes in the user's body. This requires a feedback method that can adjust the
stimulation so that it accomplishes the desired movement. Examples of adjustment goals are to

LEARNING ABOUT FES

give the best grasp force for a particular object or the best walking step length for a particular floor
surface. Some forms of feedback are already built into FES devices. For example, some FES
walking systems use pressure sensors in the shoes that signal the controller when a step is
completed.
Feedback information, whether it comes from artificial or natural sensors, has many
benefits. It can make the FES user aware of the FES system's status and how well it is performing.
It can help the control system to adjust to changing conditions. That adjustment may reduce muscle
fatigue. FES exercise can push muscles to their limit even sooner than would occur with normal
muscle contractions. The resulting fatigue is an ongoing problem with some types of FES. FES
systems with feedback also require less attention from the users. Developing such systems is an
important goal.
Factors that determine what an FES system can do

the number of electrodes


the type of electrodes (some can activate specific muscles better
than others)
how many separate channels the stimulator has (one channel may
control several electrodes)
the number and complexity of patterns of stimulation stored in the
controller
feedback designs in the controller
the characteristics of the sensors or switches

What FES systems are available?


As with any medical technology, FES methods must be demonstrated in the laboratory years
before they can be available to the consumer. Today, a newspaper or television show may report a
laboratory breakthrough in FES. That does not mean that tomorrow your doctor can prescribe a
new FES exercise system for you. Years of work by scientists, physicians, therapists and engineers
are needed to develop today's breakthrough into a practical device.
In the United States, the process of testing and approval of medical devices is governed by
a regulatory agency called the Food and Drug Administration (FDA). Gaining FDA approval can
take many years. Devices have to be tested on larger and larger groups of subjects to gather
enough information to show if they are safe and effective. Today, many FES devices are
investigational- they are still being tested and improved. This means that they are not commercially
available and that doctors cannot simply prescribe them for a medically eligible person. Only
research subjects who participate in FDA-approved studies have access to investigational devices.
And, the locations where they are available are limited to the research sites.
Even if an FES system is approved by the FDA, it doesn't mean every doctor believes that it
is the best alternative to other available treatments. It may take many years for clinicians to reach a
"consensus" and recommend the FES system over other alternatives, thereby identifying it as
accepted practice. Some clinicians, however, might never choose to prescribe the system.

When a person participates in a research project, we refer to her or him as a "subject." When a person with a disability
is receiving medical or surgical care, we refer to her or him as a "patient." Sometimes we refer to the person with a
disability as a "consumer" of an FES product or service.

FES RESOURCE GUIDE

The development of FES systems can be divided into four progressive stages as shown in
the table on page 10: basic research, clinical feasibility studies, multicenter clinical trials, and
regulatory approval. Basic research includes testing using animals and computers. Clinical
feasibility studies are the first tests of a system, involving only a small number of human subjects.
Usually, such tests are conducted at a single location. In some studies there are no costs to the
subjects.
In the third stage of development, researchers conduct multicenter clinical trials. They
collect the same type of information at all the participating clinics and involve many more subjects.
Such stUdies are designed to gather information about the safety and effectiveness of new devices.
All testing on human subjects in the United States is governed by investigational device exemptions
(IDE) that are granted by the FDA. Naturally, other countries have their own regulations for
approval of medical devices. Often, devices are approved in other countries before they receive
FDA approval. Each facility that offers an investigational device is monitored by its own Institutional
Review Board (IRB). The IRB makes sure that subjects are fully informed about any risks or
benefits of the system that is being tested by ensuring that the subject signs an accurate informed
consent form.
When multicenter trials produce satisfactory results, the device is approved by FDA and can
then be distributed commercially. If a new device is very similar to a device already approved by
the FDA, the manufacturer may be granted approval without having to conduct multicenter trials. At
this stage, the FES application has achieved regulatory approval. It is commercially available, and
may be covered by some insurance carriers. However, it is always up to a patient's doctor to
determine if a particular device or treatment is suitable for that patient.
Some FES systems are commercially available only outside the US. The tables in this part
of the book indicate that those systems have achieved regulatory approval and shows in which
countries they are available. The FDA is usually more strict than the regulatory agencies of other
countries. As a result, the same device may be investigational in the US but approved elsewhere.
Even if an FES device is FDA-approved and commercially available, many factors affect
how widely it will be used. These include how complex it is to select the people to use the system,
how easy it is to use, its appearance and cost, how long the user must train to use it effectively,
and how well it compares to other available alternatives. There may be a shortage of doctors and
therapists who know how to select people, apply the system, and train the users. Third party payers
like Medicare or private insurance companies may be reluctant to provide reimbursement. Some
FES applications may never be widely available because of the small numbers of people who can
benefit and the complexity of the treatment.
The table on page 10 shows the development stage and availability (limited, restricted or
wide) of FES systems. The key that precedes the table provides a detailed explanation of the terms
used in the table. Each of the numbered rows names an FES application. Each column heading
names a stage of development or a degree of availability. In the box where a row and column meet,
we show the activity that exists today for the application named at the left of the row. SCI refers to
spinal cord injury. MS refers to multiple sclerosis. For example, on line 5, bladder and bowel
control, "SCI, MS" under the column headed "feasibility studies" indicates that small FDA-approved
studies are underway with people who have SCI or MS. Under the column headed "regulatory
approval, non-US", "SCI, MS" indicates that systems are approved and commercially available
outside the US for people with SCI or MS. The table also indicates that the availability of this type
of system is "restricted" for people with SCI or MS, meaning that there are only a few places in the
US providing this type of FES.

--

LEARNING ABOUT FES

Applications may have activity in more than one stage, usually indicating that alternative
techniques are being investigated. See the corresponding numbered sections, beginning on page
11, for a description of each application (for example, SCI-3 for information on FES for cough
assistance). SCI applications are grouped together. MS applications follow them. See Part 2,
WHERE TO GET FES, for information about specific FES programs that provide people with
devices and training.
While FES may help many people in the future, today many FES applications are still
experimental. This becomes clear when you page through the SCI and MS applications on the
following pages. Anything that is not in the column headed regulatory approval is experimental, or
investigational. Even for most of the approved FES applications today, there is no general
agreement within the medical community that they are the preferred treatment. Education about
and training of health care providers in FES methods will help to make them more widely available
to interested consumers. Be sure to let your clinicians know that this book and other resources are
available to rehabilitation professionals who seek education and training about FES.

Key to Table (Page 10):

Development Stage of FES Systems and

Clinical Availability of FES Systems

Development Stage
Basic Research: Usually means computer modeling or animal experimentation.
Clinical Research:
Feasibility Study: Study to prove that the treatment is effective and safe for a small
number of individuals, typically up to 20.
Multicenter trial: Identical studies conducted at multiple clinics with a sizable total
number of individuals, typically 50 -100. The goal is collection of data on safety and
effectiveness that will be adequate for regulatory approval.
Regulatory Approval: The FDA, in the US, has reviewed the data of multicenter trials
and agrees that the documentation and data support the manufacturer's claims of safety
and effectiveness. This does not mean that all clinicians agree that the treatment is safe
and effective and preferred over other alternatives. In other countries, the counterpart
agency to FDA has reviewed results of clinical studies and granted approval for marketing
of the device.
Clinical Availability (includes availability in clinical research centers as part of feasibility or
multicenter studies, mayor may not be approved by FDA)
Restricted: Available in only a few (1-6 centers in the US) specialized rehabilitation
centers or clinics serving persons with SCI or MS. Personnel require extensive training to
provide this treatment.
Limited: Available in some, but not all, rehabilitation centers or clinics serving persons
with SCI or MS. Personnel require specialized training to provide this treatment.
Wide I Extensive: Available in most rehabilitation centers serving persons with SCI or
MS. Personnel may require training but it is readily available.

A note on development stage and availability in countries other than the United States:
In each specific application section of this chapter, we have included a small table describing
the status of FES systems for that application. We have indicated specific types of systems
as being in basic research, clinical research or approved practice stages. Unless a country is
specified, we are referring to the US.

.....

TABLE: Development Stage and Clinical Availability of FES Systems

1. Cardiovascular exercise

I SCI

2. Breathing assistance

Clinical

Regu'~tory

Researc;b

Approval.

Feasibility Multicenter
studies
trials

US

SCI

TSCI

SCI

SCI

3.
4. Grasping and reaching

SCI

SCI

SCI

5. Bladder and bowel control

SCI

SCI.MS

SCI.MS

6. Transfers and standing

SCI.MS

8.

SCI. MS
pressure sores

SCI. MS

SCI. MS

ing spasticity

SCI.MS

I SCI. MS I SCI. MS I

I
I

14. Preventingl treating osteoporosis

SCI.MS

15. Treating weak muscles

SCI,MS

ling tremor

I SCI. MS

SCI.MS

18. Regaining voluntary functionl

SCI

SCI

SCI

SCI

Improving control of motion

I SCI.MS

I SCI.MS

,;;1;

:J;

MS

sensation

I SCI. MS

13. Preventing! treating contractu res

SCI

.', ;./
SCI

SCI

MS

MS

rti

MS

CI)

SCI

,';

SCI

"

:':;:

CI)

c:

MS

::0

()

rn

G)

See Key on page 9

c:

i3
rn

(((((\(\1

(l

(\1\((

I.

( ( ( ( ( (

LEARNING ABOUT FES


.......

'""

'

11

What FES Applications Can Benefit People

with Spinal Cord Injury?

The picture on page 4 and the table on page 10 name 18 applications of FES that have been used
in people with spinal cord dysfunction. The sections that follow explain how each application works,
its purpose, status (availability) and cost, who is eligible, time needed for treatment, and expected
results or outcomes.
For each application, the status information is presented in a small table similar to the table
on page 10. The table indicates that the availability of the application may vary from a single
location where feasibility studies are underway to many clinics where an approved treatment and
device can be obtained. See Part 2. WHERE TO GET FES for specific details about where
particular FES treatments are available.
For each application there are also medical eligibility requirements. In addition, there are
factors which would disqualify a candidate. Many of these disqualifying factors apply to almost all
uses of FES. They include:
Heart rhythm or high blood pressure problems
Implanted pacing devices
Possible blood clots
Some types of tumors
Pregnancy
Unhealed wounds
Tendency for worsening of autonomic dysreflexia with FES.
People who have any of the conditions listed above should not use FES.

SCI-1. FES systems for cardiovascularexercise


What is the purpose?
Increase endurance and physical fitness.
Improve heart and lung function.
Maintain and increase muscle bulk.
Help to reduce secondary complications such as decubitus ulcers, colds, urinary tract
infections.
What are non-FES alternatives?
To develop and maintain physical fitness, people with paraplegia can do sports involving the arms
such as swimming, wheelchair tennis, and wheelchair racing.
People with paraplegia, or quadriplegia from C-5 to C-8Ievels, or incomplete quadriplegia can do
arm-cranking exercise or various wheelchair sports to develop greater aerobic capacity. But, like in
any exercise, overuse of the arms can lead to arm or shoulder strain, and injury. Long-term
changes may include osteoarthritis or tendonitis.
People with quadriplegia at levels above C-5 may be able to use adapted equipment to move their
limbs, but they have no non-FES exercise option for increasing cardiovascular endurance.

..

12

FES RESOURCE GUIDE

How do the FES systems work?


Exercise bicycle or ergometer
In a typical system, the user sits in a specially fitted chair that allows the legs to be positioned on
pedals. A stimulator activates 6 surface electrodes applied over leg muscles to produce a pedaling
motion. A computerized control unit tracks the stimulation applied to the leg muscles and
coordinates it with position and resistance readings taken from the pedals. The goal is 35 - 50
revolutions per minute. The controller keeps the prescribed resistance and stops the exercise when
the muscles are fatigued.

Example of an FES bicycle ergometer

STATUS OF FES SYSTEMS FOR CARDIOVASCULAR EXERCISE


Basic research
Clinical research
Multicenter trials
Rowing

ergometer

Regulatory approval
Computer
controlled FES
exercise bicycle;
several styles
available

Who is medically eligible?


Persons who fulfill all the following requirements:
Only upper motor neuron lesions.
Joints that can move throughout the range needed for the bicycling or other motion.
Skin sensation that can tolerate surface electrodes.
No abnormalities in x-ray of legs.
Good general health.
Emotionally stable and realistic.

-'

bc

LEARNING ABOUT FES

13

People who were injured more than 5 years ago will need special assessment before starting an
exercise program. They can have a large loss of muscle mass, contractures, and brittle bones.
People over 40 years of age will need additional evaluation for possible heart problems.
People with the following conditions are disqualified:
History of leg fractures.
Severe spasticity.
Contractures.
Severe osteoporosis (thin, weakened bones).
See additional disqualifying factors on page 11.

How long does the treatment take?


Exercise is not a treatment but rather a part of daily life. In past years, doctors' recommendations
for physical fitness included
Exercise at 70% of maximum heart rate for your age,
30-60 minutes each session,
At least three times a week.
In recent years, they have found that the same health benefits can be obtained from less strenuous
exercise provided it is done regularly.
PartiCipation in an FES exercise program typically involves:
Thorough medical checkup.
Physical therapy and conditioning to strengthen leg muscles (3 times/week - 10-20
weeks).
Personal exercise program in community, home or other location as part of your regular
activities.
Medical follow-up every 36 exercise sessions.

What does it cost?


Most insurance programs will pay for the medical work-up and the initial training to reach a specific
goal. They are reluctant to pay for the exercise system itself. There are several manufacturers of
FES bicycle ergometers -- the price of a complete home system ranged from $9,000 to $20,000 in

1995.
What can I realistically expect today?
With consistent exercise, about two thirds of FES exercise system users can expect
Improved cardiovascular health.
Improved fitness.
Increased leg muscle strength.
Increased leg muscle bulk.
~

'"'
,.
L

About half to two-thirds of users feel better about their appearance. More than a quarter of users
experience less swelling of the legs. Some users report decreased secondary complications.
Despite all these possible benefits, it is important to remember that a person with complete SCI will
not regain voluntary control of the legs by using an FES bicycle system.
Some FES exercise users report increases in
Emp!oyment opportunities.
Participation in social activities.
Efficiency in activities of daily living.

14

FES RESOURCE GUIDE

FES exercise can increase pain in some people. This pain has caused people to stop FES
exercise. Newer equipment is designed to reduce pain from stimulation.

Supportive family and friends are a big help to the exercise system user in following a regular
exercise program.
See SCI-14 FES for preventing or treating osteoporosis for information about bicycle exercisers
and improving bone strength.

What may be available in the future?


Research is underway on an exercise system that uses an adapted rowing exercise machine and
surface FES. A commercial stimulator is set to activate leg muscles at a rate that the user can
control. The user rows with the arms voluntarily while keeping in time with the electrically-controlled
leg muscle action.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

SCI-2. FES systems for breathing assistance


What is the purpose?
Activate the diaphragm and/or chest muscles to produce breathing.
Reduce the need for a ventilator. Provide more freedom.
Provide more consistency of ventilation.
What are non-FES alternatives?

Ventilator.
Continuous, positive nasal air pressure device (CPAP)
Pneumobelt, a corset that inflates and deflates to assist movement of the diaphragm.

How do the FES systems work?


Diaphragm muscle stimulation
In a typical system, called a phrenic pacer, cuff electrodes are surgically implanted around the
phrenic nerves in the neck or chest. The phrenic nerves (one on each side) control the movement
of the diaphragm, the large muscle that separates the chest from the abdomen. A stimulator
receiver (pacer) connected to the cuff electrodes is implanted under the skin just below the rib
cage. An external antenna-transmitter is taped onto the abdomen just above the implanted pacer
unit.
When the phrenic nerve is stimulated, the diaphragm moves downward (towards the feet),
expanding the chest cavity and 'pulling air into the lungs. When the stimulation is turned off, the
diaphragm relaxes, moves up, and air leaves the lungs.
Intercostal muscle stimUlation
Muscles other than the diaphragm playa role in breathing too. Researchers are testing an FES
device that activates the muscles between the ribs (intercostal muscles) to expand the lungs. This
device involves a single electrode implanted on the surface of the spinal cord in the upper back.
The electrode is connected internally to a stimulator with a radiofrequency receiver that is
implanted over the lower ribs. As with the phrenic pacer, an external antennaltransmitter is taped to
the skin above the implanted stimulator.

16

FES RESOURCE GUIDE

Intercostal muscle pacer


Early tests of this device showed that it did not provide adequate ventilation to be used as the only
breathing assist. However, it may be valuable in people who have inadequate air supply when
using a phrenic pacer. An example is a person with only one healthy phrenic nerve.

-
-

How long does the fitting and training take?


Following the surgical implantation of a phrenic pacer, the patient remains in the hospital for daily
training of the diaphragm muscles. At the start of this period, the FES device may be used for only
a few hours a day. The time using the FES device is gradually increased. A person with
quadriplegia may need as long as 3 - 4 months to build tolerance to using a phrenic nerve pacer
full-time. Other types of systems would probably follow a similar course.
What does it cost?
Phrenic nerve pacers cost about $50,000 - 75,000. This includes the device, the surgery to implant
it, and costs for hospitalization during training. Cost information is not available on the research
systems under development.
What can I realistically expect today?
People who can adapt to phrenic nerve pacing or intercostal muscle pacing can expect that their
breathing system will be more cosmetic, or less noticeable than with a ventilator. They will have
more freedom to move around without the interference of ventilator tubing. They may not need to
use a ventilator except as a backup if there is a problem with the phrenic or intercostal pacer.
Speaking will be more natural because they will not need to use a tracheostomy tube for breathing.
They will also be able to smell more normally. Most patients report that generally they feel much
better during pacing than during mechanical ventilation.

What may be available in the future?


In new developments, diaphragm stimulation is being tested with other types of electrodes that can
be implanted directly in or on the diaphragm muscle with laparoscopic surgery ("Sand-Aid"
surgery).
See page 64, "What Should I Know When Choosing an FES Product or Service?"

SCI-3. FES systems for cough assistance


What is the purpose?
Provide independent ability to cough and clear lung secretions.
What are

non-FES alternatives?
Positioning that helps gravity to drain lung secretions.
If secretions are heavy, suctioning.
"Assisted cough" (or "quad " cough) can be provided by a therapist or attendant. He or
she manually compresses the abdomen while the person controls the opening and
closing of the upper airway.
Mechanical negative pressure devices applied to the mouth and nose.

--

LEARNING ABOUT FES

17

How does the FES system work?


Surface electrodes are placed on the abdomen. They are controlled with a battery-powered
stimulator. Stimulation is triggered for about 1 second, producing strong, brief contraction of the
abdominal muscles, which causes a cough.
STA TUS OF FES SYSTEMS FOR COUGH ASSIST
Basic research
Clinical research

Multicenter
trials

Regulatory
approval

Surface electrode system

Who is medically eligible?


People with
Cervical level SCI.
Mid to upper thoracic level injury and impaired abdominal muscles.
FES cough assist devices may interfere with other implanted devices such as heart pacemakers or
drug infusion pumps. People with incomplete SCI may be unable to tolerate the skin sensation of
this device. See additional disqualifying factors on page 11.

How long does the fitting and training take?

People may need some training to learn to coordinate their voluntary activity with the electrically

assisted cough. No more details are available yet.

What does it cost?

All devices are still in the clinical research stage. After testing and approval, systems may cost from

$1,200 to $10,000, depending on their complexity.

'"'
.....
"'
\,..,

\...

What may be available in the future?


How effective a cough is in removing airway secretions depends on how fast it moves air out of the
lungs. The FES cough assist device can boost peak air flows up to 30% in a person with SCI. The
effectiveness of the device will depend on the volume and thickness of the patient's airway
secretions.

\,...

.......
'~

The ability to cough on demand will allow the person with SCI to clear his or her breathing
passages at any time. This may reduce the number of lUng infections, shortness of breath, and
dependence on trained assistants.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

SCI-4. FES systems for grasping and reaching


What is the purpose?
Increase the number of activities that can be performed.
Increase the ease and security of dOing certain activities.
Decrease the need for personal assistance.
Decrease the need for other adaptive equipment such as splints, braces, or customized
tools.

18

FES RESOURCE GUIDE

What are non-FES alternatives?


Splints (orthoses) covering either the forearm or the wrist.
Surgical tendon transfers, possibly together with other surgical procedures that fuse or
stabilize joints.
Combination of splints and muscle or tendon transfers.
Reliance on someone else to do activities.

How do the FES systems work?


An FES grasping system activates the muscles that control the fingers and thumb. A reaching
system also activates the muscles that control the elbow. Electrodes may be the surface type or
they may be implanted on nerves or muscles. Depending on the particular type of system, the user
controls the stimulation by either shoulder or wrist movements, voice, or breathing in a set pattern.
Control by shoulder or wrist movements works through a joystick-type device that is mounted
across a joint, such as the shoulder. For most systems, a personal assistant is needed to help you
put the system on.
Depending on which muscles are activated, FES hand grasp systems can provide some or all the
following types of grasp:
Key pinch as you would use to hold a thin object such as a key or pencil.
Three-jaw-chuck grasp, also called palmar or cylindrical grasp, as you would use to hold
a glass or a book.
Paralle/ extension grip as you would use to hold a hand of cards.
These different grips are achieved by differently coordinated actions of the finger and thumb
muscles. The patterns are tuned for each user by the rehabilitation team and with some systems,
can be further adjusted by the user. The patterns are stored in the controller, which is mounted on
the wheelchair or on the user's arm.
With a system that includes muscles for elbow control, the user may also be able to reach out in
one or more directions. Again, the electronic patterns that coordinate all the activated muscles to
achieve reaching are stored in the controller.
Examples of FES hand grasp systems: surface electrodes (left)
and implanted electrodes/stimulator (right)

LEARNING ABOUT FES

19

Some systems have features that give the user feedback about how the system is operating. A
user may get confirmation of the system's settings through tones or beeps, or a screen display.
Another form of feedback to the user can be provided by a sensory electrode. It is implanted in
the skin of the upper chest or back, and it provides a tapping sensation to indicate how the system
is working. See SCI-17 FES for sensation for more information about sensory electrodes.
In addition to nerve and muscle locations, the surface of the spinal cord is a site where electrical
stimulation may be applied. Called spinal cord stimulation (SCS) or dorsal column stimulation,
this method is usually used to treat pain and spasticity. In some people, especially those with
incomplete injuries, it also improves hand and arm function. See SCI-11 for further information.
STATUS OF FES SYSTEMS FOR GRASPING AND REACHING

Basic research

Clinical research Multicenter trials

Implantable

sensors for

control

Feedback to
prevent slip

Reaching
!

systems
12 channels,
surface
electrodes,
voice control
(Israel)

Regulatory
approval

Glove, 3 channels, surface

electrodes, controlled by voluntary

wrist action (Canada, US)


2 channels, surface electrodes built

into close-fitting splint, controlled by


user-operated push button (Israel,
Europe, US)
30 channels, percutaneous
electrodes, control by breathing
pattern (Japan)
8 channels, implanted electrodes
and stimulator; RF controlled under
direction of voluntary shoulder
action

Who is medically eligible?


Candidates for FES grasping and reaching systems are persons with quadriplegia due to traumatic
SCI with injury at C4/C5/C6/C7 levels. The various FES systems have somewhat differing
requirements. In general, the potential user needs to have:
A stabilized condition, at least 6 months following injury.
Fingers and thumb that bend and straighten in response to electrical stimulation.
Good trunk stability in the wheelchair or other seating system.
An optimistic and motivated attitude.
Acceptance of technology.
Good support from family and friends.
Note: Surgical procedures may be used to bring a person into the candidate group.
To use a system with a shoulder-mounted joystick, the person needs to have enough voluntary
shoulder control to allow positioning the hand for function and operating command switches. To use
the glove system, the person needs voluntary wrist extension against gravity.
Persons are not eligible if they have:
Uncontrolled spasticity.
Extreme sensitivity to skin stimulation.
Infection, skin breakdown.
Diabetes, but not all cases.
Chronic kidney, heart or lung disease, demand pacemaker, hand contractures.
See additional disqualifying factors on page 11.

20

FES RESOURCE GUIDE

How long does fitting and training take?


When a person begins the process of being fitted with an FES system, there will be an initial period
of muscle conditioning. The person does surface FES exercise of the arm and hand muscles for at
least several hours a day. This is an important process that reverses some of the weakening that
occurred with disuse. This conditioning phase may take from 1 to 3 months.
A system with surface electrodes may require three to four visits for initial training and fitting of the
device. Adjustments are done when needed and users may be seen every 3 months for follow-up.
Participation in the multicenter clinical trial of the arm splint/surface electrode system requires a 6
month commitment.
If the system includes implanted electrodes, the next step will be implantation. After that, the
system is tuned to the individual and both the user and personal assistant are trained to operate it
independently. In clinical research studies, subjects may require fitting, training and tuning of the
system over as long as 1 - 3 years. When systems achieve regulatory approval, that time should
decrease.

What does it cost?


The surface electrode system being tested in Canada costs around $2,000. Disposable
electrodes cost $250-500 per year. The glove may be replaced (using the same
controller) for $300.
The 30-channel percutaneous system available in Japan costs $15,000.
The 8-channel implanted system, under multicenter trials in the US, costs about $50,000
including the device, surgery and training.
Participation in clinical trials of systems may involve no monetary cost to research
subjects. However, participation may take much time away from other activities.

What can I realistically expect today?


FES hand grasp systems can provide one or more basic hand grasps. They do not restore the fine
finger control that a person had before his or her injury. You can expect an FES grasp and reach
system to increase your independence by enabling you to do activities of daily living yourself or with
less assistance. Examples are eating, grooming, writing, telephoning and operating a computer.
With the glove system, people have been able to use it for washing dishes and for using tools such
as screw-drivers and paintbrushes. People who have used FES for grasping say they feel more
self-sufficient and independent. People with SCI at C5 level can expect a greater improvement than
those with SCI at C61evel.
Electrical stimulation of arm and hand muscles can decrease spastiCity and the formation of
contractu res. In some cases, it can also improve voluntary movement. FES of the paralyzed hand
can improve grip strength.

'-'

What may be available in the future?


Basic research is underway to develop implantable sensors to control the systems and feedback
methods that will prevent a grasped item from slipping out of the user's hand. Also, researchers are
studying methods to adjust for some amount of muscle fatigue. Another experimental area is
increasing the workspace in which the FES-activated hand can operate. This type of FES system
will activate muscles that control the elbow to move the hand. Some researchers plan to work on
the exciting possibility of controlling both hands with one FES system and providing more types of
hand grasps.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

LEARNING ABOUT FES

21

SCI5. FESsystems for bladder and bowel control


What is the purpose?

Provide a reliable method for emptying the bladder.


Reduce urinary tract infections.
Reduce bladder accidents.
Reduce constipation.
Provide a reliable method for emptying the rectum.
Reduce bowel accidents.

What are non-FES alternatives?


Bladder management includes use of temporary or permanent catheters, or condom catheters
which are attached to leg bags or bed bags. Or, the bladder may be periodically drained by
intermittent catheterization. Surgical procedures may relieve obstructions, and on rare occasions,
divert the urine stream. A frequent complication of all these methods is urinary tract infection, which
must be treated with antibiotics. Some other drugs may also help to reduce bladder problems.
Bowel management involves eating a diet with more fiber, using stool softeners and suppositories,
and digital stimulation of the rectum. Bowel emptying usually takes one half to two hours on each
occasion and may require help from a personal assistant.

How do the FES systems work?


Many different approaches are in use today. In the most widely tested implanted system,
developed in Britain, electrodes are placed on the anterior sacral spinal nerve roots, which control
bladder and bowel contraction. (The sacral area is where the end of the spine joins the pelvis.) The
user controls the electrodes with an external controller that transmits radiofrequency (RF) signals to
an implanted stimulator. Different selections on the external controller will produce emptying of the
bladder or of the bowel.
During implantation of an anterior sacral root stimulator, the surgeon usually cuts the posterior
nerve roots that carry sensation. This procedure is called rhizotomy and it prevents reflexes from
interfering with the desired bladder function. However, this procedure also prevents a man from
having reflex erection of the penis (see section SCI-B). Rhizotomy has another negative effect in
people who have incomplete injuries -- it eliminates sensation in the sacral area. This may
decrease bowel and sexual function.
Another system uses an electrode inserted alongside one of the sacral nerves. These nerves
contain both sensory and motor fibers. Doctors believe that the stimulation of the sensory nerves
interferes with spasticity, which is often the cause of voiding problems. This type of interference is
called neuromodulation. (See sections SCI-12 and MS-12, FES for controlling spasticity.) Built
into the electrode are several conductors. Stimulation can be adjusted among them to get the most
benefit. First, the system is tested with a percutaneous (through the skin) lead and an external
stimulator. If voiding problems are reduced, the user tries the system at home for about a week.
Then, stimulation is stopped. If urinary control becomes difficult again, it shows that the FES
system provided improvement. Then, a permanent electrode and stimulator can be implanted.
Adjustment of the stimulation settings may be necessary during the first 6 months. This system
has helped people with a range of disabling conditions, and is also used for pelvic pain that does
not respond to other treatments.

22

FES RESOURCE GUIDE

Another location where electrical stimulation may be delivered is the surface of the spinal cord.
Called spinal cord stimulation (SCS) or dorsal column stimulation, this method is usually used to
treat pain and spasticity. In some people, especially those with incomplete injuries, it also improves
bladder function and may be implanted for that purpose. See section SCI-12, FES for controlling
spasticity, for further information.
Most bowel problems in spinal cord injury are related to the inability to voluntarily empty the bowels.
This frequently leads to constipation. Rarely, it may happen that a person with spinal cord injury
cannot contain his or her stool, despite medical care of the problem. This is called fecal
incontinence. For this condition, an FES system has been developed to keep the rectum closed.
The system requires a surgical procedure that transfers a leg muscle (gracilis) to be a loop around
the rectum. Then, an electrode to that muscle and a stimulator are implanted in the body. During
an a-week training period, the muscle is gradually conditioned until it can remain contracted all the
time. When the person wants to defecate, he or she turns the stimulation off with a small magnet
placed against the skin over the stimulator. The method is called dynamic graciloplasty.
Pelvic floor stimulation is another method that can help correct problems with bladder or bowel
function. Stimulation is applied to the supportive muscles of the pelvis that help control urination
and defecation. Probes or catheters that contain electrodes are inserted into the rectum, vagina, or
urethra. The treatment protocols vary, but usually stimulation is applied for a certain period every
day. This method strengthens the muscles and improves sensation and contro\. Another method
to improve bladder and bowel function uses surface electrodes placed over the penile nerve (male)!
vaginal area (female), or over the anal sphincter. In addition, some clinicians have reported that
electrodes placed on the skin over the abdomen can improve bowel management for persons with
paralysis.
The wide variety of stimulation techniques that are available for improving bladder and bowel
control reflect the complexity of the problem. A proper evaluation is key to determining which
techniques, if any, are most appropriate.
STATUS OF FES SYSTEMS FOR BLADDER AND BOWEL CONTROL
Clinical research
Multicenter trials
Regulatory Approval
Basic research
SCS, 1 channel,
6 channels,
3 channel, anterior Sacral nerve
totally implanted with
sacral root
stimulator, 1
anterior sacral
battery or RF power
stimulator, totally
channel, totally
root stimulator,
(Unlabeled use except
implanted.
implanted
percutaneous
when prescribed for pain
( Considered
(Multicenter trials of
leads with
control)
i
British system
investigational in the
external
in
US,
but
available
expected
to
begin
Pelvic floor
controller
US in 1996. Available
commercially in
stimulation
Direct bladder
Europe}
commercially in
Anterior sacral root
I
stimulation
Europe, Asia, Far
Dynamic

stimulator (Europe,
East) .
Pudendal nerve
graciloplasty, 1
Asia, Far East}
PelVIC floor
stimulation
channel, totally
Sacral nerve
stimulation
implanted
stimulator (Europe)
Penile nerve!
(Considered
Dynamic
vaginal! anal
investigational in the
Graciloplasty (Europe)
stimUlation with
US, but available
commercially in
surface electrodes
Europe)

--

LEARNING ABOUT FES

23

Who is medically eligible?


Many people with SCI can manage their bladder and bowel function with existing medical
techniques. Because of that, doctors are testing most stimulation devices only on people who have
complications of bladder and bowel function. If these devices receive FDA approval, people without
complications will have access to them in the future also.
Candidates for an anterior sacral root stimulator must be:
More than one year post injury.
Have a complete spinal cord injury.
Have bladder and bowel response to electrical stimulation.
Be emotionally stable and realistic.
A person may be disqualified because of:
Denervation.
Underlying bladder or bowel disease.
Substance abuse.
See additional disqualifying factors on page 11.
Candidates for the other types of systems described would include those with incomplete SCI.

What does it cost?


The British anterior sacral root stimulator costs from $13,000 to $20,000 including surgery and
training. For spinal cord stimulator treatment, the medical evaluation, the device and surgical
implantation cost about $18,000. Prices for other types of implanted systems are comparable. The
cost of pelvic floor stimulation is less than the cost of implanted stimulators, but varies depending
on the particular method. At this time, it is difficult to determine what charges will apply for those
devices considered investigational.

What can I realistically expect?


People who have used a sacral anterior root implant system for bowel and bladder control report:
Fewer urinary tract infections.
Many fewer bladder and bowel accidents.
Shorter times to empty their bowels.
Greater ease and convenience in bladder, and usually bowel, emptying.
Greater comfort and confidence in controlling bladder and bowel functions.
With a reliable method for fully emptying the bladder that is used on a consistent schedule, the user
may be able to retrain the bladder muscle. When the bladder is overfilled and not emptied promptly
the muscle can stretch so much that it becomes ineffective when it tries to expel urine. Thus, urine
is retained, increasing the chance of infection. FES used to empty the bladder may help to prevent
these problems.
The anterior sacral root stimulator can also produce penile erection, although it is unlikely that it
would be prescribed for that purpose (see section SCI-8, FES for erection and electroejaculation).

What may be available in the future?


Clinical feasibility tests are expected to begin during 1996 on an anterior sacral root stimulator that
uses a new pattern of stimulation. It has been designed to produce more effective bowel emptying.
Investigators are also comparing other methods of bladder activation, such as stimulating the
pudendal nerve that controls the bladder sphincter (the muscle fibers that keep the bladder closed
and prevent urine release) and surface stimulation of the bladder itself. These techniques may
require less invasive surgery than those involving anterior sacral root stimulation.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

24

FES RESOURCE GUIDE

SCI6. FES systems for transfers and standing

What is the purpose?


Reduce the need for personal assistance.
Increase mobility and independence.
Reduce the need for bracing.
Increase home, workplace, and leisure capability.
What are non-FES alternatives?
To transfer, people with SCI may require assistance from one or more helpers. To stand, they may
use
Standing frames.
Wheelchairs with standing appliances.
Stand-up wheelchairs.
Long-leg braces.
How do the FES systems work?
An FES system for transfer and standing activates major muscles of the legs and pelvis through
internal or external electrodes. Any FES system for stepping and walking can also be used for
standing- see SCI-7 for more information. In a standing system, electrodes may be placed
internally in or on the muscles -- or externally, on the skin over the muscle. These muscles stiffen
the knee and hip joints to support standing. The simpler FES systems use fewer electrodes -- from
2 to 6.
Some systems, called hybrid systems or hybrid orthoses, add bracing to FES. These braces
(orthoses) range from very small to very large. Small ankle-foot orthoses (AFO) prevent ankle
twisting. Large hip-knee-ankle-foot orthoses (HKAFO) extend from the feet to the ribs These large
braces provide support and balance, reducing the amount of FES used and producing less muscle
fatigue than FES-only systems. In systems that use bracing, FES is typically used during
transitions, such as from sitting to standing.
Another location where electrical stimulation may be delivered is the surface of the spinal cord.
Called spinal cord stimulation (SCS), this method is usually used to treat pain and spasticity. In
some people, especially those with incomplete injuries, it also improves transfers and standing. See
section SCI-12, FES for controlling spasticity, for further information.

STATUS OF FES TRANSFER AND STANDING SYSTEMS


Basic research
Clinical research
Multicenter trials
Vario.us
systems:

2 - 48 channels,
external or
implanted
electrodes, bracing
ranging from none
to HKAFOs

Regulatory approval
6 channels, surface
electrodes, often
used with AFOs
(Approved in 1994)

4 - 6 channels,
surface electrodes,
no bracing
(Slovenia)

LEARNING ABOUT FES

25

Who is medically eligible?


Candidates for lower extremity transfer and standing systems need to have:
Little or no peripheral nerve damage or joint damage.
Good general health.
No current substance abuse.
Flexible joints (only minor contractures).
Upper extremities intact and strong.
At least age 14 (or with fully grown bones).
Optimistic and motivated attitude.
Acceptance of technology.
"

"

'"

""
.......

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""

"
"'-"
......
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"

"
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The following conditions would disqualify a person:


Chronic infective disease.
History of transient ischemic attacks (minor strokes).
Chronic kidney, heart or lung disease.
Poor skin condition in electrode areas.
Allergy to adhesive materials .
Low tolerance to pain.
Amputation, impairment or weakness of upper extremities.
See additional disqualifying factors on page 11.
The great majority of users of FES transfer and standing systems will be people with thoracic (T)
spinal cord injuries, either incomplete or complete, between T -4 and T-12. There will also be some
people with incomplete cervical (C) injuries who will be able to use such systems.

What does it cost?


Surface electrode systems without bracing cost about $15,000 including training.
Hybrid systems (surface electrodes plus HKAFOs) cost from $30,000 - $40,000
including training.
Participation in clinical trials of implanted, percutaneous or surface electrode systems
may carry no monetary cost to research subjects. However, participation may take much
time away from other activities.
How long does the fitting and training take?
When a person begins the process of being fitted with an FES system, there is an initial period of
muscle conditioning. The first activity is FES exercise of the leg muscles while seated. This is an
important process that reverses some of the weakening and loss of bulk that occurred with disuse.
The conditioning phase may take from 1 to 3 months.
Fitting and training with surface electrodes takes from 4 to 6 months.
Fitting and training with implanted muscle electrodes is still in the clinical research phase.
Length of treatment time, varies with the individual's condition. Time ranges from as little as 6
months to as much as 2 years.
What can I realistically expect today?
You may be able to stand with FES for exercise as part of your daily routine. You will need some
type of appliance -- walker, wheelchair frame attachment, etc. -- to provide support and balance.
You may be able to use FES in your daily activities at home or work. All current systems require
you to exert a lot of physical energy, mainly with the arms and shoulders. If you have paralysis on
one side (called hemiplegia) or incomplete paralysis you can expect improved transfers and
standing with FES. You will depend less on braces or a personal assistant.

26

FES RESOURCE GUIDE

FES of the lower body has valuable health benefits. Because using FES demands so much energy,
consistent users improve their cardiovascular capability. FES may reduce spasticity of leg muscles
and increase strength in remaining voluntary muscles. Some regular users of FES standing
systems report reduced pressure sore problems and fewer urinary tract infections.

FES also has benefits for bones. In paralysis, when muscles are inactive and do not put stresses
on the bones, the bones lose mineral content. They become thinner and weaker -- this is called
osteoporosis. People who use FES standing and walking systems are putting stress on their bones.
Some studies have shown that standing with FES can stop loss of bone mineral and slow the
progress of osteoporosis.

What may be available in the future?


The next advance will probably be totally-implanted, 8-channel FES systems. Researchers predict
that FES users will be able to control transfers and standing with a beeper-sized, miniature
controller, attached to a belt.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

SCI-7. FES systems for stepping and walking


What is the purpose?
Increase mobility and independence.
Provide a supplement to the wheelchair.
Reduce the need for bracing or walking aids.
Increase home, workplace, and leisure capability.
What are non-FES alternatives?
Some people with SCI have stood and taken a few steps using the Vannini-Rizzoli stabilizing
limb orthosis. These are knee-high boots with built-in braces. The boots provide limited
balance.
Some people with lower thoracic and lumbar level SCI have successfully used long-leg braces
for stepping. They "swing through" or "swing to" and use elbow crutches or a walker for
additional support and balance. Long leg braces require a very strong upper body and good
balance, including some hip and abdominal control.
Some people with SCI have used braces that extend from the lower chest to the feet (HKAFO)
to walk. One type of HKAFO is the reciprocating gait orthosis (RGO) and another is the hip
guidance orthoses (HGO). These braces provide pelvis and hip support in addition to the
functions of long-leg braces. HKAFOs do not require as much upper body power as long-leg
braces and can be put on or taken off in less than 5 minutes by most people with paraplegia.
However, some RGO users find them too bulky and heavy. Properly fitting RGOs must be hand
made and fitted for each individual. Rehabilitation and training to use an RGO takes a minimum
of 4 months.
How do the FES systems work?
An FES system for stepping and walking activates major muscles of the legs and pelvis through
internal or external electrodes. Electrodes may be placed internally in or on the muscle -- or
externally, on the skin over the muscle.

LEARNING ABOUT FES

27

The minimum system uses four channels. Activation of both thigh muscles (quadriceps) locks the
knees during standing. Stimulating the common peroneal nerve on one side and switching off
quadriceps stimulation on that side together produce bending, or flexion, of that leg. This flexion
combined with movement of the upper body and use of the arms for support allows the user to take
a step. This is called the swing phase of the gait cycle.
If the FES system has six channels, much better performance is possible. One channel on each
side is devoted to activating the hip extensors, muscles that keep the hip joint from bending.
The user voluntarily commands the FES stimulator through switches or a miniature joystick. Some
type of walking aid -- walker, crutches, or canes -- provides support and balance.
Researchers have suggested systems for restoring walking with up to 48 channels. These systems
have either percutaneous or totally implanted electrodes. Their main advantage is their ability to
selectively activate different muscle groups. This type of muscle control can produce movement
that is much more like walking than taking one step at a time.
With the command switch, the user selects from the pre-programmed patterns stored in the
stimulator. Possible functions include standing, walking, side-stepping, back-stepping, stair climbing
and stair descending. Remember that as the technology of any device becomes more complex, the
possibility of technical problems increases.
The systems that use FES together with HKAFOs are called hybrid orthoses. Electrodes (usually
surface type) activate leg and hip muscles to initiate walking. This reduces the energy demand on
the upper body.
Examples of FES systems for stepping and walking: hybrid orthosis with
surface electrodes (left) and implanted electrodes/stimulator (right)

pelVIC anatomy
skm

radio freqUf!rH; Y

tran sm IHer
coil

path of

curren
flow

28

FES RESOURCE GUIDE

FES systems for stepping and walking use stimulation levels that will be high enough to produce
muscle contractions even when muscles are fatigued. This is a safety measure taken to ensure
that the user's legs will not buckle when the muscles tire. If bracing is used together with FES, the
stimulation levels can be lower because the brace can provide support against buckling. Since
stimulation levels are lower, muscles do not fatigue as quickly. In addition, if the FES part of the
system should fail, the brace will prevent the user from falling.

One type of brace used in hybrid systems is the RGO, which some people feel is too bulky and
heavy. To overcome these problems, one experimental system uses a two-part brace: the leg
sections are worn all the time and the trunk section can be removed to simplify some activities. The
leg sections use feedback control to provide muscle stimulation only when needed, thus delaying
muscle fatigue. Braces offer good locations for mounting the sensors that provide the feedback
information.
Another location where electrical stimulation may be delivered is the surface of the spinal cord.
Called spinal cord stimulation (SCS) or dorsal column stimulation, this method is usually used to
treat pain and spasticity. In some people, especially those with incomplete injuries, it also improves
stepping and walking. See section SCI-12, FES for controlling spasticity, for further information.
STATUS OF FES STEPPING AND WALKING SYSTEMS

Multicenter
Regulatory approval

Basic

Clinical research
trials
research

Various
systems:
6 channels, surface

electrodes, sometimes used
2 - 48 channels;
with bracing
surface,
percutaneous, or
2 - 6 channels, surface, hybrid
exercise systems using
implanted electrodes;
I
commercial braces and muscle
bracing ranging from
Ii
stimulators (in combination
none to HKAFOs
unlabeled use)
(US, Canada)
4-channel, surface electrodes,
I
no bracing (Slovenia)
30 channels, percutaneous
electrodes (Japan)

Who is medically eligible?


Candidates for FES stepping and walking systems need to have:
Little or no peripheral nerve damage or joint damage.
Limited osteoporosis.
Flexible joints (only minor contractures).
Good general health.
No current substance abuse.
At least age 14 (or with fully grown bones).
Optimistic and motivated attitude.
Acceptance of technology.
Ability to control balance and upper body posture with arms and an external support
(parallel bars, walker, crutches).
The following conditions would disqualify a person:
More than moderate spasticity.
Chronic infectious disease.

LEARNING ABOUT FES

29

History of transient ischemic attacks (minor strokes).


Chronic severe kidney, heart or lung disease.
Poor skin condition in electrode areas.
Allergy to adhesive materials.
Low tolerance to pain.
See additional disqualifying factors on page 11.

The great majority of users of FES standing and walking systems will be people with thoracic (T)
spinal cord injuries, either incomplete or complete, between C-7 and T-12. There will also be some
people with incomplete cervical (C) injuries who will be able to use such systems.

What does it cost?


Surface electrode systems without bracing cost about $15,000 including training.
Surface electrode systems with HKAFO braces (hybrid orthoses) cost between $30,000 and
$40,000 including training.
Participation in clinical trials of some systems carries no cost to research subjects. However,
there is a large time commitment.

How long does fitting and training take?


When a person begins the process of being fitted with an FES system, there is an initial period of
muscle conditioning. The first activity is FES exercise of the leg muscles while seated. This is an
important process that reverses some of the weakening and loss of bulk that occurred with disuse.
The conditioning phase may take from 1 to 3 months.
Fitting and training with surface electrodes takes from 3 to 6 months.
Fitting and training with intramuscular electrodes is still in the clinical research phase. Length of
treatment time varies with the individual user's condition. Time ranges from as little as 6 months
to as much as 2 years.
The more complex the activities -- for example, going up and down stairs -- the longer the
training will take.

What can I realistically expect today?


Many users report that FES of the lower body has valuable health benefits. Because using the
systems can demand so much energy, consistent users of some systems improve their
cardiovascular capability. For some users, FES reduces spasticity of leg muscles and increases
strength in remaining voluntary muscles. Regular users of FES standing systems report reduced
pressure sore problems and urinary tract infections.
FES also has benefits for bones. In paralysis, when muscles are inactive and do not put stresses
on the bones, the bones lose mineral content. They become thinner and weaker -- this is called
osteoporosis. People who use FES standing and walking systems are putting stress on their bones.
Some studies have shown that standing with FES can stop loss of bone mineral and slow the
progress of osteoporosis.
But, what about the walking? People with incomplete SCI can experience great improvement.
People with complete SCI who meet the entrance criteria will be able to stand up independently
and remain standing for periods as long as one hour. They will probably be able to take single
steps. Some of them will be able to take a series of steps, and some will progress to walking. A
small group of users may also master climbing up and down stairs, depending on the FES system's
capability. Remember that not everyone will benefit from an FES system. Many physical, mental,
social and health factors will influence the outcome.

30

FES RESOURCE GUIDE

Some of today's FES walking systems are useful for limited activities at home or at work. At the
same time, hybrid orthoses have allowed particularly athletic people with paraplegia to walk
several miles. Some systems have a great deal of external equipment. All systems require
excessive energy output. Walking with FES stresses the cardiovascular system as much as
running does in an able-bodied person. If you have paralysis on one side only (called hemiplegia)
or incomplete paralysis, you can expect improved standing and walking with FES. You will depend
less on braces or walking aids. You may be able to use FES daily at home, work or leisure
activities.

What may be available in the future?


Walking is very individual. Not surprisingly, each person using an FES walking system requires
different fitting and programming. Also, programming needs to be adjusted over time as muscles
respond to regular use. If electrodes should move or fail, stimulation patterns will again need to be
modified. Today's FES walking systems have very little built-in feedback to help adjust for fatiguing
muscles or changes in the walking surface. Basic research is underway to develop both the
sensors and the computer programs to provide this kind of automatic adjustment.
The next advance will probably be totally-implanted, a-channel FES systems. Researchers predict
that FES users will be able to control stepping and walking with a beeper-sized, miniature
controller, attached to a belt.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

SCI-B. FES for erection and electroejaculation


What is the purpose?
Produce erection of the penis.
Produce ejaculation to collect sperm for artificial insemination.
What are non-FES alternatives?
In men with SCI at T-9 or above erection can sometimes be produced by:
Masturbation.
Stimulation with a vibrator.
Use of a suction device.
Injection of drugs into the penis.
Implantation of penile prosthesis.
About 65% of these men can ejaculate with masturbation or vibromassage. This mayor may not be
accompanied by erection. Men with injuries at T-5/6 or above may experience sudden high blood
pressure, slow heartbeat, sweating and severe headache with ejaculation. This is called
autonomic dysreflexia. They should consult with their doctors before attempting ejaculation at
home.
For men with SCI belowT-10, only injection, suction and penile prosthesis can be used to produce
an erection. In these men, the nerves that activate the spinal cord to produce ejaculation are
damaged and vibromassage will have no effect.

LEARNING ABOUT FES

31

How do the FES systems work?


Erection
The implanted anterior sacral root stimulator described in section SCI 5, FES for bladder and bowel
control, can produce erection as well as enhance bladder and bowel function. However, it would
probably not be implanted for the sole purpose of providing erection. After the device is implanted,
the doctor will test the effect of stimulating the different nerve roots that have been equipped with
electrodes. In most men, one particular pair will produce erection without bladder contraction. The
FES controller will be tuned with a setting for erection.
Most men, however, will use one of the alternatives to FES listed above, if their primary goal is to
achieve an erection.
Electroejaculation
The doctor inserts an electrode probe into the man's rectum and electrically stimulates the nerves
that control ejaculation. Men with incomplete SCI may need local, spinal or even general
anesthesia because of the strong stinging sensation. A nurse or a second doctor collects the
sperm. In some men whose sperm goes into the bladder, the doctor or nurse will collect it from
there with a catheter. A gynecologist uses the sperm to inseminate the man's partner.
STATUS OF FES FOR ERECTION & ELECTROEJACULATION
Multicenter trials
Basic
Clinical
research
research
About 50 clinics in the US and
Canada offer electroejaculation
procedures for SCI men, but this is
still an experimental procedure in
North America.

I
I

Regulatory approval

Electroejaculation is
available in many
European countries
Anterior sacral root
stimulator for erection
(Europe, Asia, Far East
with multicenter trials to
begin in the US in 1996)

Who ;s medically eligible?


Men with
Any level SCI for electroejaculation.
SCI above T-12 for erection.
6 months post injury.
Men are usually ineligible if they have
Heart rhythm or high blood pressure problems.
Implanted pacing devices.
Possible blood crots.
Some types of tumors.
Tendency for worsening of autonomic dysreflexia with FES.

How long does the treatment take?


See section SCI-5 for details of the implanted stimulator that can produce erection. Use of this
FES system for penile erection can be done whenever and wherever the man chooses.
Electroejaculation treatments should be timed with the man's partner's most fertile time each
month. A single session takes about 45 minutes plus travel time.

bc

32

FES RESOURCE GUIDE

What does it cost?


See section SCI-5 for details on cost of the implanted FES system for erection.
Electroejaculation treatment costs about $400 per session excluding anesthesia. In some
cases, insurance will cover the cost, but this is still considered to be an experimental procedure
in North America.

What can I realistically expect?

Erection
In several studies, about 65% of men using the implanted device described in section SCI-5
achieved full erections. A smaller group achieved partial erections. The device is usually implanted
to improve bladder function and would not likely be implanted only to restore erection.
Electroejaculation
Electroejaculation is successful in nearly all men with SCI but only 70% will have adequate
numbers of sperm to induce a pregnancy. An important issue is the potency of the sperm that is
collected. Because of changes caused by SCI, sperm tends to be much less potent than sperm
from able-bodied men. Doctors may recommend actions that can improve the quality of sperm.
When a couple is trying to conceive a child, the woman's fertility is as important as the man's.
When you undertake electroejaculation, make sure that you also have experienced fertility doctors
on your medical team. Between 30% and 50% of couples who try artificial insemination are
successful. New methods of artificial insemination may increase the success rate.

What may be available in the future?


Researchers are trying to learn more about sexual dysfunction after spinal cord injury. They need
more information about the factors that make sperm different post-injury to understand the effect on
fertility. Advances are also being made in insemination and in-vitro fertilization techniques. These
types of studies may drive further research into electrical stimulation devices to correct male sexual
dysfunction. Even though the electroejaculation techniques available today are inconvenient and
have been around for many years without much innovation, they appear to be effective.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

SCI-9. FES for improving circulation


What is the purpose?
Reduce formation of blood clots (deep venous thrombosis).
Reduce swelling of limbs.
Reduce chance of pressure sores.

What are non-FES alternatives?


Re-positioning of limbs to increase blood flow.
Wearing elastic stockings to prevent clot formation in the lower legs.
Use of anticoagulant drugs. These can be a problem during the first three months after
SCI because they tend to reduce the amount of oxygen that reaches the spinal cord.
Also, they may cause bruises after minor injuries and they may increase the tendency to
bleed if they are taken for a long time.

--

LEARNING ABOUT FES

33

How do the FES systems work?


Surface electrodes are used to apply stimulation to the muscles. The muscle contraction pumps
blood back to the heart, especially from the deep veins. This can help to reduce the formation of
blood clots. Also, blood flow may be increased in the stimulated muscles. This is important because
better circulation improves the nutrition and clean-up of wastes from tissues.
Surface electrode systems used to change or shift pressure on the buttocks (See section SCI-10)
may also improve circulation of blood in that area.
FES used for exercise or walking can also improve circulation (see sections SCI-1 and SCI-7).
STATUS OF FES FOR IMPROVING CIRCULATION
Clinical research
Basic research
Multicenter
trials
Surface FES
systems

"

'
"

Regulatory approval

Physical therapy treatment


using FES with surface
electrodes

Who is medically eligible?


Any person who is at risk for clot formation and who should not use anticoagulant drugs.
Development of clots in deep veins occurs in many people with SCI in the first 3 months following
injury. See disqualifying factors on page 11.

......

"i....

How long does the treatment take?

Therapeutic treatments may last from 10 to 30 minutes, several times a day.

"

What does it cost?

There is no standard and it is difficult to state a cost. Physical therapy sessions generally cost

around $80 each. Once a physical therapist instructs a patient, much of the treatment can be done

at home with a rented or purchased stimulator. Stimulator rental costs about $80 per month.

Stimulator purchase can range from $700 to $2000, depending on the technical features of the

device. Electrodes and supplies may cost $1,000 per year.

What can I realistically expect?


One study made a three-way comparison: 1) treatment with FES, 2) no treatment, and 3) treatment
with blood thinners (low dose heparin). FES and heparin together produced a decrease in
incidence of blood clots, compared to no treatment, or treatment with only heparin.

See page 64, "What Should I Know When Choosing an FES Product or Service?"

34

FES RESOURCE GUIDE

....,

SCI..10. FES 'or preventing pressure sores

What is the purpose?


Prevent formation of pressure sores.

What are non-FES alternatives?





Use a properly designed and fitted seating system.


Change position frequently while lying in bed.
Lift the buttocks from the wheelchair while seated.
When a red area does not disappear within 30 minutes after relieving all pressure, lie on
stomach or side for 24 hours or until redness is completely gone.

How does the FES system work?


Researchers are working on several systems that could be used by people seated in a wheelchair.
These systems deliver electrical stimulation to the buttock muscles. Effects are:
During FES muscle contraction, distribution of pressure over the buttock and thigh muscles
rather than concentration on the "sit bones".
Increased blood and lymph flow that delivers nutrients and removes waste from the tissue.
A more permanent increase in tissue bulk may occur with regular use. This maintains healthy
tissue and helps to prevent pressure sores.

Various FES systems


using surface and
implanted electrodes

Who is medically eligible?


People who have
Difficulty raising their buttocks from the wheelchair seat by using their arms for weight
shifts.
Recurring pressure sores.
No allergy or excessive skin sensitivity.
See additional disqualifying factors on page 11

How long does the treatment take?


If an FES system for preventing pressure sores were developed, using it would be part of a regular
daily routine. The user would likely go through an initial conditioning and training period.
What does it cost?
Since there are no systems currently available specifically designed to prevent pressure sores, it is
difficult to specify a cost. We know that today, physical therapy sessions using surface electrodes
generally cost around $80 each. Muscle stimUlator rental costs about $80 per month. Stimulator
purchase can range from $700 to $2000, depending on the technical features of the device.
Electrodes and supplies may cost $1,000 per year.

LEARNING ABOUT FES

35

What can I realistically expect today?

Regular use of FES to activate buttock muscles that have nerve supply from the spinal cord may
help to prevent pressure sores. People who use FES exercise, standing and walking systems
report fewer problems with pressure sores. See SCI-1, SCI-6, SCI-7, and SCI-15 for more
information.

What may be available in the future?


Researchers are designing projects to measure quantities important to the health of body tissues
and how FES may affect those quantities. If results are favorable, they may contribute to FES
systems for pressure sore prevention.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

SCI-11. FESfor treating pressure sores


What is the purpose?

Speed the healing of pressure sores.

What are non-FES alternatives?

Relieving all pressure.


Antibiotics if there is infection.
In extreme cases, surgery.

How does the FES system work?


Researchers believe that electrical stimulation (ES) may help pressure sores to heal in several
ways. ES increases the amount of oxygen in the tissue around the wound and reduces the number
of bacteria in the wound. Both effects contribute directly to healing. Indirectly, the improved blood
circulation produced by ES boosts the nutrition and waste removal in the tissues (See SCI-9).
It is no surprise that ES also creates electrical currents in the tissue. Normal tissue has natural
electrical currents (different from nerve signals) flowing in it. These currents assist in healing of
wounds. When there is spinal cord injury, neurological disorder, or degeneration (as in the elderly),
these currents are reduced or missing. Surface electrode stimulation can partially replace natural
electrical currents in tissue and assist in wound healing.

electrical
properties of
wounded tissue

Various systems
using surface
electrodes

Physical therapy
treatment with surface
ES systems.

Who is medically eligible?


People who have superficial and minimally infected wounds have the best chance for healing. This
is true both with and without ES. If there is a pocket of infection under the skin or infection of bone,
surgery may be needed. See disqualifying factors on page 7.

36

FES RESOURCE GUIDE

How long does the treatment take?


Healing of pressure sores is usually a lengthy process, and ES has been shown to speed it up.

--

What does it cost?


The most important variables are the health of the individual and the extent of the pressure sore.
Costs will vary widely with the person's condition and whether or not surgery is needed.
What can I realistically expect?
Healing of pressure sores in people with SCI can take a long time. ES treatment can speed the
healing process.
What may be available in the future?
Researchers are conducting stUdies to better understand the electrica'l properties of healthy and
wounded tissue. This should help to determine more effective stimUlation patterns.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

SCI-12. FES for controlling spasticity


What is the purpose?
FES can be used to reduce spasticity. Spasticity is the abnormal, involuntary contraction of
muscles, causing stiff and awkward movements.
What are non-FES alternatives?
Various lying, seated, and standing positions can reduce spasticity.
Very localized spasticity may be treated by heat or cold.
Passive range of motion exercises (patient, therapist or caregiver moves limbs through
a range of motion) may temporarily reduce spasticity. This will also help prevent
contractu res.
Medication can reduce spasticity.
How do the FES systems work?
When FES is applied specifically to counteract spasticity, surface electrodes are applied to the
spastic muscles or to their antagonists. Each muscle has a counterpart muscle that moves the limb
in the opposite direction -- this is called the antagonist.
Spasticity usually occurs in several muscles at once. Some studies have shown that the most
effective treatments are those '!Vhere FES is applied to all the muscles of a limb. Physical therapy
treatment may also be given during the same period. In one study, 30 out of 32 patients
experienced relaxation of their spastic legs after 6 weeks of FES and physical therapy. For 35
minutes a day, they received alternate stimulation of the hamstrings and quadriceps (agonist and
antagonist).
Another method for reducing spasticity is applying FES to skin areas called dermatomes. A
dermatome is an area in which all the sensory nerve receptors belong to the same spinal cord
level. Since particular muscle groups have their motor nerves at specific spinal cord levels, the
dermatome that is stimulated is chosen to have the same spinal cord level as the spastic muscle
group. This type of stimulation is known as dermatomal stimulation.

LEARNING ABOUT FES

37

The use of implanted electrodes or stimulators also may reduce spasticity. Such electrodes may be
implanted in muscles, over nerves, or on the spinal cord. In spinal cord stimulation (SCS), low
levels of stimulation are delivered continuously. A single cable leading to a multiple electrode
provides stimulation that has a general effect on many motor nerves. Thus, an SCS device for
controlling spasticity might have beneficial effects on bladder function, arm movement, standing,
and leg movement. An individual'S level of SCI will determine exactly where on the spinal cord the
surgeon places the electrode array.
Implanted spinal cord stimulators, also called dorsal column stimulators, may be battery-powered
or controlled by radiofrequency waves passing through the skin. Similar to heart pacemakers, the
battery-powered units require replacement after several years. Both types of device are turned on
and off by the patient. Typically, users operate their stimulators most of the day. When the devices
are turned off, the benefits quickly fade.
Doctors believe that dermatomal, SCS, and sacral nerve stimulation work by a method called
neuromodulation. It seems to depend on stimulation of sensory nerves reducing the spasticity of
related motor nerves.

STATUS OF FES FOR CONTROLLING SPASTICITY


Multicenter
Regulatory approval
Basic
Clinical research
research
trials
Various surface and
Physical therapy treatment using
FES with surface electrodes
implanted electrode
Implanted
spinal cord stimulation
systems

(SCS)
(unlabeled
use, except if
Dermatomal (skin)
implanted
to
relieve
pain)
stimulation
I
,-"

Who is medically eligible?


For dermatomal stimulation, physical therapy treatment with surface stimulation or SCS, people
with incomplete or complete spinal cord injury.
See disqualifying factors on page 11.

How long does the treatment take?


When FES is used only for spasticity control, treatment time will depend on which of the many
methods your doctor or therapist is using. One study used 20-minute sessions twice a day.
For SCS, some doctors implant the electrode and stimulator in a single surgery. Others do a one
week trial with an electrode whose wire comes through the skin (percutaneous lead) and can be
implanted in a short out-patient procedure. The lead is connected to an external stimulator. If that
system provides benefit, the doctor will implant the stimulator during a short hospital stay of several
days. During that time, the doctor and therapist will determine the most beneficial stimulation
settings.

lIDs

38

FES RESOURCE GUIDE

What does it cost?


There is no standard treatment. However, a typical therapist charges about $80 per session. A
muscle stimulator costs about $80 per month for rental. Purchase of such a stimulator costs from
$700 to $2000, depending on its special features. Electrodes and supplies may cost $1,000 per
year. Once a person learns how to use the stimulator, he or she can carry out treatment at home.

--

A spinal cord stimulator, surgery to implant it, and tuning the device to provide the most benefit cost
about $18,000.

What can I realistically expect?


Some people experience a reduction in spasticity from just enough stimulation intensity to create a
"tingling" sensation. Others have better relief when FES produces a muscle contraction or moves a
limb. People who use FES daily for exercise, hand function or walking report that their spasticity is
suppressed 24-hours a day. Regular use of FES may help to reduce spasticity but it will not
eliminate the problem.
For more information about exercise, grasping, standing, and walking systems, see sections SCI-1,
SCI-4, SCI-5, and SCI-7.
If spasticity is reduced over a long period, then there may be a reduction in contractu res also. See
section SCI-13, FES for preventing or treating contractures.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

SCI-13. FES far preventingar treating cantractures


What is the purpose?
Maintain full range of joint motion (ability to move limbs to all normal angles).
Regain lost range of motion (ROM).
What are non-FES alternatives?
Many standard physical therapy techniques are available, including:
Use of splints or braces.
Passive joint ROM by therapist or caregiver, or by positioning one's own body.
Exercise against resistance (for example, lifting weights), if the muscles are strong
enough to take the joint through a full ROM.
Use of heat may assist in gaining joint ROM if it is combined with other treatments like
positioning (see section SCI-12).
If spasticity is causing contractu res, then decreasing spasticity will maintain ROM (see
section SCI-12).
How does the FES system work?

Skin surface electrodes and portable, battery-powered stimulators are used. The muscle
contraction must be strong enough to move the joint through the available ROM and "tug" a bit at
the end of the range.

--

LEARNING ABOUT FES

39

Occasionally, implanted electrodes and stimulators have been used for reducing contractures as an
intermediate step to implementing a complete grasping, standing, or walking system. See sections
SCI-4, SCI-6, and SCI-7 for more information.
STA TUS OF FES TO PREVENT OR TREAT CONTRACTU RES
Basic
Clinical research
Multicenter
Regulatory approval
research
trials
Physical therapy treatment
using FES with surface
electrodes
""'

I\...

'''-

Who is medically eligible?


FES to prevent and treat contractures is suitable for most people with SCI. See disqualifying factors
on page 11.
How long does the treatment take?
Therapeutic treatments may last from 10 to 30 minutes, possibly as frequently as several times a
day.
What does it cost?
As there is no standard physical therapy treatment for contractures, it is difficult to state a cost. A
typical therapist charges about $80 per session. A muscle stimulator costs about $80 per month for
rental. Purchase of such a stimulator costs from $700 to $2000, depending on its special features.
Electrodes and supplies may cost $1,000 per year. Once a person learns how to use the stimulator,
he or she can carry out some treatments at home.
What can I realistically expect?
Physical therapy with FES may reduce contractures.
Regular use of FES exercise, grasping, standing, or walking systems may help to
prevent contractures. In some cases, FES can improve joint ROM more than standard
rehabilitation. See sections SCI-1, SCI-4, SCI-6, and SCI-7 for more information.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

SC/-14. FES for preventing or treating osteoporosis


What is the purpose?
Stop the weakening of bone in people who are immobilized due to SCI.
In healthy people, bone tissue is kept strong by the constant stresses placed on bones in everyday
activity. In normal bone there is an ongoing process of death and regrowth of cells. Stresses on
bone cause new bone cells to grow and minerals to be deposited in bone. When a person is
immobilized, the stresses on bone, cartilage, ligaments and tendons are severely reduced. When
such a person can no longer stand, and the legs don't bear weight, there is very little stress on the
leg bones. As a result, growth of bone cells and deposit of minerals in leg bones are reduced. Bone
mass or mineral density is reduced and the bones become more porous, a condition called
osteoporosis.

40

FES RESOURCE GUIDE

"""

What are non-FES alternatives?


Standing with
Standing frame.
Bracing.
Standing attachment on wheelchair.
Stand-up wheelchair.
Some people who use these devices experience fractures of their osteoporotic bones.

--

How do the FES systems work?


Standing and walking with FES (see sections SCI-6 and SCI-7) can stress the leg bones in ways
that can help to prevent bone loss. This is effective in the months immediately following SCI. Even
in people who have had SCI for years, it can also help to reverse osteoporosis to some degree.
FES bicycle exercise does not have that effect. Some researchers have tested a modified bicycle
exerciser designed to increase bone density. The new machine mimics the forces that affect the
feet and legs during walking.
Muscle stimulation exercise routines that generate 40% of maximal voluntary muscle contraction
have been reported to aid in bone strengthening.

STATUS OF FES FOR PREVENTING OR TREATING OSTEOPOROSIS


Basic
Multicenter
Clinical research
research
trials
Standing/walking
systems

Modified bicycle exerciser


Surface muscle stimulation

Regulatory
Approval

Who is medically eligible?


See sections SCI-1, SCI-6, and SCI-7.
See disqualifying factors on page 11.
How long does the treatment take?
Bone loss begins immediately after spinal cord injury. Most of the loss has occurred by about one
year. Some researchers suggest that immediate rehabilitation with weight bearing may help to
prevent this early loss.
Benefits of regular bone-stressing exercise have been shown in one study after 4 months of three
sessions per week. No further bone was lost. But, bone mineral density did not increase.
Osteoporosis was stopped but it was not reversed. In another study, after daily use of an FES
walking system for 6-12 months, bone mineral density increased in paraplegic subjects but not to
the level of a normal person. In this case, osteoporosis was somewhat reversed.

What does it cost?


See sections SCI-6 and SCI-7 for the cost of standing or walking systems. The cost for a modified
bicycle ergometer would be similar to that of a standard FES bicycle ergometer - see section SCI-1.
The cost of a small portable muscle stimulator would be from $700 to $2000, depending on its
special features. Electrodes and supplies may cost $1,000 per year.

--

LEARNING ABOUT FES

41

What can I realistically expect?


Using FES to stress bones seems to be able to stop the progress of osteoporosis. However, the
effect may vary with the length of time since SCI and the location of the bones in the body_ Further
research is needed to understand what factors are important in stopping and reversing the
weakening of bone after SCI. A note of caution: some people who use FES systems for exercise or
standing and walking have had fractures of their osteoporotic bones. A medical evaluation prior to
starting FES is critical.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

SCI-iS. FESfar treating weak, atrophied muscles


What is the purpose?
Strengthen weak muscles.
Increase bulk of shrunken (atrophied) muscles.
What are non-FES alternatives?
When muscles are totally paralyzed, there is no other way than FES to activate them. When
muscles are partially paralyzed, voluntary exercise can help to maintain some level of strength.
How do the FES systems work?
In the general practice of physical therapy, electrical stimulation (ES) with surface electrodes is
used to treat various problems of muscles and bones. Often, these problems result from injuries
such as fractures or dislocations. ES may be used to help maintain muscle condition, to increase
the range of movement (see section SCI-13), and to assist weak muscles.
Any type of electrode or muscle stimulator may be used. Some muscle stimulators for paralyzed
people are packaged with customized electrode garments to make it easier to set up and connect
the electrodes. FES or ES activates the weak or paralyzed muscle. Even though these systems are
simple, they should only be used with appropriate instruction from a clinician.

Example of typical FES surface electrode system used in physical therapy

42

FES RESOURCE GUIDE

The muscle response to stimulation will depend on the type of weakness or paralysis. Muscle that
is weak because of inactivity but is still under voluntary control will become stronger and bulkier
(hypertrophy). Muscle that is paralyzed due to an upper motor neuron lesion will become bulkier
but voluntary strength will not improve. However, the strength during FES will increase. Muscle that
is paralyzed due to a lower motor neuron lesion (denervated) may become bulkier, but voluntary
strength will not improve and strength during FES will probably not improve.
FES systems for cardiovascular exercise, grasping, standing and stepping (see sections SCI-1,
SCI-4, SCI-6, and SCI-7) may also make muscles stronger and larger. A crucial factor is whether or
not the stimulation regimen stresses the muscle.
STATUS OF FES FOR INCREASING STRENGTH AND BULK OF PARALYZED MUSCLES
Basic
Clinical research
Multicenter
Regulatory approval
research
trials
Special stimulators
Physical therapy treatment using
designed for
FES with surface electrodes
denervated muscle
Specialized
FES systems with

electrode garments

Who is medically eligible?


Generally, FES will only work for the extended periods of time necessary to convert the paralyzed
muscle into a stronger muscle if there is no denervation -- loss of nerve supply between the spinal
cord and the muscle. For specialized physical therapy treatment with surface electrodes, persons
should have
Good skin condition.
No allergy to adhesives or gels used with surface electrodes.
See disqualifying factors on page 11.
How long does the treatment take?
Like any kind of exercise, muscle exercise for maintaining strength and bulk needs to be done as
part of a regular daily routine. Suggested exercise times will vary with the therapist and the
patient's condition. Initial sessions will be under the guidance of a therapist with later sessions
completed independently.
What does it cost?
Specialized physical therapy treatment with muscle stimulators costs around $80 for each session
with a therapist. Purchase of a home model stimulator costs $700 - $2000 and rental costs about
$80 per month. Electrodes and supplies may cost $1,000 per year. Custom muscle stimulation
systems that include electrode garments can cost several thousand dollars. They may provide long
term savings by reducing the cost of supplies. Third party payers usually do not pay for this
treatment if the condition causing the atrophy is permanent as in central nervous system paralysis.
What can I realistically expect?
Consistent exercise may result in increased muscle bulk and strength. Side benefits may include
improved circulation and reduced risk of pressure sores. As with any physical therapy treatment,
an improvement in daily function or well being should result from FES/ES (for example,
independent standing, or transfers for people with partial paralysis).

LEARNING ABOUT FES

43

What may be available in the future?


Because denervated muscle is missing a nerve supply, traditional muscle stimulators are not
effective. Although it is possible to stimulate the muscle directly, this requires very high currents
and the muscle fatigues quickly. New stimulators are being designed to get around these
problems.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

SCI-16. FES for controlling tremor


'"-

Not used in SCI. See section MS-16 for information about use of FES for controlling tremor in
multiple sclerosis.

SCI-17. FES for sensation

'

What is the purpose?


Sensory substitution is the use of one sense to receive information normally received by another
sense. In SCI, normal sensory receptors may be present in the skin, muscles, and joints but the
spinal injury prevents the sensory signals from reaching the brain. Certain FES systems can
provide a substitute for the missing or impaired sensation. Substitute sensory feedback can make
the use of FES systems more natural and easier to learn.
What are non-FES alternatives?
FES users with impaired sensation can sense when they need to make adjustments to their
systems by using visual feedback. For example, if a user of an FES grasp system sees a held
object slipping out of the hand, he or she may be able to adjust the stimulation to grasp the object
more firmly. Also, if an FES system has the capability, the user may be able to trigger a change
from one to another pre-programmed stimulation pattern when he or she sees that it is needed.
How do the FES systems work?
Besides the electrodes used to activate muscles, some FES systems have another kind of
electrode known as a sensory electrode. Typically, the electrode is placed where the user has
skin sensation. Electrotactile stimulation involves activating the sensory electrode in a certain
pattern so that the user feels a tickling sensation that represents coded information. The
information may relate to forces that the user is exerting on an object but cannot feel due to
impaired sensation. Or the information may relate to FES stimulator settings. For example, signals
about grasp force may be sent to the sensory electrode. At the beginning, this type of substitute
sensation may seem unrelated to muscle force in the fingers, because the sensation is so far away
from the fingers. With practice, the user can learn to reinterpret the skin sensation as an indicator
of grasp force. However, it may take months to achieve this.

Regulatory

......'....."'".1

Single skin
electrode and
electrode arrays for
substitute sensory
stimulation

Skin electrode
arrays for
substitute
sensory
stimulation

Substitute sensory
electrode in
grasping systems

44

FES RESOURCE GUIDE

Who is medically eligible?


See section SCI-4 for grasping systems. See disqualifying factors on page 11.

How long does the treatment take?


See section SCI-4 grasping systems. Most aspects of FES for restoring sensation are in such
basic research stages that we cannot talk about treatment times yet.
What does it cost?

See section SCI-4 FES grasping systems.

What can I realistically expect?


At the present time, only one FES hand-grasp system provides sensory information to the user.
This information is about the stimulator settings rather than about quantities that are felt at the
fingers or hand.
What may be available in the future?
Researchers are studying single electrodes and electrode arrays as ways of providing the FES
system user with more complex sensory information. Examples would be positions of the fingers,
force exerted by the fingers, and surface texture.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

SCI-18. FES for regaining voluntary function


What is the purpose?
When the spinal cord has suffered a complete injury, lost neural function will not be regained. FES
devices can be used to replace some of those lost functions in those SCI patients who are
medically eligible. However, if an injury is incomplete -- meaning that there are still some nerve
pathways that go from the brain to the peripheral nerves -- there is a possibility that some or all of
the lost function can be regained.
What are non-FES alternatives?
Voluntary exercise.
Biofeedback. Electronic devices give users information about how their bodies function.
The information may be sounds, or lines on a computer screen that are produced from
signals obtained from a pickup (or sensor electrode on the body). In this way, the user
can recognize very small muscle movements (too small to be noticed) and may begin to
exert conscious control over them. Biofeedback has been used before FES to help
establish conscious'control of muscles. Afterwards, FES is used to strengthen those
muscles. Biofeedback may also be used to establish better voluntary control following
gains achieved with FES.

How do the FES systems work?


Various FES devices may help an individual to regain voluntary function. Movement practice with
FES can assist the weak remaining function in the person with an incomplete injury. With FES
exercise, weakened muscles can become stronger. As they grow stronger, they can respond better
to the weak nerve signals. In time, they may produce a noticeable movement. At first, such a

--

LEARNING ABOUT FES

45

movement may be too small to be useful. Later, it may become functional. Biofeedback, alone or
with FES, may be valuable in converting the small movement to a functional one.

Spinal cord stimulation (SCS), also called dorsal column stimulation, applies electrical pulses
directly to the spinal cord. In some people, this produces a general improvement in coordination
and strength. See section SCI-12, FES for controlling spasticity, for more information on SCS.

Basic research
Various
stimulation
systems

Clinical
research
Various
stimUlation
systems;
some with
biofeedback

Multicenter trials

Regulatory approval

!.

Various surface
stimUlation systems;
some with biofeedback

Many different FES devices may be useful in restoring voluntary function to the person with SCI.
See sections SCI-1 through SCI-17. Benefits have been reported with use of a simple two-channel
surface electrode stimulator, providing continuous pulses during sleep.

Who is medically eligible?


People who have
Innervated muscle (active nerve cells going to muscle fibers).
Enough nerve cells remaining to permit "strengthening". If only a few nerve cells remain,
it will not be possible to improve muscle function.
See sections SCI-1 through SCI-17, for the specific function of interest. See disqualifying factors on
page 11. See the discussion in SCI-15 regarding denervation.

''-

How long does the treatment take?


This is perhaps the most unpredictable area of FES application. It may take months or it may take
years for voluntary function to return, if it returns at all.
What does it cost?
See sections SCI-1 through SCI 17.
What can I realistically expect?
In some cases, with sufficient physical therapy and FES, the injured person can regain function.
How much is regained will depend on the particular injury. Each case is different.

'.....

46

FES RESOURCE GUIDE

What FES Applications Can Benefit People

--

with Multiple Sclerosis?


Multiple sclerosis (MS) is usually managed with medical and drug care. FES is rarely used.
Therefore, there is not as much information about FES in people with MS as there is in people with
spinal cord injury (SCI).
MS is classified into types according to how the disease changes over time, or progresses.
About half of people with MS have what is called relapsing-remitting MS. They have attacks of
neural problems (such as double vision, weakness, or poor coordination) which then subside. In
some people, the symptoms may completely disappear after an attack. But, in others some neural
difficulty remains after an attack. Over the course of many attacks, the person's neurological
condition becomes progressively worse.
Selecting people with MS to receive FES systems is difficult because MS is often a
progressive condition. That makes it hard to judge if FES is bringing any improvement. The
person's condition may be changing during a period of FES treatment. This would make it
impossible to properly evaluate the treatment. To avoid this, doctors are careful to select people
with stable conditions, early in the course of their disease. Once FES treatment has begun, a
change in condition may require modifications to the FES systems. Changes may, in some cases,
exclude the use of FES systems.
Another problem is that people with MS have increased skin sensation and find surface
stimulation uncomfortable. Researchers are developing stimulation techniques that may provide
more comfortable stimulation for the future.
The picture on page 4 names 18 applications of FES, some of which have been
used in people with MS. The stage of development of the applications varies from basic research to
regulatory approval (see table on page 10). Just because a treatment is approved does not mean it
will be widely available. When a device and treatment are approved in the US, it means that the
Food and Drug Administration (FDA) has determined it to be safe and effective. In other countries,
agencies similar to the FDA grant approval according to their own guidelines, which often differ
from the FDA's. The doctor and therapist who provide you with your regular care may not know
about a particular treatment. If they do know about it, they may not have the training necessary to
give that treatment. This book and other resources are available to help rehabilitation professionals
who seek education and training about FES.
One of the few approved uses of FES in people with MS is for control of pain. This
treatment uses spinal cord stimulation (SCS), also called dorsal column stimulation. When SCS
is used for other goals, such as' improving voluntary control of movement or improving bladder
control, it is called an unlabelled use.
The sections that follow explain how each application works, its purpose, availability and
cost, who is eligible, time of treatment, and expected outcomes. See Part 2. WHERE TO GET FES
for specific details about locations where treatment is available.
For each application there are medical eligibility requirements. In addition, there are factors
which would probably disqualify a candidate. Many of these disqualifying factors apply to almost all
uses of FES.

LEARNING ABOUT FES

47

The disqualifying factors include:


Poor skin condition.
Allergy to electrode gels or adhesives.
Heart rhythm or high blood pressure problems.
Implanted pacing devices.
Possible blood clots.
Some types of tumors.
Pregnancy.
Unhealed wounds.
Chronic infective disease.
History of transient ischemic attacks (minor strokes).
Chronic severe kidney, heart or lung disease.
People who have any of the above conditions should not use FES.
The sections below provide information on the current use of FES in MS. Even jf a
particular type of FES is not used in MS treatment today, learning about how it is used in spinal
cord injury may be helpful for the future. Refer to sections SCI-1 through SCI-18 for information
about FES in persons with spinal cord injury.

MS-1. FES systems for cardiovascular exercise


Currently, FES systems to improve cardiovascular health are not designed for use by persons with
MS, although there are reports that people with MS are using the systems. For further information
see SCI-1, FES for cardiovascular exercise.

MS-2. FES systems for breathing assistance


"'--

Not used in MS at present.

MS-3. FES systems for cough assistance


A person with MS and very weak abdominal muscles might benefit from an FES cough assist
device. Such devices have not been tested in people with MS. For further information see SCI - 3,
FES for cough assist.

MS,:4. FES systems for grasping and reaching


Specialized systems for grasping and reaching have not been designed for people with MS. FES
systems implanted to control pain or spasticity in people with MS have improved hand and arm
function in some people. Also, FES has been tested for improving strength and coordination in
people with MS. Some users of spinal cord stimUlation (SCS) showed improved hand strength
and they could move their hands faster. See sections MS-12, FES systems for controlling spasticity
and MS-18, FES systems for improving control of movement.

48

FES RESOURCE GUIDE

MS-5. FES systems for bladder and bowel control

--

What is the purpose?


Provide a reliable method for emptying the bladder.
Reduce bladder accidents.
Reduce urinary tract infections.
Provide a reliable method for emptying the rectum.
Reduce constipation.
Reduce bowel accidents.
What are non-FES alternatives?
Bladder management includes
A regular toilet routine.
Exercising weak pelvic floor muscles.
Use of condom and leg bags (men).
Intermittent or permanent catheterization.
In addition, some drugs help to reduce bladder problems.
It is important not to reduce fluid intake. People might think that would make it easier to manage
needing to urinate frequently. But, reduced fluid intake is not good for you. It may cause infection
and dehydration. It contributes to constipation.
Loss of bowel control is rarely a problem in MS. But, where bowel control is a problem the exact
cause must be identified and can sometimes be helped by FES. Constipation is a more common
problem. In that case, bowel management involves eating a diet with more fiber, and using stool
softeners and suppositories when needed.

How do the FES systems work?


In an anterior sacral nerve root stimulator, electrodes are implanted on the spinal nerve roots that
control bladder and bowel contraction. The user controls the electrodes with either an external
stimulator or an external controller that runs an implanted stimUlator. This will be dictated by which
type of electrodes (totally implanted or with percutaneous leads) are used. Different selections on
the external controller will produce contraction of the bladder or bowel muscles.
Another system uses an electrode inserted alongside one of the sacral nerves. These nerves
contain both sensory and motor fibers. Doctors believe that the stimulation of the sensory nerves
interferes with spasticity, which is often the cause of voiding problems. This type of interference is
called neuromodulation. (See sections SCIIMS-12, FES for controlling spasticity.) Built into the
electrode are several conductors. Stimulation can be adjusted among them to get the most benefit.
First, the system is tested with a percutaneous (through the skin) lead and an external stimulator.
If voiding problems are reduced, the user tries the system at home for about a week. Then,
stimUlation is stopped. If urinary control becomes difficult again, it shows that the FES system
provided improvement. Then, a permanent electrode and stimulator can be implanted. Adjustment
of the stimulation settings may be necessary during the first six months. This system has also
helped people with pelvic pain that does not respond to other treatments.
Another method that has been used to control bladder function is spinal cord stimulation (SCS)
(see section MS-18, FES systems for improving control of movement).

.....,

..
LEARNING ABOUT FES

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49

Pelvic floor stimulation is another method that can help correct problems with bladder or bowel
function. Stimulation is applied to the supportive muscles of the pelvis that help control urination
and defecation. Probes or catheters that contain electrodes are inserted into the rectum, vagina, or
urethra. The treatment protocols vary, but usually stimulation is applied for a certain period every
day. This method strengthens the muscles and improves sensation and control. For treating
constipation, sometimes, surface electrodes applied to the skin of the abdomen, thigh or the anus
can be used.
The wide variety of stimulation techniques that are available for improving bladder and bowel
control reflect the complexity of the problem. A proper evaluation is key to determining which
techniques, if any, are most appropriate.
STATUS OF FES SYSTEMS FOR BUADDER AND BOWEL CONTROL
Basic research
! Clinical research
Multicenter trials
Regulatory Approval
f---------f--___::--:---:----~___1r_____:=______:----___1.-_=:=_=_::__-o"-:-'-"---."--., - 3 channel, anterior - Sacral nerve
- SCS, 1 channel,
stimulator, 1
totally implanted with
. sacral root
channel, totally
battery or RF power
stimulator, totally
implanted.
(Unlabeled use except
implanted
(Multicenter trials of
British system
expected to begin in
us in 1996. Available
commercially in
Europe, Asia, Far
East)

(Considered
investigational in the
US, but available
commercially in
Europe)

Pelvic floor
stimulation
Anterior sacral root
stimulator (Europe,

Pelvic floor

stimulation with
various types of

when prescribed for pain


control)

Asia, Far East)

Sacral nerve
stimulator (Europe)

electrodes

Who is medically eligible?


A person with MS who
- May need to urinate frequently.
- Cannot contain urine voluntarily (incontinence).

- Has bladder and bowel response to electrical stimulation.

- Is emotionally stable and realistic.

A person may be disqualified because of:


- Denervation.
- Underlying bladder or bowel disease.
- Substance abuse.
- See additional disqualifying factors on page 46.

What does it cost?


The British anterior sacral root stimulator costs from $13,000- $20,000, including surgery. It is only
available in the US as an investigational device. For SCS treatment, the medical evaluation, the
device, and surgical implantation cost about $18,000. The cost of pelviC floor stimulation is less
than the cost of implanted stimulators, but varies depending on the particular method.

50

RESOURCE GUIDE

How long does the treatment take?


Preliminary assessment to determine if you are medically eligible for implanted bladder/bowel
devices may take several months. Lengthy tests of the urinary tract and colon may be needed. If
implantation surgery is necessary, it will involve a hospital stay of up to one week.

--

--

What can I realistically expect?


Only a few dozen people with MS have received the anterior sacral root stimulator. Their
experience is similar to that of the people with SCI who received the same device. In one study,
more than half of the users found it to be good or satisfactory for emptying the bladder. See
section SCI-5 for additional information.
The anterior sacral root stimulator can also produce penile erection, although it is unlikely that it
would be prescribed for that purpose only (see section MS-8, FES for erection and
electroejaculation) .
Spinal cord stimulation produced improvement on nerve tests and urine flow tests in 42% of 40
people with MS. An even larger group, 77%, felt that implantation of the SCS improved their
bladder control.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

NlS-6. FES systems for transfers and standing


Systems for transfers and standing have not been designed for people with MS. Some systems for
people with SCI are being modified for use in people with MS. See section SCI-6, FES systems for
transfers and standing.
FES systems implanted to control pain or spasticity in people with MS have improved transfers and
stepping in some of those patients. FES delivered at the surface of the spinal cord, spinal cord
stimulation, has been tested for improving strength and coordination in people with MS. See
sections MS-7, FES systems for stepping and walking; MS-12, FES systems for controlling
spasticity; and MS-18 FES systems for improving control of movement.

NlS-7. FES systems for stepping and walking


What is the purpose?

Increase mobility and independence.


Improve muscle coordination.
Improve muscle power.
Increase home, workplace, and leisure capability.

What are non-FES alternatives?

Braces.
Anti-spasticity drug treatment.

--

LEARNING ABOUT FES

51

How do the FES systems work?


Surface FES systems have been designed to help with walking by lifting the toe or the whole foot
during a step. Such systems may help those who have footdrop. This is a condition where the toe
drags on the ground as a step is taken. During walking, the FES system produces a short burst of
stimulation timed by a trigger switch usually placed under the heel or toe.
Spinal cord stimulation (SCS), also called dorsal column stimulation, may improve a person's
ability to stand and take steps. See section MS-18, FES systems for improving control of
movement, for details about this implanted stimulation system.

Various surface
electrode systems
Surface electrode
system with
feedback

Surface electrode
systems with foot
switch (US, Europe,
other regions)
Spinal cord stimUlation
(SCS) (unlabelled use
except if implanted to relieve

Who is medically eligible?


People with
Little or no peripheral nerve damage or joint damage.
No current substance abuse.
Flexible joints (only minor contractures).
Optimistic and motivated attitude.
Acceptance of technology.
See disqualifying factors on page 46.
What does it cost?
A foot drop system with surface electrodes costs $300-$1,500.
Surface electrode systems without bracing cost about $15,000 including training.
How long

does fitting and training take?


Fitting and training with a footdrop system takes 1 - 2 days.
Fitting and training with the spinal cord stimulator may take about a month.
Fitting and training with a surface electrode walking system is still under development.

What can I realistically expect?


Only a small number of people with MS have been treated with FES. Doctors disagree on the value
of FES for this population. Some doctors feel SCS should be used as soon as possible in the
weakened person with MS. Others observed that there were no benefits of SCS two years after
implantation. Some of these failures were probably the result of faulty equipment in the early
devices (1970s to mid 1980s).
FES has valuable health benefits in some people. Because using the systems demands so much
energy, consistent users improve their cardiovascular capability. When FES is used for weight
bearing activity, it can help to increase bone strength. See section MS-14, FES for osteoporosis.
Regular SCI users of FES standing systems report reduced pressure sore problems and urinary
tract infections.

52

--

FES RESOURCE GUIDE

What may be available in the future?


A surface FES system for standing and walking in SCI is being modified for use in people with MS.
The specific goals of motion control in people with MS change constantly. For FES to work with the
person's voluntary movement, feedback is needed to adjust the stimulation levels. The goal is to
create automatic minute-to-minute changes in the FES pulses.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

MSM8. FES for erection and electroejaculation


What is the purpose?

Produce erection of the penis.


Produce ejaculation to collect sperm for artificial insemination.

What are non-FES alternatives?

Masturbation.
Stimulation with a vibrator.
Use of a suction device.
Injection of drugs into the penis.
Penile prosthesis.

How do the FES systems work?


Erection
The bladder and bowel device described in section MS-5 (anterior sacral root stimulator) can also
produce erection. although it would probably not be prescribed solely for that purpose. After the
device is implanted. the doctor will test the effect of stimulating the different nerve roots that have
been equipped with electrodes. In most men, one particular pair will produce erection without
bladder contraction. The FES controller will be tuned with a setting for erection.
Most men with MS will choose one of the above non-FES alternatives if the primary goal is to
achieve erection.

Electroejaculation
The doctor inserts a probe into the man's rectum and electrically stimulates the nerves that control
ejaculation. The individual may need local or general anesthesia because of the discomfort,
particularly if he retains sensation in the rectum and lower abdomen. A nurse or a second doctor
collects the sperm. In some men whose sperm goes into the bladder. the doctor or nurse will collect
it from there. A gynecologist uses the sperm to inseminate the man's partner.
STATUS OF FES FOR ElECTROEJACUlATION
Clinical
Multicenter trials
Basic
research
research
About 50 clinics in the US and
I
Canada offer electroejaculation
procedures, still considered
experimental in North America.

Regulatory approval

Electroejaculation (many
European countries)
i

--

LEARNING ABOUT FES

53

Who is medically eligible?


Men with MS who cannot achieve ejaculation by other methods.

See disqualifying factors on page 11.

"-

How long does the treatment take?

""-

Electroejaculation treatments should be timed with the man's partner's most fertile time each
month. A single session takes about 45 minutes plus travel time.

What does it cost?


Electroejaculation treatment costs about $400 per session plus anesthesia charges. In some
cases, insurance will cover the cost, but this is still considered to be an experimental procedure in
North America.

What can I realistically expect?


Electroejaculation has been successful in a few men with MS.
An important issue is the potency of the sperm that is collected. Also, when a couple is trying to
conceive a child, the woman's fertility is as important as the man's. When you undertake
electroejaculation, make sure that you also have experienced fertility doctors on your medical team.
Between 30% and 50% of couples who try artificial insemination are successful. New methods of
artificial insemination may increase the success rate.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

MS-9. FES for improving circulation


Currently, customized FES systems to improve circulation are not designed for use by persons with
MS. Still, it is possible that these and generic muscle stimulation systems may be beneficial. For
further information see SCI-9, FES for improving circulation.

MS-10. FES for preventing pressure sores


What is the purpose?
Prevent formation of pressure sores.

What are non-FES alternatives?





Use a properly designed and fitted seating system.


Change position frequently while lying in bed.
Lift the buttocks from the wheelchair while seated.
When a red area does not disappear within 30 minutes after relieving all pressure, lie on
stomach or side for 24 hours or until redness is completely gone.

How do the FES systems work?


Researchers are working on several systems that could be used by people seated in a wheelchair.
These systems deliver electrical stimulation to the buttock muscles. People with MS may have a
level of sensation that makes use of such systems very uncomfortable. See SCI-10, FES for
preventing pressure sores, for further information.

54

FES RESOURCE GUIDE

STATUS OF FES FOR PREVENTING PRESSURE SORES


i Basic
Clinical research
Multicenter trials
research
i
Various prevention
systems using surface
electrodes

---

Regulatory
approval

Who is medically eligible?


For surface electrode FES treatment, the person with MS should have
Otherwise good general health.
No allergy or excessive skin sensitivity.
See disqualifying factors on page 46.
How long does the treatment take?
If an FES system for preventing pressure sores were developed, using it would be part of a regular
daily routine.
What does it cost?
Using FES to prevent pressure sores may be done in a variety of ways by different doctors and
therapists. There is no standard and it is difficult to state a cost. Physical therapy sessions
generally cost around $80 each. Once a physical therapist instructs a patient, much of the FES can
be done at home with a rented or purchased stimulator.
What can I realistically expect?
Regular use of FES to activate buttock muscles that have nerve supply from the spinal cord may
help to prevent pressure sores.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

MS-11. FES for treating pressure sores


What is the purpose?
Speed the healing of pressure sores.
What are non-FES alternatives?

Relieving all pressure.


Antibiotics if there is. infection.
In extreme cases, surgery.

How do the FES systems work?


Researchers believe that electrical stimulation (ES) may help pressure sores to heal in several
ways. ES increases the amount of oxygen in the tissue around the wound and reduces the number
of bacteria in the wound. Both effects contribute directly to healing. Indirectly, the improved blood
circulation produced by ES boosts the nutrition and waste removal in the tissues (See sections MS9 and SCI-9, FES for improving circulation).

--
--

LEARNING ABOUT FES

"
'-'
'-'
'-'
'-'

55

It is no surprise that ES also creates electrical currents in the tissue. Normal tissue has natural
electrical currents (different from nerve s;gnals) flowing in it. These currents assist in healing of
wounds. When there is neurological disease, or degeneration (as in the elderly), these currents are
reduced or missing. Surface electrode stimulation can be used to substitute for the electrical
currents in tissue and to assist in wound healing.

Regulatory approval
trials
'

'-'

Studies
electrical
properties of
wounded
tissue

Various
systems using
surface
electrodes

Physical therapy treatment using


FES with surface electrodes

Who is medically eligible?


People who have superficial and minimally infected wounds have the best chance for healing. This
is true both with and without ES. If there is a pocket of infection under the skin or infection of bone,
surgery may be needed. See disqualifying factors on page 46.
How long does the treatment take?
Healing of pressure sores is usually a lengthy process, and ES has been shown to speed it up.
What does it cost?
The most important variables are the health of the individual and the extent of the pressure sore.
Costs will vary widely with the person's condition and whether or not surgery is needed.
What can I realistically expect?
Healing of pressure sores in people with MS can take a long time. ES treatment can speed the
healing process.
What may be available in the future?
Researchers are conducting studies to better understand the electrical properties of healthy and
wounded tissue. This should help to determine more effective stimulation patterns.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

MS-12. FES for controlling spasticity


What is the purpose?
FES can be used to reduce spasticity. Spasticity is the abnormal, involuntary contraction of
muscles. It interferes with voluntary movements, causing them to be stiff and awkward.
What are non-FES alternatives?
Various lying, seated, and standing positions can reduce spasticity.
Very localized spasms can be treated by heat or cold.
Passive range of motion exercises (patient, therapist or caregiver moves limbs through
a full range of motion) can reduce spasticity. This will also help to prevent contractures.
Medication can reduce spasticity.
In extreme cases, surgery may be used to control spasticity.

...,

56

FES RESOURCE GUIDE

How do the FES systems work?


Several methods of reducing spasticity use skin surface electrodes. People with MS who have
intense skin sensation may not be able to use these FES methods.

When FES is used specifically to counteract spasticity, surface electrodes are applied to the spastic
muscles or to their antagonists. Each muscle has a counterpart muscle that moves the joint in the
opposite direction -- this is called the antagonist.
Spasticity usually occurs in several muscles at once. Some studies have shown that the most
effective treatments are those where FES is applied to all the muscles of a limb. Physical therapy
treatment may also be given during the same period.
Another method for reducing spasticity is applying FES to skin areas called dermatomes. A
dermatome is an area in which all the sensory nerve receptors belong to the same spinal cord
level. Particular muscle groups also have their motor nerves at specific spinal cord levels. The
dermatome that is stimulated is chosen to have the same spinal cord level as the spastic muscle
group.
The use of implanted electrodes or stimulators also may reduce spasticity. Such electrodes may be
implanted in muscles, over nerves, or on the spinal cord. In spinal cord stimulation (SCS), also
called dorsal column stimulation, low levels of stimUlation are delivered continuously. A single cable
leading to a multiple electrode provides stimulation that has a general effect on many motor nerves.
Thus, an SCS device for controlling spasticity might have beneficial effects on bladder function,
arm movement, standing, and leg movement.
Implanted SCS stimulators may be battery-powered or controlled by radiofrequency waves passing
through the skin. Similar to heart pacemakers, the battery-powered units require replacement after
several years. 80th types of devices are turned on and off by the patient. Typically, users operate
their stimUlators most of the day. When the devices are turned off, the benefits quickly fade.
Doctors believe that dermatomal, SCS, and sacral nerve stimUlation work by a method called
neuromodulation. It seems to depend on stimulation of sensory nerves reducing the spasticity of
related motor nerves.
Grasping, standing and walking systems may help to reduce spasticity. See sections MS-4, MS-6,
and MS-7.

STATUS OF FES FOR CONTROLLING SPASTICITY


Multicenter trials
Basic
Clinical research
research
Various surface and
implanted electrode
systems
Dermatomal
stimulation
i

I
I

Regulatory approval

Physical therapy
treatment using FES with
surface electrodes
. SCS, 1 channel, totally
implanted, with battery or
RF control. (unlabeled use
except when implanted to
control pain or spasms)

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LEARNING ABOUT FES

57

Who is medically eligible?


. '-

People with MS who have spasticity that cannot be controlled by medical methods. For surface
electrode FES treatment, the person with MS should have
Otherwise good general health.
No allergy or excessive skin sensitivity.
See disqualifying factors on page 46.

How long does the treatment take?


When FES is used only for spasticity control, treatment time will depend on which of the many
methods your doctor or therapist is using. One study used 20-minute sessions twice a day.
For SCS, some doctors implant the electrode and stimulator in a single surgery. Others do a one
week trial with an electrode whose wire comes through the skin (percutaneous lead) and can be
implanted in a short out-patient procedure. The lead is connected to an external stimulator. If that
system provides benefit, the doctor will implant the stimulator during a short hospital stay of several
days. During that time, the doctor and therapist will determine the most beneficial stimUlation
settings.

'

'

What does it cost?


As treatment with surface electrodes is adjusted to each individual, costs of therapy will
vary. Therapists typically charge $80 per session. Stimulators can be rented for $80 per
month or purchased for $700 - $2000, depending on the specific features of the device.
For SCS treatment, the medical evaluation, the device, and surgical implantation cost
about $18,000.

What can I realistically expect?


Researchers who have used surface FES or SCS to treat spasticity in people with MS have found a
variety of results. In addition to reduced spasticity, some people with MS have experienced
improved grasping, standing, walking and bladder function. This occurs because the reduction in
spasticity removes interference with these movement functions. Spasticity can be decreased but it
will not be eliminated with the use of FES.
\....
',\....
"-

When there was a benefit following FES treatment, in some cases it disappeared within days or
years. However, in other cases it persisted for up to 4 years. Perhaps, the natural progress of the
MS wiped out the improvement in some people. This is an area where much more basic and
clinical research is needed to know what we can expect of FES.
If spasticity is reduced over.a long period, then there will be a reduction in contractures also. See
the next section.

See page 64, "What Should I Know When Choosing an FES Product or Service?"

58

FES RESOURCE GUIDE

MS-13. FES for preventing or treating contractures

--

What is the purpose?


Maintain full range of joint motion (ability to move limbs to all normal angles).
Regain lost range of motion (ROM).

What are non-FES alternatives?


Many standard physical therapy techniques are available, including:
Use of splints or braces.
Positioning and stretching.
Passive joint ROM exercise by therapist or caregiver, or by positioning one's own body.
Exercise against resistance (for example, lifting weights), if the muscles are strong
enough to take the joint through a full ROM.
Use of heat may assist in gaining joint ROM if it is combined with other treatments like
positioning.
If spasticity is causing contractures, then decreasing spasticity will maintain ROM (see
previous section).
How does the FES system work?
Skin surface electrodes and portable, battery-powered stimulators are used. The muscle
contraction must be strong enough to move the jOint through the available ROM and "tug" a bit at
the end of the range.
In the general practice of physical therapy, FES with surface electrodes is used to treat a variety of
muscle problems. Often, these relate to injuries such as fractures or dislocations. FES is used to
produce low levels of contraction. This maintains muscle condition, increases the range of
movement, and assists weak muscles.

Basic
research

Physical therapy treatment using


FES with surface electrodes

Who is medically eligible?


FES to prevent and treat contractures is suitable for most people with MS. See disqualifying factors
on page 46.
How long does the treatment take?
Therapeutic treatments may last from 10 to 30 minutes. They may be given several times a week,
or several times a day, depending on the condition.
What does it cost?
As there is no standard physical therapy treatment for contractures, it is difficult to specify a cost. A
typical therapist may charge $80 per session. Stimulators can be rented for $80 per month or
purchased for $700 - $2000, depending on the specific features of the device.

--

LEARNING ABOUT FES

59

What can I realistically expect?


Contractu res are often caused by spasticity. If spasticity can be reduced, contractures will also be
reduced. See previous section.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

MS14. FES for preventing or treating osteoporosis


What is the purpose?
Stop the weakening of bone in people who are immobilized due to MS.
In healthy people, bone tissue is kept strong by the constant stresses placed on bones in everyday
activity. In normal bone there is an ongoing process of death and regrowth of cells. Stresses on
bone cause new bone cells to grow and minerals to be deposited in bone. When a person is
immobilized, the stresses on bone, cartilage, ligaments and tendons are severely reduced. When
such a person can no longer stand, and the legs don't bear weight, there is very little stress on the
leg bones. As a result, growth of bone cells and deposit of minerals in leg bones are reduced. Bone
mass or mineral density is reduced and the bones become more porous, a condition called
osteoporosis.

What are non-FES alternatives?


Standing with
Standing frame.
Bracing.
Standing attachment on wheelchair.
Stand-Up wheelchair.
Some people who use these devices experience fractures of their osteoporotic bones. Also, some
people who use FES systems for exercise or standing and walking have fractures of their
osteoporotic bones.

How do the FES systems work?


Standing and walking with FES (see section MS-6, FES systems for transfers and standing and
MS-7, FES systems for stepping and walking) can stress the leg bones in ways that prevent loss of
bone mineral.
Muscle stimulation exercise routines that generate 40% of maximal voluntary muscle contraction
have been reported to aid in bone strengthening.
I...,
I...,

Researchers have tested a modified bicycle ergometer to increase bone density for people with
SCI. See section SCI-14, FES systems for preventing or treating osteoporosis.

I...,

'
'-...
iI....

'
'-...

'
'
'-...

STATUS OF FES FOR PREVENTING OR


TREATING OSTEOPOROSIS
Basic
Clinical research
research
Standing/walking systems
Surface muscle stimulation

Multicenter trials

Regulatory
approval

60

FES RESOURCE GUIDE

Who is medically eligible?


See sections MS-6, MS-7.
See disqualifying factors on page 46.
How long does the treatment take?
There have been no studies documenting the length of treatment for people with MS.
What does it cost?
The cost of a small portable stimulator would be in the range of $700 to $2000. Annual cost of
supplies is about $1,000. See section MS-6, FES systems for transfers and standing and MS-7,
FES systems for stepping and walking.
What can I realistically expect today?
Using FES to stress bones seems to be able to stop the progress of osteoporosis. However, the
effect may vary with the length of time of immobilization and the location of the bones in the body.
Further research is needed to understand what factors are important in stopping and reversing the
weakening of bone in MS.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

MS-15. FES for treating weak, atrophied muscles


What is the purpose?
Strengthen weak muscles for specific movement functions. (See sections MS-4, 6, and
7, FES systems for grasping and reaching, for transfers and standing, for stepping and
walking.)
Increase bulk of shrunken (atrophied) muscles.
What are non-FES alternatives?
When muscles are totally paralyzed, there is no other way than FES to activate them.
When muscles are partially paralyzed, voluntary exercise can help to maintain some
level of strength.
How do the FES systems work?
In the general practice of physical therapy, electrical stimulation (ES) with surface electrodes is
used to treat a variety of problems of the muscles or bones. These problems often result from
injuries such as fractures or dislocations. Similar methods may be used to treat people with weak
muscles due to MS.
Any type of implanted or surface electrode FES system may be used (see section MS-12, FES for
controlling spasticity for information about spinal cord stimulation (SCS)). Some muscle
stimulators for paralyzed people are packaged with customized electrode garments to make it
easier to set up and connect the electrodes. FES or ES activates the weak or paralyzed muscle.
Even though these systems are simple, they should only be used with appropriate instruction from
a health care provider. A consistent exercise program may produce increases in strength and in
muscle size.

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LEARNING ABOUT FES

61

In a partially paralyzed muscle, the portion of the muscle that is weak because of inactivity but still
has a nerve supply will become stronger and bulkier (hypertrophy). The portion of the muscle that
is paralyzed due to neural damage will become bulkier but voluntary strength will not improve.
However. the strength during FES will increase.
FES systems for cardiovascular exercise. grasping, standing and stepping (see sections SCI-1,
MS-4, MS-6. and MS-7) may also make muscles stronger and larger. A crucial factor is whether or
not the stimulation routine stresses the muscle.
STATUS OF FES FOR PREVENTING OR
TREATING WEAK, ATROPHIED MUSCLES
Clinical research
Basic
Multicenter
research
trials
Specialized
stimulators designed
for denervated
muscle

Regulatory approval

Physical therapy treatment using


FES with surface electrodes
Specialized systems with
electrode garments

Who is medically eligible?


Generally. FES will only work for the extended periods of time necessary to convert the
paralyzed muscle into a stronger muscle if there is no denervation -- loss of nerve
supply between the spinal cord and the muscle.
See disqualifying factors on page 46.

'-'
'-'

How long does the treatment take?


Like any kind of exercise, muscle exercise for maintaining strength and bulk needs to be done as
part of a regular daily routine. Suggested exercise times will vary with the therapist and the
patient's condition. Initial sessions will be under the guidance of a therapiSt. Later sessions can be
carried out independently.
What does it cost?
See sections SCI-1. MS-4, MS-6. and MS-7 for details of exercise. grasping. standing
and walking systems that also reduce atrophy.
Specialized physical therapy treatment with muscle stimulators costs around $80 for
each session with a therapist. Purchase of a home model stimulator costs $700 - $2.000
and rental costs about $80 per month. Electrodes and supplies may cost $1,000 per
year.
Custom muscle stimulation systems that include electrode garments can cost several
thousand dollars but may provide long term savings by reducing the cost of supplies.
What can I realistically expect today?
MS patients with mild to moderate dysfunction will gain the most benefit from surface stimulation.
Changes may include improved endurance, strength. coordination. joint movement, and walking.
Consistent exercise may increase muscle bulk and strength. Side benefits may include improved
circulation and reduced risk of pressure sores.
What may be available in the future?
Because denervated muscle is missing a nerve supply, traditional muscle stimulators are not
effective. Although it is possible to stimulate the muscle directly, this requires very high currents
and the muscle fatigues quickly. New stimulators are being designed to get around these
problems.
See page 64, "What Should / Know When Choosing an FES Product or Service?"

62

FES RESOURCE GUIDE

MS-16. FESfor controlling tremor

Tremor is shaking that occurs continuously or whenever voluntary movement is made. Poor
muscle coordination and balance (ataxia), another symptom of MS, may also be helped by FES.
However, this is a very specialized type of treatment that requires frequent adjustment of
stimulation.

What is the purpose?


Reduce and control tremor.
What are non-FES alternatives?
Bracing.
Drug treatment.
Brain surgery.

How does the system work?


Surface electrodes are built into a glove or armband. The timing of FES pulses is tuned so that the
FES movement and the tremor movement cancel each other out. This is done by a type of
feedback control.

Basic
research

Clinical research
Surface electrode system fitted into a glove I
or armband, with feedback

Who is medically eligible?


People with MS and tremor. See disqualifying factors on page 46.
How long does the treatment take?
This method was tested in only one series of experiments. No treatment has been developed yet.
What does it cost?
The glove or armband system costs about $2000. Annual supplies and maintenance costs about
$500.
What can I realistically expect?
Forearm tremor was decreased by more than 50% in three of the five people with MS who tested
the system. However, the stimulation caused discomfort and muscle ache in two of the five
subjects. The system required time-consuming and delicate adjustment. The developers of the
system have made improvements and the second round of clinical tests is underway. The first
multicenter trials of a modified glove device are expected to begin in 1996.
The researchers also found that it was possible to control only one joint. That would mean that a
person who had tremor due to muscles around several joints might need to use a brace to control a
second joint.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

--

LEARNING ABOUT FES

63

MS-17. FES for sensation


There are no FES systems to compensate for impaired sensation that are specifically designed for
use in MS. See section SCI-17, FES for Sensation for more information.

MS-1B. FES systems for improving control of movement


People with MS often have enough muscle strength for daily activities. But, they may lack muscle
control and coordination.

What is the purpose?

Improve muscle coordination.


Improve muscle power.
Increase home, workplace, and leisure capability.

What are non-FES alternatives?

Braces.
Drug treatment.

How does the FES system work?


The method called spinal cord stimulation (SCS) was discovered when a person with MS was
fitted with a stimulator to control pain. It seemed to improve control of movement.
In SCS, flat electrodes are surgically placed on the spinal cord, usually in the upper back. The
procedure can be done by passing the electrodes through a special needle. A fine wire connects
the internal electrode to an external stimulator with a percutaneous lead. If the system produces
benefits, a miniature stimulator is then implanted within a week or two. Such a stimulator can be
operated for short periods or at a low level all the time. When it is successful, the FES seems to
affect all movement functions and bladder function also. This method is also called dorsal column
stimulation.
Surface electrode systems for standing and walking may also provide improved movement control.
See section MS-7 .

research
SCS, 1 channel, totally
implanted, with battery or RF
control. (unlabeled use except when
implanted to control

Who is medically eligible?


People with
Little or no peripheral nerve damage or joint damage.
No current substance abuse.
Flexible joints (only minor contractures).
Optimistic and motivated attitude.
Acceptance of technology.
For disqualifying conditions, see 46.

bs

64

FES RESOURCE GUIDE

What does it cost?


For SCS treatment, the medical evaluation, the device, and surgical implantation cost about
$18,000.

How long does fitting and training take?


Fitting and training with the spinal cord stimulator may take about a month.

What can I realistically expect today?


Only a small number of people with MS have been treated with FES. Doctors disagree on the value
of FES for this population. Some doctors feel SCS should be used as soon as possible in the
person with MS who has a relapsing-remitting pattern of symptoms (see page 46). Others observed
that there were no benefits of SCS two years after implantation. Some users of SCS experienced
improved hand strength and the ability to move their hands faster.
See page 64, "What Should I Know When Choosing an FES Product or Service?"

What Should I Know When Choosing an FES Product or Service?

How will participation in an FES program affect me?


Typically, when you receive an FES system, a specially trained rehabilitation team will work to
ensure that the system is doing its job. The team may include physicians, surgeons, therapists,
engineers, and technicians. If the FES system is complex, you may need to spend much time with
the team members. You may need to receive implants, be fitted with devices, and train to
independently use the devices safely and effectively.
Each individual has personal goals for adding FES to his or her life. Also, medically, each
person is different. If you are interested in exploring FES, you will want to talk with a physician or
therapist who is experienced in FES treatment. Ask that person what you can realistically expect
from the particular FES system that is available now. This is important because many FES devices
are still being developed. Some people may want the devices that are available today and may be
willing to accept their limitations. But, others may prefer to wait until the technology is more fully
developed.
FES systems may require either no surgery, simple surgery, or complex surgery. Your
medical condition and personal feelings about surgery will be important factors in determining
whether or not you receive a particular FES system. Even if a system seems ideal, some
individuals with normal or heightened sensation may not be able to tolerate the stimulation.
Today, many FES systems are not covered by insurance. The main reason is that they are
not yet approved by FDA. People are concerned that even when systems receive approval, the
health care system may not cover FES devices. Because FES is a new technology in the medical
marketplace, much education is needed for funding agencies, insurance companies, medical
technology investors, and consumers. Only by knowing the risks, benefits, and costs can we
evaluate FES as a health care option. This is especially true for the consumer so that he or she
does not develop false hopes about FER As an interested consumer, you can help to educate
yourself and others.

--

LEARNING ABOUT FES

65

What questions should I ask? I


Choosing an FES product or service can be complicated because there are many factors to
consider. FES treatment is usually very specialized. That means it is offered by only a limited
number of health care providers. And, that means that insurance companies have little experience
with it. Therefore, what is covered will usually be decided on a case-by-case basis. The insurance
company will require supporting documentation that clearly shows the benefit of this treatment over
more traditional ones. Since there is little agreement in the medical community about FES, such
documentation may be difficult to produce. Usually, the manufacturer of a device can supply
documentation to insurance companies to back its claims.
Much of the FES treatment available is in research programs. These usually cost little or
nothing. But they may take much of your time in travel and long testing sessions. On the other
hand, if you are so inclined, you can be more than a "subject" - you can be part of a research team.
Since many FES treatments are new, it is often helpful to know how many people have
been successfully treated with the system you are considering, how many reached their goals, and
whether they continue to use the FES system. Here are some guidelines to help you in choosing an
FES product or program:
DO check out the credentials of any FES service provider or product manufacturer.
How long have they been in business?
How many satisfied customers or clients have they served?
Are they accredited by a professional organization or review board? For example, the
Commission on the Accreditation of Rehabilitation Facilities (CARF) sets minimal standards for
facilities. Certain rehabilitation professions require their practitioners to maintain licensure
credentials that are monitored by a professional review board.
For a company or clinic, has the Better Business Bureau received complaints about them?
(Look up the local number in your Yellow Pages.) For a health care professional, has a medical
review board received complaints?
DON'T rely on the provider'S or manufacturer's claims.
Ask for names and phone numbers of clients who have received FES treatment and speak with
them.
Tour the facility.
Arrange for demonstrations.
DO obtain, in advance, a written good faith estimate of all costs that you may incur.
Check out your insurance coverage immediately.
Beware of hidden costs such as supplies and equipment that you must purchase for home use,
and transportation and accommodation expenses.
DON'T become carried away by your emotions. Be as realistic as possible about the benefits you
may receive and the risks you will be exposed to.
DO obtain a written statement that describes your treatment plan. It should include:
Initial evaluation.
Treatment goals.
Frequency and length of treatments.
When the treatment will be terminated.
Any follow-on activities that will be needed to maintain the benefits of treatment.

66

FES RESOURCE GUIDE

DO find out if use of FES will require permanent or irreversible surgery. Doctors who implant FES
systems are constantly developing better surgical procedures. Ask if the surgery can be broken into
short sessions. Ask if any of it can be done on an outpatient basis. Ask about the risks of surgery.

Discuss the proposed treatment plan with health care providers whom you trust.

-
-
-

DO explore all the alternatives to FES. More traditional treatment plans may be just as effective,

and less expensive.

You may decide to volunteer for an experimental FES project. If you do, make sure that you
completely understand your commitment to the project. Ask how the FES treatment may affect
other assistive technologies that you already use or may use in the future. Ask about the risks and
benefits of the treatment. This should be detailed in a document called an Informed Consent. The
researchers are required to write out these details and explain them to you. They will ask you to
sign the document to show that you understand it.
If you choose to partiCipate in a research project, find out in advance what expenses are
involved and who will be paying them. Ask how much time you need to be at the research clinic,
and how that will affect your daily activities. Ask what FES, if any, will be available to you when the
project is over, or when you stop being an active participant.
FES holds great potential to improve the health, well-being, and quality of life of many
people. As you would in considering any elective treatment, learn all you can about FES. If you are
satisfied that the application is safe, that it may help you, and that you can fit it into your life -- go
for it.

--

---

PART 2. WHERE TO GET FES


This part contains a list of facilities where FES is available. This information is not an advertisement for
products or services. Rather, the information provides a detailed description of the current practice of FES
in the US and elsewhere. The information was compiled from survey data that were provided to the FES
Information Center between April and October, 1995. Surveys were sent to SCI and MS clinics around
the United States, and to SCI and MS professionals around the world known to be involved in FES
treatment or investigation. The FES Information Center received no payment or other remuneration from
any organization or individual who completed the survey. Since the data were provided voluntarily, the
FES Information Center cannot guarantee its accuracy or completeness.

How to use this part:


Each entry in this part has a unique number, and each facility described has at least two different types of
entries. The first type of entry (the shaded box with the envelope icon W) describes the facility or program
providing the FES. The other (the clear box with the page icon ~) describes the particular FES application
that a given facility or program offers. You will need to look at both types of entries to get complete
information about the service that is being offered.
To identify an FES Program Entry: Look for the shaded box with an envelope icon W followed by a
LARGE, bolded number that ends in .00 (For example, W 15.00). All application entries that are
offered by this facility/program will begin with this number. This type of entry includes address and
contact information, as well as a general description of the facility.
To identify an FES Application Entry: Look for a clear box with a page icon ~ followed by a SMALL
bolded number that ends in .01 through .05 (for example, ~ 15.01). This type of entry includes a
description of the treatment, who is an appropriate candidate for the treatment, what the treatment
course might consist of, and what type of FES equipment is involved. Ideally, there will be a separate
entry for each treatment offered, each ending in a different number. (In some cases, information
about different types of treatment was not provided as separate entries, therefore the different
applications are combined under a single entry.) For example, entry numbers 15.01, 15.02, 15.03
and 15.04 describe four different FES applications offered by the program/facility described in entry
number 15.00.
The SAMPLE ENTRY on the opposite side of this page describes each field or label that appears in the
entries. Refer to the Glossary or a medical dictionary if there are terms that you do not understand.
The entries are listed in numeric order. They are grouped by geographic location. The geographic locations
appear alphabetically in the following order:
United States
State (alphabetical order)
California
Connecticut ...
Other Countries (alphabetical order)
Argentina
.
Brazil ...
For example, if you want to find all of the programs in Michigan, page through the USA entries passing those for
Massachusetts and stopping before those for Nebraska, to where the Michigan heading appears at the top of the
page.

How to use the Index (Part 5) with this part:


If you want to look up an entry by the FES application, candidate description (medical condition, age group, or
veteran status), or name of organization providing the application, find the term you are looking for in the index. If
there are any programs that match the term, you will find their identification number listed. Look for that
identification/entry number in Part 2 to find the entries that are of interest. Remember, the entries are in numeric
order.

SAMPLE ENTRYI EXPLANATION

PART 2

General Program Information (Look for the shaded box with the envelope icon)

Program IdentiflcatlonNomber- Each facility or program hass unique number~ It


is linked to the Application.ID number described below. The index refers to this
I number when you lookup s program by.fopic.
FESPmgram
I Program Name
XYZ Rehabilitation~ssociates I Organization Name

456 Any Street


City State Zipcode
USA
Tel:
FAX:
Tollfree: 800MXXX~XXXX
E-Mail: xx123@univ.edu
Director: Jane Smith
Contact Person: K. Jones
Program Description:
Information Available:
Hours:
Location of seniices;
Accessibility:
Populations served:
Areas served:
Referral required?
Billing Info:
Payment methods:
Type of facility:
Accreditation:
Licensing/Certification:

I
I
I

Address

r Telephone Numbers
f

Electronic Mail Address


Director of FES Program
Person to contact with questions about the FES Program
General description of programs at this facility
Description of the type of information that the facility can send in response to your
questions, ex. printed material, videotapes, foreign language capability.
Hours of. operation
Description of where services are provided, ex. service providers location. patient's
home.
Description of accommodations available at this facility for persons with disabilities,.ex.
handicapped parking, accessible public transportation.
General description of the persons/patients served. May include age group, sex, or
veteran status.
Persons who live in these geographic locations are eligible for services at this facility
Specifies whether an individual needs a referral to be seen at the facility. If yes,
describes who can refer.
Describes charges aSSOCiated with the services provided at this facility
Describes methods of payment that are accepted at this facility
Lists one or more categories that describe the type of facility, ex. hospital, outpatient
clinic, research & development center.
Depending on the type of facility, lists any special credentials or evaluations
that this facility has passed. See the Glossary for specific definitions.
Lists any special licenses or certifications that the facility staff have obtained

Specific FES Application Information for the facility described above (Look for the clear box with the page icon)
@) 123.01
Program Application Identification Number- This number links the FES application with
the facility that offers it. If a facility offers more than one application, the last two digits
distinguish among applications. (The index refers to this number when you look up a topic)
FES Application:
Lists the FES applications that are available at this facility and that are described in the
information that follows. These are the same applications described in Part 1. Learning
about FES.
Description:
A description of the application(s) available at this facility.
History:
Describes the history of the FES application at this facility, ex. number of persons treated.
Status:
Identifies the status of this application as Clinical service or Experimental research. If
the status is research, may identify the research as a feasibility study or multicenter
clinical trial. Some treatments may include both aspects. See the Glossary for terms.
Describes, in clinical terms, the type of individual who may benefit from this application,
Candidate Description:
ex. spinal cord injury or multiple sclerosis.
Restrictions/ Contraindications:
Describes characteristics that may disqualify an individual from treatment.
Treatment course:
Describes the typical sequence of events that an individual receiving this treatment can
expect, ex. evaluation, training, check-ups, number of visits.
Explains whether it is necessary to get an evaluation from this facility vs. another facility
Requires evaluation
at this facility?
which may be closer to you.
Requires local lodging?
Explains whether it is necessary for you to live near the facility while you receive treatment.
Provides a range for the typical cost of this treatment
Typical cost:
3rd party payers typically cover:
Explains the extent to which insurers usually pay for this treatment
Type of equipment:
Describes the type of stimulation equipment used for the treatment, ex. home use
stimulator, clinic use stimulator, surface electrodes, implanted electrodes.
Availability of equipment:
Explains how the equipment is made available to the user, ex. purchase, rental.

WHERE TO GET FES

67
USA - CALIFORNIA

ftoo

REeR8~rogtaJ'ftz1

Hours: 9:0'0' AM to 5:0'0' PM, 5 days.aweek


~ocationof services: Service providers location;
Outpatient clinic
AccestJilt'lity:Wheelehair apcessible, IncLbathrooms;
Beverly HillsGA90ZH
USA
Handicapped parking ,a\laitable;Near accessible public
Tel: 31O-553~a33
T:Qll-free:
transport; Accessible hotel nearby
FAX: 310'';858-80'08
E,;Mail:
Populalonsserved:No restrictions
Direct().r:Dr~;R~)oQugtas,Areas setVedtrlJn1imited
iUf.PauIBemSji.MedicaIDirector
Referral"recivLied? No
Pro9""m D_rip~ion: Dr. DougJiJ!;isco.,inventot~
Billing:lnfo: Varies with ability to pay
thepatimted hybritLsystern (runstibnaleleetrical ...
P.ay. .ntmethods~CaSh; Payment~ Optiont:yVitl
stimulatiGnand brace). FuncfibnaleleCtricalstirlmlation"bIlHnsuranee; Will bUI:Medicaid;WillbjJ~lIIedicare;Will
isuse~.~~a;physical therapytecnttiqde mode for
"bill Ottierthird-partypayment'
....
"eurol()Qical disorders - in comb1nation with the
Type of facility: Privately supported; Outpatient
facility; Rehabilitation center; Rehabilitation program
Douglas RGO brace (hybrid system) in our office
Accreditation: .No informatiOn provided
enVironment.
Ihfo~on;available:Printedformat;,tanguages
licensing/Certification: Neurorehabilitation

L(Js"A.ngeles~ts MediCal Group


8~12 OlympjcBbulevard

Conta~t)Penson:

otfler .than English~'" Japanese; Chinese; Spanish

1.01

FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Description: Topical unit - 3 leads for each extremity
History: Has been in use since 1987, more than 150
participants.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-8 / Sensory: C5-8
Thoracic: Motor: T1-11 I Sensory: T1-11
ASIA International Impairment Scale: A B
Paraplegia
Tetraplegia/ Quadriplegia

1.02

FES Application:
Cardiovascular exercise
Bicycle ergometry
Description: Therapeutic Technologies Inc. exercise
bike - topical leads to each lower extremity
History: Has been in use since 1987, more than 150
participants.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-8 / Sensory: C5-8
Thoracic: Motor: T1-10 / Sensory: T1-10
ASIA International Impairment Scale: A B
Paraplegia
Tetraplegia/ Quadriplegia

Restrictionsl Contraindications: Recent fractures


obesity, contractu res, lack of discipline or motivatio~
Treatment course:
Evaluation! assessment - 4 days
Training - 6 weeks to 24 weeks or more
Approximate number of visits required in total: - 100 or
more
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: More than $20,0'00
3rd party payers typically cover: Some costs
Type of equipment: Clinic use stimUlator; FDA
approved stimulator; Transcutaneous/surface
electrode( s)
Availability of equipment: No charge

Restrictionsl Contraindications: In good


cardiovascular condition - no recent fractures
Treatment course:
Evaluation/ assessment - 4 days
Training - 30 minutes 3 times a week
Approximate number of visits required in total: - 100 or
more
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: More than $20,0'00
3rd party payers typically cover: Some costs
Type of eqUipment: Clinic use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode{ s)
Availability of eqUipment: No charge

68

FES RESOURCE GUIDE

USA - CALIFORNIA
~
1 .03
FES Application:
Lower limb movement
Stepping and walking
Description: Hybrid system - Douglas RGO brace and
PEERS stimulator (6 channel system - topical) by
Henley in our office. FOR EXERCISE USE ONLY.
History: Has been in use since 1987, more than 150
participants.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-8 / Sensory: C5-8
Thoracic: Motor: T1-11 / Sensory: T1-11
ASIA International Impairment Scale: A B
Paraplegia
Tetraplegia/ Quadriplegia
Restrictionsl Contraindications: Obesity, recent
~
1.04
FES Application:
Neuromuscular treatments
Regaining voluntary function
Description: Neuroeducator - original equipment by
Therapeutic Technologies Inc.
History: In use since 1987, more than 150
participants.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-8/ Sensory: C5-8
Thoracic: Motor: T1-12/ Sensory: T1-12
ASIA International Impairment Scale: A B

L:::J

fractures, severe contractu res and deviated spine, lack


of motivation or discipline.
Treatment course:
Evaluation/ assessment - 4 days
Pre-implementation therapy/treatment - 6 weeks
Outpatient fitting/implementation - 1 week
Training - 20 weeks or more
Approximate number of visits required in total: - 150 or
more
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: More than $20,000
3rd party payers typically cover: Some costs
Type of equipment: Clinic use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: No charge

Paraplegia
Tetraplegia/ Quadriplegia
Restrictions/ Contraindications: Recent fractures,
lack of motivation and discipline
Treatment course:
No information provided
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $1,000-$5,000
3rd party payers typically cover: Some costs
Type of equipment: Clinic use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode( s)
Availability of equipment: No charge

2.00

Petrofsky Center for Rehabilitation and


Research
Petrofsky Center for Rehabilitation and Research
13765 Alton Parkway Suite E
Irvine CA 92718
I

USA
Tel: 714-855-4837
TolI..free:
FAX: 714-855-9553
E-Mail:
Director: Dr. Jerrold Petrofsky
Contact Person: Dean Maccabe
Program Description: Physical therapy and research
center specializing in rebuilding paralyzed muscles for
SCI, stroke, etc. with Nobel nominee Dr. Jerrold
Petrofsky. High tech braces, gait training, computerized
muscle stimulation, bowel and bladder programs,
Information available: Printed format; Videotape
format
Hours: 8:30 AM to 5:00.PM, Monday - Friday

Location of services: No information provided


Accessibility: Handicapped parking available; Near
accessible public transport; WHeelchair accessible,
incl. bathrooms; Other accommadatians - hatels
Populations served: NO' restrictians
Areas served: Unlimited
Referral required? No
Billing info: Fixed rates; Varies with ability to' pay
Payment methods: Cash; Charge/Credit Card; Will 0111
Insurance; Will bill Medicare
Type of facility: Privately supported; For profit;
Outpatient facility; Callege I University program;
Rehabilitation center; Rehabilitatian pragram;Research
& develapment center
Accreditation: Not applicable
Licensing/Certification: All stafftncluding MD's,RN's
and physical therapists are licensed in the stateof
California.

--

WHERE TO GET FES

69
USA - CALIFORNIA

@l

2.01

FES Application:

'
'

'

'

'

Bladder control
Bladder emptying
Bladder incontinence
Description: Bladder control involves two stages. First
electrical stimulation is used through a transurethral
catheter for half hour treatments 4 days a week for 4
weeks. Stimulation opens up dormant receptors and
allows the restoration of feeling in the bladder wall. In
the second phase, pressure transducers inside the
bladder and the urethra help monitor pressure while
saline is infused. Pressure is monitored by computer
and neuromuscular re-education. Re-Ieaming bladder
muscle control is attempted.
History: Approximately 20 years. Approximately 5,000
individuals treated, program capacity - 10.
Status: Clinical service; Experimental research;
Feasibility study

'

Candidate Description:

'

Multiple sclerosis

@l

2.02

FES Application:

Bowel control
Bowel emptying
Bowel incontinence
Description: Bowel control uses electrical stimulation
from a multiple channel stimulator for bowel emptying.
It involves 4 sets of electrodes across the bowel to
all?w the bowel program to go more simply and easily.
Pnor to the program, electrical stimulation is used on
abdominal muscles to increase strength.
History: Approximately 20 years. Approximately 5,000
individuals treated, program capacity -10.
Status: Clinical service; Experimental research;
Feasibility study
Candidate Description:

Multiple sclerosis
Spinal cord injury
Cervical

Spinal cord injury


Cervical
Thoracic
Lumbar
Hemiplegia
Paraplegia
Tetraplegial Quadriplegia
Restrictions/ Contraindications: No info. provided
Treatment course:

Evaluation/ assessment - 2 days


Pre-implementation therapy/treatment - 1 day
Outpatient fitting/implementation - 4-7 weeks
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: No information provided
3rd party payers typically cover: All costs
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;
Transcutaneous/surface electrode(s)
Availability of equipment: Purchase

Thoracic
Lumbar
Hemiplegia
Paraplegia
Tetraplegia! Quadriplegia
Restrictions/ Contraindications: No info. provided
Treatment course:

Evaluation/ assessment - 1 day


Training - 3 weeks
Post-implementation therapy/treatment - 1 week
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: No information provided
3rd party payers typically cover: All costs
Type of equipment: Clinic use stimulator; Home use
stimUlator; FDA approved stimulator;
Transcutaneous/surface electrode(s)
Availability of equipment: Purchase

br

70

FES RESOURCE GUIDE

USA - CALIFORNIA

I@

2.03

FES Application:

Cardiovascular exercise

Circulatory/Skin treatments

Neuromuscular treatments

Treating weak, atrophied muscles

Description: Electrical stimulation is used on both the

paralyzed and non-paralyzed muscles in the body.

FES IS used with exercise in incomplete injuries or pure

FES exercise is used in complete injuries.

~ardiovascular toning can be achieved including

Increased circulation, reverse atrophy, reduced

spasticity and pressure sore reduction. Equipment

includes FES bicycles, FES rowing machines, FES

weight lifting equipment, upper body ergometry using

electrical stimulation and voluntary exercise.

~i~t~ry: Approximately 20 years. Approximately 5,000

IndiViduals treated, program capacity -10.

Status: Clinical service; Experimental research;

Feasibility study

Candidate Description:

Multiple sclerosis

I@

2.04

FES Application:
Lower limb movement
Stepping and walking
Standing / transfer assistance
Description: A small electrical stimulator, the size of a
calculator, provides up to six channels of muscle
stimulation for the lower body allowing walking with a
hybrid system, a combination of FES and braces. The
braces, or stored energy orthoses, are very light and
brace to the level of the injury. With these braces,
successful walking at normal walking speeds is
provided. Individuals with incomplete injuries can use
this technology to achieve good gait. History:
Approximately 20 years. Approximately 5,000
individuals treated, program capacity - 10.
Status: Clinical service; Experimental research;
Feasibility study
Candidate Description:
Multiple sclerosis

Spinal cord injury


Cervical
Thoracic
Lumbar
Hemiplegia
Paraplegia
Tetraplegia! Quadriplegia
Restrictionsl Contraindications: No info. provided
Treatment course:
Evaluation/ assessment - 3 days
Training - 1-3 month program
Approximate number of visits required in total: 20-70
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: No information provided
3rd party payers typically cover: All costs
Type of equipment: Clinic use stimUlator; Home use
stimulator; FDA approved stimUlator;
Transcutaneous/surface electrode(s)
Availability of equipment: Purchase

--

Spinal cord injury


Cervical
Thoracic
Lumbar
Hemiplegia
Paraplegia
Tetraplegia! Quadriplegia
Restrictionsl Contralndications: No info. provided
Treatment course:
Training - 3-4 month program
Approximate number of visits required in total: 70
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: No information provided
3rd party payers typically cover: All costs
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;
Transcutaneous/surface electrode( s)
Availability of equipment: Purchase

WHERE TO GET FES

71
USA - CALIFORNIA

.p~m.lationl~rogram forSer

M~rryWia'Rehabilitatlon Hospital
.street1'Suite 416
b CA 90806

Long

USA

tek~1~~2~~1t1

F~:31'CH\9~;;a830

DJ~~~AnfJ.va~ne,. MD...~.

Co...~Per$on;AnnVa$ile.,NlE)

Pr()gramOescripton:Parsstepf:ES Ambulat!on

PrQgram;candidates i
rsons with thoracic

levelparapl~9ia. Device ......... reas~~~onal


activi~~asfwell as cardiopu1monary,Orthopedic.and
tone benefits.
Information available: Printed and Videotape format
liours:{B:OO AM to 5:00 PM, WeeK\1ays
Location ofs:services: Cons.tlmer'sresidellce;S~rvlce
provltierslqcation
~
'

'

'

thir'(:ipartYp~yment

Typeoffacf~ty~'Ptivately!~upported; Inpatienffacility;
Ou~ntfaGjlity; consulta~t I Private practice;

Hospital; Rehabmtationcenter;Re~~bilitationprogram
Accreditatipn: CARF Accredited; JCAHQA~redited;
PrudentiatGenter of Excellence
.
licensiog/Certifi~tion: Board CertifiedPhysical
MediCine,snd.RehabilitatiGn

3.01

FES Application:
Lower limb movement
Stepping and walking
Description: FES Parastep system for ambulation.
Electrodes on lower extremities; hand controls on
walker; AFO (ankle foot orthosis). Ultimately
participant should be independent in use of equipment.
History: Began as an experimental grant, now FDA
approved for approximately 2 years. About 20
individuals have been treated, no limit to our capacity.
Status: Clinical service
Candidate Description:
Spinal cord injury
Thoracic
Paraplegia
Time elapsed post-injury/onset: 6 months

Accessibility: Wheelchair accessible; incl ..bathrooms;


Handicapped parking available; Nearaccessibl.e public
fr~nspdi1 .
Populatio
Areas.s .. ....... ywhere intheU:SA
Ref Jrequ~1 No
Bilnng hlfO
rates.
Payment mds: Cash; Charge/Credit Card;
PaymenfRla!'1. Option; Will billlr'l'surance; Wilfbill Other

Restrictions/ Contraindications: Restrictions: 1.) if


sensory incomplete, electrical stimulation may not be
tolerated; 2.) upper motor neuron lesion (ie. peripheral
nerves intact).
Contraindications: severe osteoporosis.
Treatment course:
Evaluation/ assessment - 1 time office visit with MD
Training - as an outpatient 30 1 hour session
Maintenance / check-ups - only as needed
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $10,000-$20,000
3rd party payers typically cover: Some costs;
depends on the insurance policy
Type of equipment: Home use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: Purchase

4.00

Mark W. Vogel. MD
8635 W. 3rd Street, #1060 W
Los Angeles CA 90048
USA
Tel: 310.652-2973
Toll-free:
FAX: 310-289-0187
E,-MaU:
Director: Mark W. VogeJ,MD
Contact Person: Mark W. Vogel, MD
Program Description: Electrical stimulation using
Seager-type device for electroejaculation.
Information available: No intormation provided
Hours: 7:30 AM 5:00 PM, Monday - Friday
Location of services: Service providers location

Accessibility: Wheelchair accessible, incL bathrooms;


Handicapped parking available; Near accessible public
transport Populations served: Male Only; Adult (age
16to 65)
Areas served: Unlimited
Referral required? No
Billing iofo: Fixed rates
Payment methods: Cash; Charge/Credit Care
Type of facility: Forprofit
Accreditation: Not applicable
licensing/Certification: Medicallicense-State',dr
California, Certified by the Amer. Board of Urology.

72

FES RESOURCE GUIDE

USA - CALIFORNIA

4.01
FES Application:
Sexual function
Electroejacu lation
Description: Pulsed electrical stimulation delivered via
transrectal probe to achieve ejaculation.
History: In use approximately 8 years, treated
approximately 25 persons, some repeats.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Cervical
Thoracic
Lumbar
Sacral

5~OO

Functional Electrical Stimulation onSel


Patients
West Los Angeles~VA Medical Center
11301 Wilshire Boulevard
Los Angeles.CA 90073
USA
Tel: 310-824-3124 x7088
TolI~free:
FAX: 310-824-3125
E-Mail:
Director: AM. Erika Scremin, MD
Contact Person: A.M. Erika Scremin, MD; Karen L.
Perell, Ph.D.
Program Description: This is a research program
focusing on the effects of FES on metabolism,

@J

5.01
FES Application:
Cardiovascular exercise
Bicycle ergometry
Description: This is a research program in which
subjects exercise 3 times a week for 6-9 months.
Cardiovascular, spasticity and osteoporosis
parameters are tested 3-4 times during this time period.
We use a REGYS I bicycle ergometer.
History: This program has been available for 3 years
12 subjects have completed the program. We can ha~e
4 subjects at anyone time at the West Los Angeles
location and 2-3 SUbjects at our Rancho location.
Status: Experimental research; Feasibility study
Candidate Description:
Spinal cord injury
ASIA International Impairment Scale: A

Hemiplegia
Paraplegia
Tetraplegia! Quadriplegia
Restrictionsl Contraindications: No info. provided
Treatment course:
Evaluation/ assessment - generally one time
Outpatient fitting/implementation - as many times as
necessary
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: Less than $1,000
3rd party payers typically cover: No costs
Type of equipment: Clinic use stimUlator; Not FDA
approved stimulator
Availability of equipment: Purchase

spasticity, bone density and overall health parameters


in persons with SCI.
Information available: Printed format
Hou~: 8:00 AM to 4:30 PM, Monday - Friday
Location of services: Service providers location
Accessibility: Wheelchair accessible, incl. bathrooms
Populations served: Male Only; Adult (age 16 to 40)
Areas served: California, LA County; California,
Orange County
Referral required? No
Billing info: No charge
Payment methods: No information provided
Type of facility: Publicly supported; VA agency
Accreditation: JCAHO Accredited
Licensing/Certification: Not applicable

Paraplegia
Tetraplegia/ Quadriplegia
Time elapsed post-injury/onset: any time post injury.
Restrictions! Contraindications: No unhealed
fractures, must have spasticity, no history of
cardiovascular problems.
Treatment course:
Training - 3x1week for 6-9 months
Approximate number of visits required in total: 100
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: Less than $1,000
3rd party payers typically cover: No costs
Type of equipment: Clinic use stimulator; FDA
approved stimulator, Transcutaneous/surface
electrode( s)
Availability of eqUipment: No charge; research study

WHERE TO GET FES

73
USA - CALIFORNIA / CONNECTICUT

6..00
Spinal Corddnjury Unit

\!~~fcal Genter -San Diego

3300'1,.:a Jolla Village Drive

San Diego CA 92161

USA

Tel: 619-552-7453
Toll-free:

i'FAX: 619,;552-7452
li;.ifVIa11~
Director: Sr. Susan SzoHa'i':.<'
CordactPerson: Or. SusarlSzollar; Dr. Kevin Gurhart;
Dr. Marc Kelly
Program Description: SCI Unit with use of FES
primarily to increase motor function.
Information available: No information provided

6.01
FES Application:
Neuromuscular treatments
Regaining voluntary function
Description: Primarily used for persons with spinal
cord injury with the goal to increase function. Can
include upper limb and/or lower limb movement.
History: Has been available since program opened 4
years ago.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Cervical
Thoracic
Lumbar
Sacral

Hours: 8:00tMto4:00 PM, Monday - Friday


Location. OfservicesrServiGeproviderslocation
Accessibility: Wheelchair aQcessiblei incl. bathrooms;
Handicapped parking"available; Near aooessible public
transport; Accessible hotel nearby
Populations. served: LJ.S.Veteran Only
Areas served: California, Southern; Arizona; Nevada
Referral required? No
Billing info: No charge; VA covers costs for veterans
Payment methods: No infurmation provided
Type offacjljty: VA agency
Accreditation: JCAHO Accredited
Licensing/Certification: Not applicable

Paraplegia
Tetraplegia/ Quadriplegia
Other spinal disorder: post-polio
Restrictions/ Contraindications: No info. provided
Treatment course:
Inpatient fitting/implementation - inpatient
hospitalization is typical.
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: No information provided
3rd party payers typically cover: All costs; depends
on length of treatment.
Type of equipment: Clinic use stimulator; FDA
approved stimulator
Availability of equipment: No charge; in-house use
only

CONNECTICUT

@
7.00
Yale University School of Medicine
333 Cedar Street; 121 FMB
New Haven CT 06520-7898
USA
Tel: 203-785-2705
Toll-free: 800-432-7898
FAX: 203-785-3346
E-Mail:
Director: John A Elefteriades, M.D.
Contact Person: John A Elefteriades, M.D.
Program Description: Diaphra9,mpacing for 1)
quadriplegia; 2) central hypoventilation
Information available: Printed format
Hours: 9:00 AM to 5:00 PM, weekdays
Location of services: Consumer's residence

Accessibility: Wheelchair accessible, incl.bathrooms;


Handicapped parking available
Populations served: No restrictions
Areas served: Unlimited
Referral required? Yes From: Physician
Billing info: Fixed rates
Payment methods: Cash;Charge/Credit Card;
Payment Plan Option; Will bill Insurance; Will bill
Medicaid; Will bill Medicare; Will bill Other third~party
payment
Type of facility: Non-profit; College I University
program; Hospital
Accreditation: No information provided
licensing/Certification: Not applicable

74

FES RESOURCE GUIDE

USA - CONNECTICUT

7.01

FES Application:
Respiratory treatments
Breathing assistance
Description: Pacemakers are implanted on the
phrenic nerve in the chest via mini thoracotomies and
the diaphragms are trained to accept electrical '
stimulation. Independence from the ventilator and
normal speech are achieved.
History: 25 years
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C3-4 / Sensory: C3-4
Tetraplegia! Quadriplegia
Restrictionsl Contraindications: Intact mental status.

. 8.00

FESiat Newi"~n Childml1s.Hospital


Newington ChilCl~ris Hospital
181 Cedar Stre~t
Newington. CT 06111
USA
ToU"-free:
Tel: 203-667"'5582
FAX: 203.:.667-5284...
E'Miil:
Director: Philip B;Ambld;cIVlD
contactPerson:Ptiilip8;Amold, MD
Program~Description~ Computer directedblcycle
ergometryfOrcardiovascular fitness
Information available: No infOrmation provided
Hours: 8:00 AM - 5:00 PM, Monday - Friday; Patient's
convenience (outpatientfacility)
Location of services: Service providers location

Treatment course:
Evaluation/ assessment - 3 days
Pre-implementation therapy/treatment - 0 -14 days
Inpatient surgical procedure(s) - 2 days
Training - 2 weeks - 3 months
Post-implementation therapy/treatment - 2 weeks - 3
months
Maintenance / check-ups - every 2 years
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: More than $20,000
3rd party payers typically cover: Some costs
Type of equipment: Clinic use stimulator Home use
stimUlator; FDA approved stimulator; Not FDA
approved stimulator
Availability of equipment: Purchase

8.01

FES Application:
Cardiovascular exercise
Bicycle ergometry
Description: Includes integrated EMG Biofeedback
History: Active since 1985. One of the first programs
in the country.
Status: No information provided
Candidate Description:
Spinal cord injury
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 3 weeks
Restrictionsl Contraindications: Requires good
range of motion in lower extremities

AccessibilitY:VVheelchair accessible; incl. bathrooms;


Handicapped parking available; Near acceSsible public
transport
PopulatiOns served: Child (up to age 16)
Areas served: Connecticut
Referral required? No
Billing info: Varies with ability to pay
Payment methods: Cash; Charge/Credit Card;
Payment Plan Option; Will bill Insurance; Will bill
Medicaid; Will bill Medicare; Will bill Cltherthird-party
payment
Type offacility: Non-profit; Inpatient facility;
Outpatient facility; Home health agency; Rehabilitation
center; Rehabilitation program
Accreditation: JCAHO Accredited
LicensinglCertificatlon:Not applicable

Treatment course:
Evaluation/ assessment
Pre-implementation therapy/treatment
Training
Maintenance / check-ups
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $1,000-$5,000
3rd party payers typically cover: Some costs; For
initial training and evaluation
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator
Availability of equipment: Purchase; must purchase
Stimwear

WHERE TO GET FES

75
USA - DISTRICT OF COLUMBIA

9.0~;

Male'Fe
National R
102 Irving
Wasbington
U~~4V,:.... ......../ ..

2949

c.,~Ui':.02~77'"~~5
,Fmc:202..a17...a592

I:)irector: Or.S;W.J.8eaQer;Or."L.S.
. COfJtactPersOrfz;f)r.S.~iJ. Seager

HaIsf~t:f

.
P~r;am
.~c.z:F'J'fE!"fertility Programcat the
NatIonal
.. fiHos~1 in Northwest
Washington, D.C., isdfferedtb men with neUrological
impairmentsW!1o wish to father children or todetermine
whether they l"I1ightbe able.tofatl1er children in',the
future.

9.01

FES Application:
Sexual function
Electroejaculation
Description: Fertility evaluation begins with an
educational overview of the procedure, and a
comprehensive assessment including a medical and
physical exam, psychosocial evaluation, and laboratory
tests. On subsequent visits, the electroejaculation
procedure is performed to assess and improve fertility
potential. Generally, between four and six 30-minute
visits are needed. Electroejaculation is a simple
procedure that involves inserting a specially designed
probe into the rectum adjacent to the prostrate gland.
Using a low-level current, electrical stimulation is
applied to the tissues and nerves adjacent to the
prostrate and seminal vesicles, often resulting in
ejaculation.
History: The fertility program at NRH has been
ongoing for the past 9 years. The number of males that
have been treated in this and other programs is 600+.
Status: Experimental research; Feasibility study
Candidate Description:
Multiple sclerosis
Spinal cord injury

Information available: PrintedfOnnat.


HQ!I~: No infOrmation provided
Location of'iervi'. iceprovidEet'Sloca~(jn
ACcessibilitY:. .... .
atl'~~eS$iblermCkbathroomsi
Handicapped;~ngavailabfe; .Near accessibleypublic
transport
Populatious served:;;Mate OnlY; Adult (age 16to 65)
AreasserY'~i:~g infOrmation' provided
rral~~uirjd~'No

~'info!fixedt;tates
Payrnent.. m~d$:Wil1blltlhsurance
Type offadlly~PrivatelysuPported; For profit;
Hospital; Rehabilitation cent.er
AecreditatignlCARF Accredited; JCAHO Accredited
Licensing/6ertification: Not appliCable

Cervical
Thoracic
Lumbar
Sacral
ASIA International Impairment Scale: ABC D
Other spinal disorder: Spina Bifida
Paraplegia
Tetraplegial Quadriplegia
Time elapsed post-injury/onset: 6 months
Restrictionsi Contraindications: Fertile age range
needed. Restrictions: persons with cardiac pace
makers.
Treatment course:
Evaluationl assessment - 1 hour
Outpatient surgical procedure(s) 1 hour
Approximate number of visits required in total: 1 - 10
post visits
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: Less than $1,000
3rd party payers typically cover: Some costs
Type of equipment: Clinic use stimulator; Research
prototype stimulator
Availability of equipment: No charge; in-house use
only

76

FES RESOURCE GUIDE

USA - FLORIDA

~. 10.00
thefrllJ~ibi' Pro~1tOCuteParalysis
Uni\l~~ity~ofMia
1600~N;W/1oth A

ool/,ofMm;tiCine

MiamLFL" 33136
USA
.
Tel: 305:"f4~001't0l1~fiee! 800-7&2~a87
FAX: 305"2~3-6017.e~Mall:
Director:R:ichard Bunge, Ph:D.; Barth Green,MD
Contact Person: Maria':Amador, RN
Program Des~ription: The Miami Project, a research
center.forspinal cordfinjury,is investigating the effect of
FES applications on spinal.corcl injured individuals.
Current'studies are. evaluating electroejaculation
equipment and amassisted,walking system: Future
studies will focus,on the application of FEStar upper
extremity; Clinical services proposed for Parastep1

10.01

FES Application:
Lower limb movement
Stepping and walking
Description: Utilizing Parastep I from Sigmedics Inc.
we are evaluating the physiologic effects of ambulating
with FES. This is a research program only. The length
of the study participation is 5 months.
History: We have been involved with the application of
FES for upper extremity and lower extremity activity for
over 8 years. Our involvement with the Parastep I
began in 1991.
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Thoracic: Motor: T4-11/ Sensory: T4-11

10.02

FES Application:
Upper limb movement
Grasping
Description: Device designed to assist persons with
quadriplegia in achieving powerful hand opening and
closure function. The device is activated through
tenodesis action.
History: Initial study Jan, 1995, we have evaluated 4
people, limited to 5 participants at a time.
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Cervical: Motor: C4-6 / Sensory: C4-6
Tetraplegial Quadriplegia
Restrictionsl Contraindications: Spasticity in
forearm, contractu res of the hand.

and upper extremity arrncrank ergometer in late 1995.

InformatiolJavailable: Printm;t:wrmat

H01J,",= 8:30~AM to 5:30 PM.;M(;Jnday~Friday

Loca~~services: Servicerproviders location

Acc~ilitf:Wheelchair accessilSJe, incllbathrooms'

H~pm;t parking available; Near~sible publi~

trarisriJrt

Popu'dDnsserved: Adult (age 16 to 65~


Areas'served: Unlimited
Referral required? No
BlUing info: No charge
P~yment methods: No information provided
Type of facility: Privately supported; Non-profit;
Research & development center
Accreditation:. NOinformation provided
Licenslng/Oertificatlon: Not applicable

Paraplegia
Time elapsed post-injury/onset: greater than 6 months
Restrictionsl Contraindications: All candidates must
be: without fractures, contractu res or dislocations of the
lower extremities, medically stable, and without obesity.
Treatment course:
Evaluation/ assessment.: 1 week
Training - 5 months
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: Less than $1,000
3rd party payers typically cover: No costs; research
Type of equipment: Clinic use stimUlator; FDA
approved stimUlator; Transcutaneous/surface
electrode(s)
Availability of equipment: Purchase; upon
completion of the study, from Sigmedics

Treatment course:
Evaluationl assessment - 1 day
Outpatient fitting/implementation - 1 day
Training - 6 months
Maintenance / check-ups - as needed
Approximate number of visits required in total: as
needed
Requires evaluation at this facility? Yes
Requires local lodging? No information provided
Typical cost: Less than $1,000
3rd party payers typically cover: No costs; research
Type of eqUipment: Home use stimulator; Research
prototype stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: No charge; !\lot available
for purchase.

WHERE TO GET FES

77

USA - FLORIDA / GEORGIA


~

'
'
.......

"""
\...

10.03

FES Application:
Sexual function
Electroejaculation
Description: We use electroejaculation to obtain
semen from men with SCI for use in research and to
help them father children. History: Available since Feb.
1991. Studied 145 individuals. Waiting list
approximately 6 weeks at this time (Spring 1995).
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Paraplegia
Tetraplegia/ Quadriplegia
Restrictions/ Contraindications: 1. heart problems;
2. younger than 18; 3. lesions in bowel; 4. unable to
understand procedure.

Treatment course:
Evaluation/ assessment - 1 hour orientation
Inpatient fitting/implementation - some inpatients
undergo electroejaculation once a month until they are
out of the hospital
Outpatient fitting/implementation - Mostly (95%) are
done as outpatients, once - twice/month for 2-6 months
Approximate number of visits required in total: 2-30.
depending on which protocol participant is in.
Requires evaluation at this facility? Yes
Requires local lodging? No; Can travel to the center
on days of treatment
Typical cost: Less than $1,0.0.0.
3rd party payers typically cover: No costs; research
Type of eqUipment: Clinic use stimulator; Not FDA
approved stimulator
Availability of equipment: No charge; Not available
for purchase

\...

'

'
'

'
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\...

'

'
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~

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~

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\,...

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'
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GEORGIA

W .t1.00 ...

Rehatillitation<$$tvices' ...Qenter for


Rehabilitatforrl.MedicineEffio_University
Departme....oIRehabilitationMedicine
1441 Clifton Road, N.
Atlanta GAa0322
USA
Tel: 40.4-712.460.1
Toll-free:
FAX: 414-712480.9
E-Mail:stElve@Spinal.emory.edu
Director: Steven L. Wolf, PhD, FAPTA
Contact Person: Steven L. Wolf
Program'Description:FES is provided as partof a
comprehensive rehabilitation program within the
context of surface EMG volitional activation that
requires voluntary movement (recruitment on the part
of the person with paralysis). This program emphasizes
a surface EMG/FES interface in which the

participanjplays an active role.Information aV8iiabfe:


No information provided
Hours: a:oq;AMtb6:DD PM; MondaYilhrougnFrlday.
Locationof~services: .Service providers locatiQn
Accessibility: Wheelchair accessible, incl.baflirooms
PopulatlOnS5*iv.ed: Adult (age 16;;t(65)
Areas ~efVetf~'llh1imited
Refemrl'Fequired? Yes From: Government Agency;
Physician
BilUl1ginfo: Fixed rates
PaymentnfethOds: Cash; Willbilllnsurance;;WilibiU
Medicare
Type offacility: Privately supported; Hospital;
Rehabilitation center
Accreditation: CARF Accredited
licenSing/Certification: PT license,MD license .

11 .01
FES Application:
Neuromuscular treatments
Regaining voluntary function
Description: FES is integrated into surface EMG
stimulation where FES is "triggered" based upon
VOluntary muscle activation of the same muscle or a
synergist. History: No information provided
Status: Clinical service
Candidate Description:
Spinal cord injury
Hemiplegia
Tetraplegia/ Quadriplegia
Restrictionsl Contraindications: In-tact sensation,
and paretic rather than plegic.
Treatment course:
Evaluationl assessment - weeki

Pre-implementation therapy - 1-2x1 wk for 2 wks


Outpatient implementation - daily - in, weekly - out
Post-implementation treatment - weekly to monthly
Approximate number of visits required in total: 20
Requires evaluation at this facility? Yes; All
treatment and charges are based on the evaluation.
Requires local lodging? Yes, but not for follow-up.
Typical cost: $1,0.0.0.-$5,0.00.
3rd party payers typically cover: Some costs; for
those that are "non-legal" and out-of-state, must pay
first then receive reimbursement from insurance co.
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimUlator;
Transcutaneous/surface electrode( s)
Availability of equipment: Rental; from manufacturer

78

FES RESOURCE GUIDE

USA - GEORGIA

"",' 12.00
Shepherd Center'
2020 Peachtree RoaQ:;;NW.
Atlanta GA 30309
USA
Tel: 404;.350-7487
Toll-free: 800.:54845651
FAX: 404--350-7356
E-Mail:
DirectoflDOnald P. Leslie, MD
ContactiPerstm: .
B. Abice, PT
Program Descri
i'l~:Parastep FESiSa:fe'E! for
ate two Physical.:tbertiPists
service progJ"am.
trained in system:use. Wecsn see about 210 4;st a
tirne. P:el'Sons ml;!stmakegood progress.mcol'ltinue.
there 1$a commitment for 32 sessions, 2,.. 5 x I Wk.
Il1fol'rt'l8tron available:' Printed format
Hours~9:00 AM to 4tOO PM, Monda - Frida
~

12.01

FES Application:
Lower limb movement
Stepping and walking
Standing I transfer assistance
Description: The Parastep System is manufactured
fur stepping and standing. Electrodes are applied in a
surface manner. Electrode cables connect the
electrodes to a microprocessor which is battery
powered. The system is connected to a walker.
Standing and step taking is achieved through finger
switch controls on the walker handle.
History: Served as a clinical trial site fur Parastep pre
FDA approval. We continue to see clients post FDA
approval. We have trained 20 clients. We can see 2 to
4 clients at one time.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C8 I Sensory: C7
Thoracic: Motor: T1-11/ Sensory: T1-11
ASIA Internationallmpairrnent Scale: A B
Other spinal disorder: Transverse myelitis
Paraplegia

Loca.lJt:ofD",ices: Service provlders location


Ac
. : Wh'eelchair accessible,lnch bathrooms;
Handicapped parkrng available; Near accessible public
transpQrt
Popula,tiona~erv~~:Adult (age 16 to 65)
Areas~~:, Unlimited
R
ired? N02
Billi
fixed.tates.,..
P~Od$1C~; Will bill Insurance, through
Sig
pr~rtification. is required:; Will bill Other
third-party payment
Type offacilitytNon-profit; Outpatient facility;
Hospital;' Rehabilitation center
Accreditation: CARF Accredited; JCAHO Accredited
Licensin ICertification: Not a licable

---

Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 6 months - 10 years
Restrictions! Contraindications: Must have enough
hand function to trigger switches. Contra indications:
recent fractures; osteoporosis; severe spasticity; hip,
knee and ankle contractu res; extreme de-conditioning;
obesity.
Treatment course:
Evaluation/ assessment - 3 hours, in one day
Outpatient fitting/implementation - 1 day
Training - 32 sessions, 2 - 5 times a week
Maintenance I check-ups - quarterly
Approximate number of visits required in total: 33 - 35
Requires evaluation at this facility? Yes
Requires local lodging? No; If the partiCipant can
travel back and furth at their own cost, they are free to
travel to and from the Hospital without restraint.
Typical cost: $10,000-$20,000
3rd party payers typically cover: Some costs; about
a 60% success rate with private insurance companies
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimUlator;
Transcutaneous/surface electrode(s)
Availability of equipment: Purchase

13.00

Next Step Rehabilitation and Research


NSRR, Inc.
2337 Perimeter Park Drive, Suite 220
Chambelee GA 30076
USA
Tel: 404-458-6777
Toll-free: 1-800-827-7618
FAX: 404-458-3314
E-Mail:
Director: Joseph Toadvine
ContactPerson: Joseph Toadvine; Todd Daugherty
Program Description: At Next Step Rehab we try to
have the most advanced and newest equipment
available. We work closely with Steve Petrofskyof
Electrologic of America and will be one of their clinical
testing sites.
Information available: Printed format
Hours: 9:00 AM to 6:30 PM, M'dnday - Friday

Location of services: Service providers location


Accessibility: Wheelchair accessible, incL bathrooms;
Handicapped parking available; Near accessible public
transport
Populations served: No restrictions
Areas served: Unlimited
Referral required? Yes From: Physician
Billing info: Varies with ability to pay
Payment methods: Cash; Payment Plan Option; Will
bill Insurance; Will bill Medicare; Will bill Other third
party payment
Type of facility: Privately supported; For profit;
Outpatient facility; Rehabilitation center; Rehabilitation
program; Research & development center
Accreditation: No information provided
Licensing/Certification: Not applicable

..

--

WHERE TO GET FES

79
USA - GEORGIA !ILLINOIS

~ 13,01
FES Application:
Cardiovascular exercise
Circulatory/Skin treatments
Lower limb movement
Neuromuscular treatments
Description: No information provided
History: No information provided
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury

Restrictions/ Contraindications: No info. provided


Treatment course:
No information provided
Requires evaluation at this facility? Yes
Requires local lodging? No information provided
Typical cost: No information provided
3rd party payers typically cover: Some costs
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;
Transcutaneous/surface electrode(s)
Availability of equipment: Purchase

ILLINOIS

JiJ 14~!OO
~~Pl'itzk~f!.stitQt&,o;MediCan:ng!l1eering

;~l:i6cat1on
"b,.
. 'ti"
,
: .... ... .'ofservices'N
. . . . ' 0 .'Inlvf;[r1a
on pro

". "A':~.~~~~tlity:Wheelchair acee~sjble, inel.

'HaTld~pped parking available',:

10West32nd Sffeet,.E1-125

PcrPJ!ati~ns,served: Adult {aget6 to 65)

Chicago Il 60616~S793 .

.
Areasse.ved::No informatiol1provided.

USA'
..
.

Refe,....hequired? Yes. From; P:hysicllsl1; Onlyaceepf


Te?;312~67~392a
.lrolt-tree:
referralS!ftomlocali.COOpe.ratingmeditai;centers, no
FAX~312~Z~sfa7. I:~~il:
self-referrals.
/ ..
pimejaeger@h1!pna~a:OOJii~ .
Billing~infO: No charge
pi~tor:ROber:tJ.Jaeger,.Ph.D.
paY[I1ent methods: No informatia1'fj.5~()vided
Contact Penf#m:RobertJ.daeger, Ph:D:
TYPB'offacility: Privately supported; f"ilublicly
p~:ra,m
n: This is a research 'program in
supportedrFederal agency; NOn'"profit;.College I
theuseof .... " pulmonary applications (cough and
UniVerslty.~rami Research &developmentcenfer
breathing)At~i~bot a clinical service program ..
Accreditation: Noirlforrl1ationp~ided
Infonnatiom_ailable: No information provided
Licensing/Certification: Notapplicable
Hours: No information provided
IIlinois.ln~te ot,;Teehnology

14.01
FES Application:
Respiratory treatments
Breathing assistance
Cough assistance
Description: We stimulate abdominal muscles either
open-loop or closed-loop in synchrony with normal
breathing. This is a research study only - no treatment
is involved.
History: This research has been going on since 1992.
Over 50 persons have been studied.
Status: Experimental research; Feasibility study
Candidate Description:
.
Spinal cord injury
Cervical: Motor: C4-8
Thoracic: Motor: T1-6
Paraplegia
Tetraplegial Quadriplegia

Restrictionsl Contraindications: Candidates are


selected by invitation only from the inpatient and
outpatient populations of local cooperating medical
centers. We do not accept self-referrals.
Treatment course:
Evaluation! assessment - 1 day
Training - 1 day
Other research experiments - 1 day
Approximate number of visits required in total: 1
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $1,000-$5,000
3rd party payers typically cover: No costs; research
Type of equipment: Research prototype stimulator;
Transcutaneous!surface electrode(s)
Availability of equipment: No charge; in-house use
only

80

FES RESOURCE GUIDE

USA -ILLINOIS

15.00... . . .. . . . . . . . . ...............

F'ESfor A~no~icll)ysfunction

Hines VA Hospital; ReflabilitationR & Genter (151t)


P.O. Box20
HineslL 60141.
USA
!ek708-343,.7200x5805
101141'88:
FAX: 708-531,.7928
E-Mail:
Directo~James S; Walter, Ph.O.
Contact Person: James S. Walter;e;t.l:.Q,,..8Iadder
and sexual functioning; Lisa Riedy,Ph.D, .;BoWSI
control; R,ObertOunn, Ph.D. - Respiratory control
Pro~ra~D.~.~ption: We have been conducting
studlesJorthe last 5 year~. (1) Boweicontrolisa new
study.usingsurface electrodes overtheqnalsphincter.
(2) Respiration is a.new studY.. evaluatingdireefthoracic
muscle stimUlation for assistance. (3)Sfadderand
sexual functioning is being evaluated by stimulation
with percutaneous electrodes,

15.01

FES Application:
Respiratory treatments
Breathing assistance
~escription: Small percutaneous wires are implanted
In chest muscles and stimulation is conducted to
determine if ventilation is assisted. Studies conducted
only in the clinic, electrodes are then removed.
History: This is a new project, just starting.
Status: Experimental research; Feasibility study
Candidate Description:
Spinal cord injury
Cervical: Motor: C1,2 or above
Tetraplegial Quadriplegia

15.02

FES Application:
Bladder control
Bladder emptying
Description: Percutaneous wire electrodes evaluated
fo! direct bladder stimulation. The extremely small
wires are placed low in the abdomen and stimulation is
conducted during a one hour session. The goal is to
determine implant candidates.
.
History: This application has been available for 5
years; 30 have been treated; capacity of 30 new
individuals.
Status: Experimental research; Feasibility study
Candidate Description:
Spinal cord injury
Paraplegia
Tetraplegia! Quadriplegia

fhformationavailible:Prif1ted tormat

~ours: 8:00 Amto'4:30 PM,Mond:Eiy ;.FriGiay

~on ofs
:Consumer's;residence;$ervice

providers la

ACC~Sibility:Vvneefahairaccessible, irlek~hrooms"

Handlcappedpar.kinflj availa~e:. Neataccessll::l!e>public

transport

Pipulationssel

Areasserv
lnlinrt!teo.

Referral requ
1"No ;

Billing info: Noaharge

P!?ment met~od~~JIlOinforrnatlonprovided

Type offacifitY:PuoJicly supported; VA agency;

Rehabilitation center
.

Accreditation: Nojntormation.provided

Licensing/Certification: Studies are done in

conjunction With physioians~

Restrictions/ Contraindications: Must be in good


health, no cardiovascular problems.
Treatment course:
Evaluation! assessment - 3 hours
Approximate number of visits required in total: 1 or 2
Requires evaluation at this facility? Yes
Requires local lodging? No; Could travel to clinic for
a one day study
Typical cost: Less than $1,000
3rd party payers typically cover: No costs; research
Type of equipment: Clinic use stimulator; Not FDA
approved stimulator; Implanted electrode(s)
Availability of equipment: No charge

Restrictions! Contra indications: Restrictions - in


good health, no upper urinary tract problems, no
diverted lower urinary tract. Contraindications - heart
pacemaker.
Treatment course:
Evaluation! assessment - 1 or 2 times for 1 - 3 hours.
Requires evaluation at this facilitY? Yes
Requires local lodging? No; Could travel to clinic for
a one day study
Typical cost: Less than $1,000
3rd party payers typically cover: No costs; some
travel funds may be available; waiver for non-VA
participants requested
Type of equipment: Clinic use stimulator; Not FDA
approved stimulator; Implanted electrode(s)
Availability of equipment: No charge

WHERE TO GET FES

81
USA -ILLINOIS / MAINE

15.03

FES Application:
Bladder control
Bladder incontinence
Description: Small pocket stimulator with surface
electrodes placed over dorsal penile nerve (male) /
vaginal area (female) or over anal sphincter.
Stimulation is applied during periods when urinary
incontinence may be a problem. For home use.
History: This application has been available for 3
years; 5 have been treated; capacity of 5 new
individuals.
Status: Experimental research; Feasibility study
Candidate Description:
Multiple sclerosis
Spinal cord injury
Paraplegia
Tetraplegia! Quadriplegia
Restrictionsl Contraindications: Restrictions - must
have documented urinary incontinence
lJ

Treatment course:
Evaluation/ assessment - urodynamics with a urologist
Pre-implementation therapy - record incontinence
episodes
Outpatient implementation - shown how to use portable
stimulator
Training - as outpatient
Maintenance / check-ups - followed by phone and mail
Approximate number of visits required in total: 1 or 2
Requires evaluation at this facility? Yes; Other
institutions getting IRB approval could use the device.
Requires local lodging? No
Typical cost: Less than $1,000
3rd party payers typically cover: No costs; research
Type of equipment: Home use stimUlator; Not FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: No charge

15.04

FES Application:
Bowel control
Bowel emptying
Bowel incontinence
Description: Surface electrodes are placed around the
anal opening. Stimulation is applied to induce bowel
emptying. Longer daily stimUlation used for
incontinence of stool.
History: This is a new project.
Status: Experimental research; Feasibility study
Candidate Description:
Spinal cord injury
Thoracic: Motor: T1
Paraplegia
Restrictions! Contraindications: Restrictions - must
be in good health, no ulcers around anal area.

Treatment course:
Evaluationl assessment - 1 week
Inpatient fitting/implementation - 10 weeks
Training - 1 day
Maintenance / check-ups - 1 week
Requires evaluation at this facility? No; Defecation
is the end point
Requires local lodging? No
Typical cost: Less than $1,000
3rd party payers typically cover: No costs; research
Type of equipment: Home use stimulator; Not FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: No charge

MAINE

16.00

Neural Engineering Clinic


26 Eastern Avenue
Augusta ME 04330
USA
Tel: 207-626-01 00
Toll-free:
FAX: 207-622-0268
E-Mail:
Director: Ross Davis, MD
Contact Person: Sandra Emmons, CNRN
Program Description: No infOrmation provided
Informationavailable: No information provided
Hours: 9:00 AM to 4:30 PM, 5 days a week
location ofservices: Service providers location
Accessibility: Wheelchair access. inel. bathrooms;
Handicapped parking avail.; Near access. public

transport
Populations served: Aged (age 65 or older); Adult
(age 16 to 65); Child (up to age 16)
Areas served: Anywhere inthe U.S.A
Referral required? No
Billing info: Varies with ability to pay; Require
documentation of financial need
Payment methods: No information provided
Type of facility: Privately supported; PubKcly
supported; Non-profit; In~tient facility; Outpatient
facility; Research.& development center
Accreditation! JGAHO Accredited - for Kennebec
Valley Medical Center
licensing/Certification: Not applicable

82

FES RESOURCE GUIDE

USA - MAINE / MARYLAND

16.01

FES Application:
Lower limb movement
Standing / transfer assistance
Description: Paraplegic subject, implanted in 1991
with a modified cochlear FES-22 stimulator for lower
extremity restoration of function. Our subject is
standing regularly.
History: See application description.
Status: Clinical service; Experimental research;
Feasibility study
Candidate Description:
Spinal cord injury

Thoracic: Motor: mid levels


Paraplegia
Restrictions/ Contraindications: No info. provided
Treatment course:
No information provided
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: No information provided
3rd party payers typically cover: No information
provided
Type of equipment: Research prototype stimulator
Availability of equipment: No information provided

MARYLAND

~
17,.00
Physical Medicine and Rehabilitation Service
Baltimore Veterans Affairs Medical Center
10 N. Greene Street, Mail Stop 117
Baltimore MD 21201
USA
Tel: 410-605-7171
Toll-free:
FAX: 410-605..7932
E.;Mail:
Director: Dr. Peter Gorman
Contact Person: Linda Marshall, M.S., OTR
Program Descriptiom No information provided
Information available! Pril1tedformat; Videotape
format
Hours: 8:30 AM to 5:00 PM; Monday - Friday
Location of services: Consumer's residence; Service
providers location
Accessibility: Wheelchair accessible, incl. bathrooms;

17.01

FES Application:
Upper limb movement
Grasping
Description: Research program testing
NeuroControl's Freehand system, Neuroprosthetic
Hand Grasp System, to produce functional grasp and
release in persons with C-5/6 quadriplegia. Produces
lateral and palmar grasp patterns.
History: Has been available for three years, have
implanted 3 persons, able to accept at least 7 more at
this time (as of 4/95), have had successful outcomes of
all 3 participants.
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-6 / Sensory: C5-6
Tetraplegia! Quadriplegia
Restrictions/ Contraindications: Contraindications:
severe upper extremity contractu res, incomplete injury,

Handicapped parking available; Near accessibJe public


transport
Populations served: AUtli1 (age 16 to 65)
Areas served: mainly from the East Coast
Referral required? No
Billing Info: No charge; No charge to participant, but
3rd party reimbursement sought; Musftiave own
transportation
Payment methodS:WiU billlnsurance?Willbili
Medicaid; Will bill Other third-party paymenl;l:Jo notbill
participant
Type of facility: Publicly supporteQ~VA agency; Non
profit; Inpatient facility; OutpatientfaPility; College!
University program; Hospital;Rehabilitafion program
Accreditation: JCAHO ACCtedfted
Licensing/Certification: Not applicable

asymmetry, head injury or cognitive limitations, poor


health, severe decubiti.
Treatment course:
Evaluation! assessment -12-15 hours
Pre-implementation treatment - 1-2 mos at home
Inpatient surgical procedure(s) - 8-12 hours
Training 2-3 week inpatient stay
Post-implementation therapy/treatment - 3 times a
week for 8-12 weeks if also have tendon transfers
Maintenance / check-ups - as needed
Approximate number of visits required in total: 45-75
Requires evaluation at this facility? No; May also
visit at participant's home or office
Requires local lodging? No
Typical cost: More than $20,000
3rd party payers typically cover: Some costs; for
inpatient stay during surgery
Type of equipment: Home use stimulator; Research
prototype stimUlator; Transcutaneous/surface
electrode(s)
Availability of eqUipment: No charge

--

WHERE TO GET FES

83
USA - MARYLAND

,~h!:~rs~~ltI\a.'SClf'fnalOng;term>se,ttiDg~
fnfoMati'
, Printeaformat'"

Hours:; 8: ....." ,.' ~ilM~PM, Tuesday, Wednesday,

,REG'Programfor Spina' ,CON",


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Injured
,Metlicalllln

nseling Center
2 Wisconsi
,Suite 530
CheVy Chase MD 208,14
USA
'

Thursday.F~",

Tel: 301-654-3638

Toll-free:
E*Mail:
J)iJ1ftor: CharteEJneRFrazier, RN
S!!"ct Person:Charleene Frazier, RN; Kathy"
I?Ssha, RN
Program D~riptlon:inisGOmputerizedFES
(CFES) Pr~fSm;',s Offetedina multidisciplinary'~linic
that stre~holisticn~lalthandwhere clients ar~
enco~~ged'and guided to ,become active h~lthSelf"
careslvers:Jhe comprehensive rehab.
is
'
managed~y' nurses withadvanceddegr
"
extensive professional"eXperience. In addition to the
CFES,tt:fesenursE!s,Q~~wide~range of services

FAX.:~3U1-652':90M

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18.01

FES Application:
Cardiovascular exercise
Bicycle ergometry
Description: The REGYS-ERGYS Program of
computerized functional electrical stimulation is cycle
ergometry utilizing the lower extremities through
synchronized sequential electrical stimulation delivered
by a computer through surface electrodes placed on
quad,rice~s, hamstring and gluteal muscles. Multiple
phYSiological benefits are achieved and sense of well
being is improved.
History: Began REGYS in 1986; began ERGYS in
1989; began full time offering in 1992 through May
1995. Over time about 20 participants have been in the
in-patient program, of those, 7 currently own and use
an ERGYS consistently 2-3 times per week, There are
currently 5 persons in the clinic program and 2 to be
evaluated to start,
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C4-7 I Sensory: C4-7
Thoracic: Motor: T 1-11 / Sensory: T 1-11
ASIA International Impairment Scale: A B, with no pain
sensation Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset varies

locationQf'lervices:Service providers location


Acce$'''1IBY: Wheelchairaccessible, incL battlrooms;
Ha
parking avaiJable (cars only); Near
public transport
.
81i~nt,d: No restrictions
dzMa,yl;and;\tirginiar, Washington, DC

area

?YesFrorn~ Howev.e'r,:rnust'have

Referrall'ef4"
been seen
'previous};~ear fora~e:ornplete

physical e
hysiatrist familiarwitfilSCI.

BIlling Infl.
las::; .

Paymentmethoc:ls:\Casl1;'Gftar@i;WCredit Card' Will 'bill

Medicaid; WiH'bill Medicare .


,"
'

Type ()ffacHitfi'Non-profit; 'Olltpatientfacilily

AccnKIitation:No information provIded

Lh:~ensr '~rtification: NotapRli~ble

Restrictionsl Contraindications: Must be free of:


cardiovascular limitations, unhealed fractures in lower
extremities, severe osteoporosis, limited range of
motion in lower extremities, presence of pressure sores
in treatment area, and/or any acute disease process.
Treatment course:
Evaluation/ assessment - one session with a doctor
Pre-implementation therapy/treatment - one hr physical
therapy session and one hr REGYS session
Training - 2 - 6 months
Maintenance / check-ups - 4 times per year
Approximate number of visits required in total: 24 - 72,
based on 2 - 3 times per week
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $10,000-$20,000
3rd party payers typically cover: Some costs'
insurance companies purchase as durable medical
equipment,; the ERGYS and a training session are
reimbursed,; depends on the insurance policy
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;
T ranscutaneous/su rface electrode( s)
Availability of equipment: Purchase; Rental; those
who do not own an ERGYS can use the clinic's
ERGYS for a nominal fee depending on scheduling,

..,
84

FES RESOURCE GUIDE

USA-MARYLAND/MASSACHUSETTS

19.00

Baltimore Efectroejaculation Program


Drs. Moulsdale, Murphy. Sigelbaum and Lerner, P.A.
7505 Oster Drive, Suite 508
Towson MD 21204
USA
Tel: 410-296-0166
Toll-free:
FAX: 410-828-7275
E-Mail:
Director: Dr. Brad Lemer
Contact Person: Carolyn Eney, Administrative
Assistant
Program Description: Rectal probe electroejacuJation
- after undergoing an initia1.assessment, the participant
undergoes rectal probeelectroejaculation. Once the
semen quantity is adequate, artificial insemination or in
vitro fertilization is pursued.
.
Information available: Printed format

19.01

FES Application:
Sexual function
Electroejaculation
Description: Rectal probe electroejaculation - A probe
is placed in the rectum and voltage is discharged to
stimulate contraction and emptying of ejaculatory
apparatus. Once semen quality is acceptable, artificial
insemination or in-vitro fertilization is pursued.
Hi~t0':Y.: Has been available for 4 years; approximately
15 individuals have been treated; 5 pregnancies to
date, 3 live births, 2 miscarriages, 1 expecting (as of

5/95).
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Multiple sclerosis

Houn:: 9:00 Am to 4:30 PM, Monday - Friday


Location of services: Service providers location
Accessibility: Wheelchair accessible, incJ. bathrooms;
Handicapped parking available; Near accessible public
transport
Populations served: Male Only
Areas served: Unlimited
Referral required? No
Billing info: Fixed rates
Payment methods: Cash; Charge/Credit Card;
Payment Plan Option; Will bill Insurance; Will bill
Medicaid; Will bill Medicare; Will bill Other third-party
payment
Type of facility: Privately supported; For prOfit;
Outpatient facility
Accreditation: Not applicable
Licensing/Certification: Board Certified in Urology

Spinal cord injury


Other spinal disorder: Transverse myelitis
Restrictions/ Contraindications: No info. provided
Treatment course:
Evaluation/ assessment - 1 time a week, one time
Outpatient surgical procedure(s) - 1 time/mo, 2 - 6
times
Approximate number of visits required in total: 3 - 7
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: $1,000-$5,000
3rd party payers typically cover: Some costs
Type of equipment: Research prototype stimulator
Availability of equipment: Purchase

MASSACHUSETTS

20.00

Department of Urology
Boston University School of Medicine
DOB Suite 606
720 Harrison Avenue
Boston MA 02118
USA
Tel: 617-638-8485
Toll-free:
FAX: 617-638-8487
E-Mail:
Director: Dr. Robert D. Oates
Contact Person: Dr. Robert D. Oates
Program Description: All types of management of
infertility including rectal probe electroejaculation.
Information available: Printed format
Hours: 9:00 AM to 5:00 PM, Monday - Friday
Location of services: Service providers location

Accessibility: Wheelchair accessible, inc!. bathrooms;


Handicapped parking available; Near accessible public
transport
Populations served: No restrictions
Areas served: Unlimited
Referral required? No
Billing info: Fixed rates
Payment methods: Cash; Charge/Credit Card;
Payment Plan Option; Will bill Insurance; Will bill
Medicaid; Will bill Medicare; Will bill Other third-party
payment
Type of facility: For profit; Inpatient facility; Outpatient
facility; College / University program; Consultant /
Private practice; Hospital; Rehabilitation center
Accreditation: JCAHO Accredited
Licensing/Certification: Not applicable

.....

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WHERE TO GET FES

85
USA-MASSACHUSETTS

~ 20.01

FES Application:

Sexual function
Electroejaculation
Description: Rectal probe electroejaculation for
treatment of infertility.
History: This has been available for seven years, we
have treated 50 individuals.
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Multiple sclerosis
Spinal cord injury

Restrictions! Contraindications: No info. provided


Treatment course:
Evaluation/ assessment - 1 visit
Outpatient fitting/implementation - varies with each
person.
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: $1,000-$5,000
3rd party payers typically cover: Some costs
Type of eqUipment: Clinic use stimulator; Not FDA
..
approved stimulator
Availability of equipment: No information proVided

'
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'"'-'

Spinal Cord Injury Services, Physical


Medicine and Rehabilitation Service

\..

Brockton tWest Roxbury VA Medical Center


1400 VFW Parkway
WestRoxbury MA 02132
USA
Tel: 617-323-7700 ext. 5300
Toll~free:
FAX:617~323-6693
E-Mail:
wiegner.allen@forum.va.gov.
.
Director: Mehdi Sarkarati, MD, Chief ofSCI Service
Contact Person: Allen W. Wiegner, Ph.D.
Program Description: This VA Medi~l <?enter offers
several therapeutic and research applications'of FES.
Therapeutic uses include muscle strengthening and
prevention of deep venous thrombo~es. R~s~arch .
uses include restoration and prevention of limited galt
to paraplegics and improved hand function of C5 level

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"

21.00

tetraplegics.
Information available: Printed format
Hours: 8:00 AM to 4:30 PM, Monday - Friday
Location of services: Service providers location
Accessibility: Wheelchair accessible, incl. bathrooms;
Handicapped parking available; Near accessible public
transport
Populations served: U.S. Veteran Only; Aged {age 65
or older); Adult (age 16 to 65)
Areas served: New England States
Referral required?Yes From: Physician
Billing info: No charge; Fixed rates
Payment methods~ No information provided.
Type of facility: Publicly supp?~ed; VA ~gency;
Inpatient facility; Outpatient faCIlity; Hospital;
Rehabilitation center; Rehabilitation program
Accreditation: JCAHO Accredited
Licensing!Certification: Not applicable

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21.01
FES Application:
Lower limb movement
Stepping and walking
Description: Development of a hybrid orthosis for.
limited paraplegic gait. Uses FES and leg braces With
magnetic particle brakes at knees.
History: 5 subjects active over 5 years
.
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Thoracic: Motor: T4 or below
Paraplegia
Restrictions! Contraindications: Need to be in good
health; no autonomic dysreflexia; no denervation of
quadriceps muscles, hamstrings, or glutii.

Treatment course:
Evaluation/ assessment - 2 hours
Pre-implementation therapy/treatment - FES exercise
for 1-3 months
Outpatient fitting/implementation - 2 or 3 times a week
bicycle ergometry
Training and evaluation of gait - 1 time/wk for 6-12 wks
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: Less than $1,000
3rd party payers typically cover: No costs; research
Type of equipment: Home use stimulator; Not FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: No charge

86

FES RESOURCE GUIDE

USA - MASSACHUSETTS I MICHIGAN


I~

21.02

FES Application:
Upper limb movement
Grasping
Description: We are a satellite center for
implementation of the NeuroControl Freehand system
for improving hand function of persons with C5/C6
tetraplegia.
HiStory: 1 implantation as of 3195.
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Cervical: Motor: C5
Tetraplegia! Quadriplegia
Restrictionsl Contraindications: Candidates should
be in good health, no upper limb contractu res,
controlled spasticity, no hand function beyond weak
. wrist extension, no previous tendon transfers to their
~
21.03
FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Description: To assist in muscle strengthening and
maintenance of function after neurological damage
including stroke, nerve palsy, etc.
History: No information provided
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical
Other spinal disorder: stroke, nerve palsy, etc.
Hemiplegia
Tetraplegia! Quadriplegia
Restrictionsl Contraindications: Healthy, able to

hand. Contraindications : extensive muscle


denervation.
Treatment course:
Evaluation/ assessment - 4 hours
Pre-implementation therapy/treatment - exercise for 8
hours a day, 5 days a week for 3 months
Inpatient surgical procedure(s) - 3 weeks of
casting/immobilization post-surgery
Training - daily, 3 weeks in/outpatient
Maintenance / check-ups - every 6 months for 2 years
Requires evaluation at this facility? Yes
Requires local lOdging? No
Typical cost: Less than $1,000
3rd party payers typically cover: No costs; to
Veterans
Type of equipment: Home use stimulator; Research
prototype stimulator; Implanted electrode(s)
Availability of equipment: No charge

---

tolerate surface stimulation


Treatment course:
Evaluation/ assessment - 1 visit
Outpatient fitting/implementation
Outpatient therapy - 2 times a week for 10 weeks
Approximate number of visits required in total: 20
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: Less than $1,000
3rd party payers typically cover: No costs; to VA
outpatients
Type of equipment: Home use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode( s)
Availability of equipment: No charge

MICHIGAN
~
22.00

FES-Leg Cycle Ergometry (LeE) Program


Grand Valley State University School of Health
Sciences
126 Lake Michigan Hall
Allendale MI 49401
USA
Tel: 606-895-3318
Toll-free:
FAX: 616-895-2090
E-Mail:
Director: Brian Curry, Ph.D.
Contact Person: Brian Curry, PhD.
Program Description: Program consists of an
ERGYS I home rehab. system, supervised by Dr. Brian
Curry. Graduate Physical Therapy students are trained
and assist one on one with the FES-LCE (Leg Cycle
Ergometry) participants. Participants (donate) pay
$5.00 a session and split the costs of supplies and
maintenance. Participants are then eligible to ride the

ergometer 1 to 3 xl week as preferred or available. We


evaluate the long term effects of FES use.
Information available: No information provided
Hours: 9:00 AM to 8:00 PM, Monday - Friday
Location of services: Service providers location
Accessibility: Wheelchair accessible, inc!. bathrooms;
Handicapped parking available
Populations served: No restrictions
Areas served: Michigan, Western
Referral required? Yes From: Physician; Clinical FES
program
Billing info: Pay for expendable supplies
Payment methods: Cash
Type of facility: Privately supported; Publicly
supported; Non-profit; College / University program
Accreditation: No information provided
Licensing/Certification: Not applicable

WHERE TO GET FES

87
USA - MICHIGAN

22.01

FES Application:
Cardiovascular exercise
Bicycle ergometry
Description: An ERGYS I home rehabilitation system
is used to develop and maintain cardiovascular fitness
in persons with tetraplegia. Participants ride 1-3 xl wk
for 30 min. with 1 on 1 assistance at all times.
History: FES-LCE has been available here for 5 years.
Five people have participated regularly during the past
5 years. The program has a total capacity of 10.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-7
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 1 year
Restrictionsl Contraindications: Lower motor neuron
lesions; mod-max lower extrem. spasticity; inadequate
lower extrem. range of motion; poor general physical
~.

23.00

University of Michigan Electroejaculatlon


Project
University of Michigan - Department of Urology
1500 E. Medical Center Dr., Box 0330
Ann Arbor MI 48109
USA
Tel: 313-936-5770
Toll-free:
FAX: 313-936-9127
E-Mail:
Director: Dana Ohl, MD
Contact Person: Marcianna McCabe, RN; Mandy
Stuck
Program Oescription: Initially we evaluate sperm
production / quality in the male partner., then the
female partner is evaluated for fertility .. The couple is
entered into an artificial insemination program. If a
pregnancy doesn't occur this way, higher level assisted
reproductive technologies are instituted.

I@

health; implanted pacemakers; uncontrolled


hypertension; degenerative joint disease; osteoporosis;
previous lower extrem. fractures; history of hip or knee
dislocations; plates or pins in lower extrm.; inadequate
skin tolerance; intact lower extrem. sensation.
Treatment course:
Evaluation/ assessment - 2-3 times week for 4 weeks
Training - 2-3 times a week for 4 weeks
Post-implementation treatment - unlimited time 1-3
times a week, 30 minute sessions.
Requires eval. at this facility? No; Any FES vender
Requires local lodging? Yes
Typical cost: Less than $1,000
3rd party payers typically cover: No costs;
participants (donate) payout of pocket.
Type of equipment: Home use stimUlator; FDA
approved stimulator; Transcutan/surface electrode(s)
Availability of equipment: No information provided

Information available: NO information provided


HourS: 8:00AM to 5:00 PM, Monday - Friday
location oflservices:.Service providerslo~tion
Accessibitit;y:Wheelchair accessible, incLb~throoms;
Handicapped parking available; Nearaecessible public
transport; Accessible hotel nearby
Populations served: Male Only; Adtilt (age 16 to 65)
Areas served: Unlimited
Referral required? No
Billing info: Fixed rates
Payment methods: Cash; Charge/Credit Card;
Payment Plan Option; Will bill Insurance; Wilt bill
Medicaid; Will bill Medicare; Insurance reimbursement
is handled on a case by case basis.
Type of facility: Non-profit; Outpatient facility; College
/ University program
Accreditation: JCAHO Accredited
Licensin ICertification: Not a Iicable

23.01

FES Application:
Sexual function
Electroejaculation
Description: Electrical stimulation is applied via rectal
electroejaculation probe to stimulate ejaculation.
Progressively increasing voltage is delivered in a wave
like pattern until ejaculation is achieved. Blood
pressure is monitored throughout the procedure.
History: The program began in 1985 and has been a
pioneer program in male infertility associated with
spinal cord injury and disease. We have treated over
200 couples and welcome all injuries.
Status: Experimental research
Candidate Description:
Multiple sclerosis
Spinal cord injury
Cervical
Thoracic
Lumbar
Sacral

Hemiplegia
Paraplegia
Tetraplegia/ Quadriplegia
Restrictionsl Contraindications: Not suitable for
persons with surgical removal of rectum or chronic
ano-rectal inflammatory problems.
Treatment course:
Evaluation/ assessment - 1 time a month until ready to
begin partner insemination
Pre-implementation therapy- intake via phone by nurse
Outpatient surgical procedure(s) - done with
anesthesia for persons with incomplete lesions
Approximate number of visits required in total: 4 - 5
Requires eva!. at this facility? Yes
Requires local lodging? No
Typical cost: $1,000-$5,000
3rd party payers typically cover: No info. provided
Type of equipment: Clinic use stimulator; Not FDA
approved stimulator; Availability of equipment: No
charge; Not available for home use

88

FES RESOURCE GUIDE

USA - MICHIGAN
24~OO

~hab!Utitibn Institute'ofNlichigan
Detroit: Medical Center
261 Mack Boulevard . . .
Detroit /MI. 48201
USA
Tel: 313-74So9801 i ',+

FAX! 313-745-1019t>
Director. Patti Detiear

Totl.free:

e:'MaH:.

Contact Petson:'tineenPuei
Program.OBscriplon: FESis:used in our new
Parastepsystem: This atlowsparsenstoambulate with
sti~ula~ntothed~Em!~it'ie$r4a~anassistive
device. We also USe FEa~fbstrengtnen muscles and
treat.~eakened or 8trophiedmusclesr0Ccasionally
FES Isused,toc()ntrolspastim~:

~ 24.01
FES Application:
Lower limb movement
Stepping and walking
Description: The neuromuscular stim. generates
sequences of electrical impulses that are targeted at
the quadriceps and peroneal nerves. This causes knee
extension which allows the person to stand. The
peroneal nerve causes hip flexion and allows the knee
to bend. The Parastep system is a comprehensive
a~proach to enable standing & short distance walking.
History: Currently Parastep is just getting underway
here, there have been no persons evaluated with this
system as of mid March '95, one evaluation is
scheduled for late March '95.
Status: Clinical service
Candidate Description:
Paraplegia
Restrictionsl Contraindications: Cardiac demand
pacemakers; cancer in electrode placement area;
severe scoliosis; severe osteoporosis; skin disease at

@] 24.02
FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Description: FES for treating muscle weakness is
done by placing electrodes over the affected muscle(s)
and by setting up contract/relax patterns that
correspond with active or assistive exercises.
History: Regularly available
Status: Clinical service
Candidate Description:
Spinal cord injury
Restrictionsl Contraindications: Pacemakers
implanted defibrillators, implanted pain control d~vices,
cardiac instability. Restricted to complete SCI.

Information availab"'~~l1nted format


Hout$: 8:00 AM to 5:00PM, Monday - FridSW
Locatl()n of services:8ervice providers I~tlbn
Accessibility: Wheelehafr.sccessible,. inc~(~~too~i
Handicapped parking available; Near. accessiblepu:!:lJro:
transport
P~ldations~nm'ed!Noinformation provided
Areas;served:Anywhereinthe U.S.A.
R.rralrequired?'tes;From: Physician
Billibttlnfo: Fixed rates
~ymentmethod&:WiIl bill Insurance; willNbill
Medicaid; Will bill Medicare; Will bill Other third'"party

payment

Type of~ftrcility: Rel;labH.itatiofl center

AccreditatiomCARF Accfeaitea~ JCAHOAccredited


Licensing/Certification: Nofapplicable
.

stirn. sites; irreversible contractu res; autonomic dysrefJexia.

Treatment course:
Evaluation/ assessment
Training
Post-implementation therapy/treatment
Maintenance / check-ups
Approximate number of visits required in total: 32
Requires evaluation at this faCility? Yes; Participant
must be evaluated by a therapist trained with Parastep
and a PhysiCian.
Requires local lodging? Yes; Because the treatment
is ongoing and the participant must be in the area to
attend sessions.
Typical cost: More than $20,000
3rd party payers typically cover: Some costs;
Medicare/Medicaid payment being researched
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;
Transcutaneous/surface electrode(s)
Availability of equipment: Purchase

Treatment course:
Evaluation/ assessment - 2-3 days
Pre-implementation therapy/treatment - 2 days
Outpatient fitting/implementation; Training
Maintenance / check-ups - as needed
Approximate number of visits required in total: variable
Requires evaluation at this faCility? Yes
Requires local lodging? Yes
Typical cost: No information provided
3rd party payers typically cover: No infor. provided
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;
Transcutaneous/surface electrode(s)
Availability of equipment: Purchase; Rental

WHERE TO GET FES

89
USA - MICHIGAN / MINNESOTA

T
R
515 Mia

,Suite200

'G~d Rapids MI 495133

usA

Tel:616-4584:~
,FAX.: 616-4
Di8~tor:Xi~
MUl;,

lFoll~free:

E-Mail:

.'

R Hoyt, MD; Andrea.S~:~ij~~.

clR,rson: Sharon Moore, TES Clinidalt:


raI1QO.cription:low intensRy( njght.;,tirmt~;i0::

ulatiOn.."
" ,
7:
Informati.n'a\f.ila~I"~l Printed"andMdeG~tima~
' m

I@
25.01
FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Description: Therapeutic Electrical Stimulation (TES)
can be used as treatment for many conditions (Bladder
Control, controlling incontinence; Lower Limb Mobility stepping and walking, standing I transfer assistance;
Upper Limb Movement - grasping, reaching;
Neuromuscular Treatments - controlling spasticity). It is
a low intensity night-time stimulation used to facilitate
muscle, nerve and even bone growth in children.
History: Program began January, 1994; 50 active
participants.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical
Thoracic
Lumbar
Sacral
Hemiplegia

H9~~8i3Q AM to 5:1313 PM, Mon~tiIY'~~~day


Lo~on of services: Servicep~iQers,..lbcatiOn
.' i l i t y : Wheelchair acces'sl~Te. In(!. bathrooms;
pped parking'available
., '.
atlons served: Child (up to li~~'1e) ,
~l'.as served: Anywhere in the U.S:.:A.
Referral required7Yes From: Physioran; Therapist
BlUing Info: Fi~~'rates
~,pa~h; ,
Card;
. 'llftblfl'

,'ee

11

:profit

ACel'iJiltJOri:'NointOrmation provi~d; Ceitfficatign


tIlf=glilh~pMagee Clinic, Toronto,Gallada "
UcenSin IOertification:No informatIOn provi6ed

Paraplegia
Tetraplegia/ Quadriplegia
Time elapsed post-injury/onset: acute to 6 years
Restrictionsl Contraindications: Must be at least 2
years of age or at least have a body build to allow 2
inches in between electrodes. Contraindications
cancer, obesity, pregnancy, pacemaker.
Treatment course:
Evaluationl assessment - 1 hour
Training -1-2 hours
Maintenance I check-ups - at 6 weeks, 3 months, 9
months, 1 year, then every 6 months.
Approximate number of visits required in total: 5 times
for the first year.
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: $1,000-$5,000
3rd party payers typically cover: All costs
Type of equipment: Home use stimulator; FDA
approved stimulator; Transcutan/surface electrode(s)
Availability of equipment: Purchase; must be
purchased from Mayatek, Toronto, Canada

MINNESOTA

26- ~oo
Electrically Stimulated,SkeletalMtlscle
Neosphincter
~.

Cdlohand RectelSurglcal Asst>ciates,. Ltd. University


ofMinnesota 1731 Medical Arts Building
Minneapolis MN 55413Z
USA
Tel: 612-339-4534
Toll.;free:
,FAX: 612-339:'-6074
E-MaU:
Dlrector:<Robert D. Madoff, MD
ContactP'erson: Robert D. Medoff, MD
Program .Description:Electrically stimulated
neosphincter for fecal incontinence;
Informatlonavailabfe: No infomiationprovided
Hours:'No infoni'lation rovided

Location of services: Service providers'location


Accessibility: Near accessible public transport,
Populations served: Adult (age 16 to 65)
Areas ,served: No information provided
Referral required? No
Bifllnglnfo: Fixed rates
Payment methods: Cash; Will billlhsuraoce; Willbill~
Medicaid; Will bill Medicare; Will bill Other thirdtparty
payment
Type of facility: Privately supported; f n~atient;fScllitY;
Hospital
Accredltatlo",=',Ncfinformation'provided
LicensinglCertificatiOhi 0Nofapplicable

90

FES RESOURCE GUIDE

USA - MINNESOTA

[@

26.01

FES Application:
Bowel control
Bowel incontinence
Description: A gracilis muscle neosphincter is
surgically created and maintained in a tonically
contracted state by use of an implantable pulse
generator.
History: Has been available for 2 years; 10
participants have been treated to date.
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Sacral
Paraplegia

@
27.00
University of Minnesota I Minnesota VA
Medical Center
111 Church Street, SE
Minneapolis MN 55455
USA
Tel: 612-625-0099
TolIfree:
FAX: 612-624-1398
EMail:
wkdurfee@maroon.tc.umn.edu
Director: William K. Durfee, Ph.D.
Contact Person: William K. Durfee, Ph. D.
Program Description: A feasibility study on FES
aided standing and gait which combines electrical
stimulation with orthotics.
Information available: No information provided

[@

27.01

FES Application:
Lower limb movement
Stepping and walking
Description: A feasibility study on FES-aided standing
and gait which combines electrical stimulation with
orthotics.
History: Three year project, three to four users at any
onetime.
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Restrictions/ Contraindications: Must meet these
requirements: (1) full motion range of leg joints; (2)
good stability of leg joints; (3) can stand using a
standing frame; (4) good upper body strength and trunk
stability; (5) no lower motor neuron damage; (6) at least
3 months post-injury; (7) realistic expectations about
the technology. Contraindications: (1) no response to

Restrictions/ Contraindications: Must have


functioning gracilis muscle on one side.
Treatment course:
Evaluation/ assessment - 2 days
Inpatient surgical procedure(s) - twice, 1st wk & 3rd wk
Training - 1 day every 2 weeks for eight weeks
Maintenance / check-ups - 1 day every three months
Approximate number of visits required in total: 12
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: More than $20,000
3rd party payers typically cover: Some costs
Type of equipment: FDA approved stimulator;
Implanted electrode(s)
Availability of equipment: Purchase

---

Hours: No information provided


Location of services: Service providers location
Accessibility: Wheelchair accessible, incl. bathrooms;
Handicapped parking available; Near accessible public
transport
Populations served: No restrictions
Areas served: Minneapolis area
Referral required? No
Billing info: No charge
Payment methods: No information. provided
Type offacility: Publicly supported; VA agency; Non
profit; College / University program; Research &
development center
Accreditation: No information provided
licensing/Certification: Not applicable

stimulation; (2) cardiac complications; (3) epilepsy; (4)


unhealed skin ulcers; (5) unhealed bone fractures; (6)
severe osteoporosis; (7) history of leg joint dislocations;
(8) uncontrollable spasticity; (9) abnormal blood
pressure response to stimulation; (10)
thrombophlebitis; (11) substance abuse.
Treatment course:
Specifics of the treatment program vary from subject to
subject. A commitment to the program of sessions in
the clinic once per week for one year is required of
subjects.
Requires evaluation at this facility? Yes
Requires localloclging? Yes
Typical cost: Less than $1,000
3rd party payers typically cover: No costs; research
Type of equipment: Clinic use stimulator; Research
prototype stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: No information provided

WHERE TO GET FES

91
USA - MISSOURI

lnfonna~~vailabl~'Rrlhtfiiformat; \fj~tape,

Uni
Pro'
Ul'livets. of
5IONorth,

Wrtiversity of '. .U";SCh~I()'f;~l9alCirie,.


MIl\;S5:2.
. .... '

fqr~at;AQ~f?rmat~ . . . .
,..
... HQ~~:a:OO~A~;to:i5:00~onday. ~Friday
LOCition'9fY$etytces:;~.IGe . providerslooation
Accessibmty:Wh~I~~accessible; lOcI. bathrooms".

Handicapped,par!(i~~le; Near.~cce$slble Pl.Jbli~

transport

, .'

.. "

methods: Cash;

I'~Y,fJlentPlan

Cha~~dit Card;

Option; Will bill IriSb'tal1ce; Will bill


Meclicaid; Win bill Medicare; Will tilitl Other thirdparty

nenlti.j~l.n('JiWElVa~lableat

ent

. :of facifity; Outpatient faCil~~~II_ J University


program; RepaQilitation .program

Accted~J1:JC,Al",'j;l)i,)4~~ited;>

28.01

FES Application:
Sexual function
Electroejaculation
Description: A probe is placed into the rectum
electrical stimulation applied causes ejaculation. The
semen is collected, processed and intrauterine
insemination of the partner is performed. Used for
persons with SCI and any other persons with
ejaculatory failure.
History: In operation since 1990; no capacity limitation;
successful pregnancy rate about 30% (national
average).
Status: Experimental research; Multi-center clinical
trial
Candidate Description:
Multiple sclerosis
Spinal cord injury
Cervical
Thoracic
Lumbar

Sacral
Other spinal disorder
Hemiplegia
Paraplegia
Tetraplegia! Quadriplegia
Restrictions/ Contraindications: Contraindication:
HIV+
Treatment course:
Evaluationl assessment - 1 visit
Outpatient surgical procedure(s) - 6 visits usually 1
month apart
Approximate number of visits required in total: 7
Requires evaluation at this facility? Yes
Requires local lodging? No; All outpatient, usually
candidates live some distance away
Typical cost: $1,000-$5,000
3rd party payers typically cover: Some costs
Type of equipment: Clinic use stimulator; Not FDA
approved stimulator
Availability of equipment: No information provided

92

FES RESOURCE GUIDE

USA - MISSOURI
.OO.0{~

ra,G,s .. REGY'S.

A'cCcps.ibility:.~eelchair.aooessible, . inel...battlptnSi'

;~tnstitute

fi~l1dQjp:pedpa,Tklng;~aiISbIe; Neara~lepublic

t~f'l~poilr

KansssCi

USA

Tel:
Toll-free:
FA
..E,.Mail:
Director: PatH~'dart, CRRN
Contact ~tI1lQn~ linda Jessen, PT; Ra~o,Leightoh;
PT

Program
REGysteR.

decumtus.ul
Informati'

popUiationss
A ...asserved:

restriQtio~

ed
.Ref."l s l7rom:Physidjan;ln.smance .

~mplny, .
'Iv~ti:~nyonecan.referiibutneeda
.. ~of"sonjerto.f:j .......

' < / ...

~ j~fO!

mentm

billlnsUll'artet

p~paYment

of facni!:pl.lJjl~ty supported;JNon-pr~' .

tlent facilitVr.Qutpatlentfacility;Rehabjii1:a~on

cenfer..

..

A~Cfeditatioft:(;~~7~ited. ....

Licen'Sih

29.01

FES Application:
Cardiovascular exercise
Bicycle ergometry
Description: REGYS and ERGYS bikes - training
phase on REGYS bike to advance to independence on
ERGYS bike.
History: Available for 8 years. Approximately 10-15
have started in the program, with about 7-8 with
insurance approval to continue. Capacity of 3-4 in
training at one time.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C6 / Sensory: C6
Thoracic: Motor: T1-10 / Sensory: T1-10
ASIA International Impairment Scale: A
Sacral: Motor: / Sensory:
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 6 months
Restrictionsl Contraindications: Bone fractures in
~

1~,rtific.atiOtl: Not alic;abte

the last 3 years; lower motor neuron lesion;


cardiovascular deficits; limited range of motion.
Treatment course:
Evaluation/ assessment - doctor's evaluation and
physical therapy evaluation
Pre-implementation therapy/treatment - leg training of
appropriate, time varies
Outpatient fitting/implementation
Post-implementation therapy/treatment - home bike or
can use our ERGYS
Approximate number of visits required in total: 3-4
months, 3 times a week
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: More than $20,000
3rd party payers typically cover: Some costs
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;
Transcutaneous/surface electrode(s)
Availability of equipment: No charge

...,

29.02

FES Application:
Lower limb movement
Stepping and walking
Description: Parastep system: synthesized gait
restoration for spinal cord injured individuals.
History: Has been available since Jan. 1995.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Incomplete
Thoracic: Motor: T3-9
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 6 months
Restrictions/ Contraindications: Bone fractures in
the last 3 years; cardiovascular deficits; decreased
bone density; poor upper extrem. function; lower motor

neuron injury
Treatment course:
Evaluation/ assessment - MD and PT evaluation
Pre-implementation therapy/treatment -leg training if
appropriate, time varies
Outpatient fitting/implementation
Training - 30 sessions, 2-3 times a week
Maintenance / check-ups
Approximate number of visits required in total: 30-40
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $10,000-$20,000
3rd party payers typically cover: Some costs
Type of equipment: FDA approved stimulator;
Transcutaneous/surface electrode(s)
Availability of equipment: Purchase

WHERE TO GET FES

93
USA - MISSOURI

29.03
FES Application:

Treatment course:

Circulatory/Skin treatments
Treating pressure sores
Description: E-Stim (electrical stimulation) at
approximately 100 Volts 60pps to decubitus ulcer for
healing.
History: Has been available for approximately 3 years,
about 10 persons treated.
Status: Clinical service

Candidate Description:
Spinal cord injury

Restrictions! Contraindications: Needs to be away


from heart

~ 29.04
FES Application:

Candidate Description:
Spinal cord injury
Cervical: selected cases that are incomplete
Thoracic: Motor: T4-12
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 1 year
Restrictionsl Contraindications: See stepping and
walking programme

30.00
~E'S;Ut:J~r,EXtremityHandGrasp,SJ$tef1l

Carncal'Study
eenter for Physical

Reftabilitati(>Iil'2i3~Mfan1i'Stteet

St.Louis MO 63118

USA

~,314-577-5706
,IolI",free:
...,............. 3t4-172~19'92l .... ~..,.iil~
lli~,.'.S~~anMciLa~gnlin '
.g.~~~ac,t~~n:.Susal1.MpLaughlin
p~~J .p~t1pti?~:FoJI~ing!f'OAlfRB~pproval
thIS
. >.~f1f~llnicalrS$earclil~lte fotan

'~~'device whiCh wilk9i~eperSonswith

sho

Inpatie~t fittin~li~plementation- daily to every other day


Outpatient fittlngllmplementation
Maintenance / check-ups - check up as indicated
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: No information provided
3rd party payers typically cover: All costs
Type of equipment: Clinic use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: No information provided

Treatment course:

Lower limb movement


Standing / transfer assistance
Description: Available since 1990, 6 individuals
treated, 3 continue to stand with FES, 1 is using FES to
transfer into seats in public areas.
History: See stepping and walking programme
Status: Clinical service

LUttterancMedicab~enter,

Evaluation/ assessment

:~~egtipi8ndr~elaseitfirougtisman
ermovement8;

Informalion.avaflaijJe:.Printed'fOrmat

Evaluation! assessment- 2 times a week for 3 weeks


Pre-implementation therapy/treatment - home muscle
conditioning for 4 - 6 months.
Tra.ining - 4 - 6 months, attend clinic weekly
Maintenance / check-ups - 1 time every three months
Approximate number of visits required in total: 40
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $10,000-$20,000
3rd ~arty payers typically cover: No costs; private
funding
Type of equipment: FDA approved stimulator;
Transcutaneous/surface electrode(s)
Availability of equipment: No charge; loaned to
participants

HOlJrs:, 8:00 AM to SiOOPM, Monaay"'Eriaati


Location.ofs~rvices:S;ervice proyid~t$Y~trG
Accessibnity!WheeIGhair.'acc~SSj.
'
Handic;~~diAATking;faVaiIEI~le;Near

traosport:
."
POf)~latfo~ise"e;d: Adijlt;(ag~.16to 65),
Areasservijd~ I3nlimited

Referral~~it8d? No

BIQinginfGiFixe<i:ra~;, ....... . . .

p~ym!ntrpetftodsrlNOi'in~/prO~i~.
TYp&'offa~lity~Feoeral;11lgen .,. .
()l;ItPati~l1tTa~ifity;Hom~cheal .......

Rehabllitation~nter;Reh8bifitation?

&.developmQJlt,center '.. ,....

....."
. ;'tf;taoili~

.)tal;;;~., '

. "rRes~J:Ch
. . . .'. ". . ..', ......."?;>

Accredftation:;C}\R~ ACor~jtedpJC~Ff9bAeOreditti.
l.IcensingtCeJtifieation~N~hpplicable,; ..;.

94

FES RESOURCE GUIDE

USA - MISSOURI
~

30.01

FES Application:
Upper limb movement
Grasping
Description: Implanted device for active grasp and
release through the use of small shoulder movements.
History: This is an anticipated research site pending
FDA approval. The device has been available at other
sites for several years, more than 20 persons have
received the device.
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-6 complete / Sensory: C5-6
complete
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 1 year
Restrictions/ Contraindications: No info. provided

Treatment course:
Evaluation/ assessment
Pre-implementation therapy!treatment - 1-2 mos
Inpatient surgical procedure(s) - 7-9 hrs, 3-5 day stay
Outpatient fitting - 5-15 times over 3-6 mos
Training - 3-6 months with 5-15 therapy sessions
Post-implementation therapy - 5-15 times over 3-6 mos
Maintenance I check-ups - every 6 mos. for at least 1
year, once annually thereafter
Approximate number of visits required in total: 20-25
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: More than $20,000
3rd party payers typically cover: Some costs
Type of equipment: Research prototype stimulator;
Implanted electrode(s)
Availability of equipment: No charge; research
device

J4!ffiFsoh Barracks - SpinaJ_tP5lnjury Unit

Location of se~ces:s~tvice prt:)vide);Sl,lo~"n


Accessibility: V\1f'rE!elchair':a
athOOd\1JS;

Veterans AdmttJistration - St. Louis .

Attn #128 JB?$flinal Cord Injury Unit

Building 52

St. Louis I'Vf063.125

USA

Tel: 314.;894"-6671
Toll-free:

E..,...U:

FAX: 314-8455039
Director: .. ..
Isey; MD
Contact Pe
Jai Park
Prog-:am DescfiPtiom The FES program is prifnarily
designeCl for. adult veterans with a variety Of diagnoses
(primarily SCI). The goals program includelncteasing:
muscle strength; muscle bulk; bone density in the lower
extrem.; and cardiopulmonary conditioning.
Information available: Printed format
Hours: 7:30 AM to 4:30 PM, Monda - Frida
I~

Handicapped:parKingavailable; N
8$; pub1ic
transport ...
...
. . . . . . . . ........ .
Populations served: U.S. VeteranOnty~Adtllt (age.16<
~~

Areasserved~Missouri; Illinois, Southern: .Kentllcky ,

Northern; Kansas; Eastern; Iowa, Soutli\i!irn;Nebraska,


Eastern
Refent required? Yes From: Phy"tejan
Billing info: No Charge
.
Pajment methods: No information provided
Typeoffaclllty!Puplicly supported; VA agency
Accreditation: JCAHOAccredited
LicerJstng/Certificatlon: MisSoUrjlicenses: doctors
Neurologist and Physiatrist;;,Ftr~Sel specialist

31.01

FES Application:
Cardiovascular exercise
Bicycle ergometry
Description: The ERGYS bike is used on individuals
with spinal cord injury. Benefits include: reversal of
muscular atrophy, increased bone density in the lower
extrem., and increased cardiopulmonary conditioning.
History: Have had the ERGYS unit for about 4 years,
approximately 8 participants have been treated,
capacity is 2 clients / day, max. of 4 at a time.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-8 / Sensory: C5-8
Thoracic: Motor: T1-12 / Sensory: T1-12
Lumbar: Motor: L 1 / Sensory: L 1
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: when cleared by a IVID
Restrictionsl Contraindications: No: pacemaker; hip
disarticulation; hypertension; denervated muscles;

--

severe muscle spasticity; tachycardia; autonomic


dysreflexia,; heart disease or fever.
Treatment course:
Evaluationl assessment - 1st visit for about 1 hour; re
evaluation every 2 weeks for about 15 minutes
Pre-implementation therapy/treatment - 2-3 x over 1-2
wks for an hour
Outpatient fitting - 15-30 min. I visit, 3x1wk for 12+ wks
Training - 30-45 min. / visit, 3x1wk for 12+ weeks
Post-implementation treatment - 10 minlvisit, 3 a wk
for 12+ wks
Approximate number of visits required in total: 36+
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $5,000-$10,000
3rd party payers typically cover: No costs to
Veterans
Type of eqUipment: Clinic use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: Purchase

WHERE TO GET FES

95
USA - MISSOURI 1 NEBRASKA

31 .02
FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Description: Designed to treat atrophic musculature,
weakened from disuse or partial innervation.
History: Available more than to years, with 100+
treated throughout the program. Capacity - 5 - 101 day.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Cervical: Motor: <1= C5 1 Sensory: </= C5
Thoracic: Motor: T1-12/ Sensory: T1-12
Lumbar: Motor: L 1-5 / Sensory: L 1-5
Hemiplegia
Paraplegia
Tetraplegia/ Quadriplegia
Time elapsed post-injury/onset: as close to original
injury as possible to 5-10 years post injury
l)

Restrictionsl Contraindications: No: pregnancy;


metal implants in treatment area; active CA; intact
sensation in the area to be treated; and no pacemaker.
Contraindications: skin rash, burns, not intact skin,.
Treatment course:
Evaluationl assessment - 1 x initially; 1 x every 2 wks
Inpatient implementation -10 -15 minutes per session
Outpatient implementation - 10 - 15 mins per session
Training - 30-40 minutes per session, 3x1wk for 6 wks
Approximate number of visits required in total: 18+
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $5,000-$10,000
3rd party payers typically cover: No costs; to
Veterans
Type of equipment: Clinic use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: Purchase

NEBRASKA
'-

32.
Physical Th~ra~BepartJnent
Immanuel R.eli$pilitafionCenter
6901 N. 7200 Street
Om:aha NE6S'f22

UsA

Tel: 402-572;'4;)27
ToU-free:
FAX: 402-572 .
E-Mail:
Director. K
ones, PT
Contact Persol1:KatherineJones, PT
program Description: We evaluate and train persons
with paraplegia the use of theParastepFES system
for standing and taking steps. Also used as a training
tool in re-Iearning.gpit for personswithincomplete SCI.
Info. available: Printed format; Vtdeotapeformat
HourS: 8:00 AMto 5:00 PM,Monda .:. Frida b

in

Il
32.01
FES Application:
Lower limb movement
Stepping and walking
Description: Surface electrodes placed on quadriceps
and gluteals to provide kneelhip extension in stance.
Surface electrodes are placed over the peroneal nerve.
A walker with remote finger switches activates the
stand and step fu nctions.
History: Available since Dec. 1991, experimental from
Dec. 1991 till April 1994. Ten have been treated since
Dec. 1991. Capacity of 2-3 .
Status: Clinical service
Candidate Description:
Spinal cord injury
Thoracic: Motor: T3 & below 1 Sensory: T3 & below
Lumbar: Motor: L 1 1 Sensory: L 1
ASIA International Impairment Scale: ABC
Paraplegia
Time elapsed post-injury/onset: usually 6 months

appointment)
location of services: Service providers location
AccessibJlity: Wheelchair;aecessib,le,incl. bathrooms;
Handicapped
i l1g avail~ble;Neafaccessiblepublic
transport;Ho
House'
populatiorisserved:Ncrtestrictions
Areas served: Iowa; Nebraska
Referral'required?;Yes From: Physician
Billing info: NoinformatfonRfOvided
Payment methods:ArrangedthroughSigmedics
Type of facility: Privately supported; Non~profit;
Rehabilitation center
Accreditati.on: CARFAccredited; JCAHO Accredited
licenSing/certification: Not applicable

Restrictions! Contraindications: Must have:


functional range of motion in trunk and lower extrem.;
good finger dexterity; decreased or absent lower
extrem. sensation; no joint instability or contractu res in
the lower extrem. No history of long bone fractures.
Treatment course:
Evaluationl assessment - 2 x a week, for 1-2 weeks
Pre-implementation /treatment - 2 xl wk for 1-2 wks
Training - 2-3 times a week for 10-15 weeks
Approximate number of visits required in total: 32
Requires evaluation at this facility? Yes
Requires local lodging? No; If they are able to travel
to the clinic 1-2 times a week
Typical cost: $10,000-$20,000
3rd party payers typically cover: No costs; no
successful 3rd party reimbursement
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;
T ranscutaneous/su rface electrode(s)
Availability of equipment: Purchase

96

FES RESOURCE GUIDE

USA-NEBRASKA/NEVADA

~ 32.02
FES Application:
Lower limb movement
Stepping and walking
Description: Surface electrodes are placed on
quadriceps and gluteals (if needed) to provide knee/hip
extension in stance. Surface electrodes are placed
over the peroneal nerve. A walker with remote finger
switches is used to activate the stand and step
functions through the above surface electrodes.
History: Available since Dec. 1991. Ten individuals
have been treated since Dec. 1991. Capacity: 2-3 at a
time. FES has been used to facilitate gait retraining for
2 persons with incomplete SCI. Begin ambulating with
FES and continue conventional PT, when ambulating
distance with FES equals distance without, FES is
discontinued.
Status: Clinical service
Candidate Description:
Spinal cord injury
Lumbar: Motor: L3-5 ASIA Intemationallmpairment
Scale: B C

---

Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 4 - 6 months
Restrictions! Contraindications: Must have:
functional range of motion in trunk and lower extrem.;
good finger dexterity; decreased or absent lower
extrem. sensation. No: joint instability; contractu res in
the lower extrem.; history of long bone fractures.
Treatment course:
Evaluation/ assessment - 1 treatment
Outpatient fitting/implementation - 1 treatment
Training - 2-3 times a week for 2 - 4 weeks
ApprOXimate number of visits required in total: variable
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: No information provided
3rd party payers typically cover: All costs; billed as
gait training
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;
Transcutaneous/surface electrode(s)
Availability of eqUipment: Rental; exercise unit only

NEVADA

[;j 33.0'0
"Help Them Walk Again" .Foundation, Inc.
5300 W. CharlestooBoulevard
Las Vegas NV 89102
USA
Tel: 702-878--8360
Toll-free:
FAX: 702878.;.9508
E-Mail:
Director: JoAnne Toadvine, Ph.D.
Contact Person: JoAnne Toadvine, Ph.D.
Program Description: No information provided
Information available: Printed format
Hours: 9:30 AM to 4:00 PM, Monday - Friday
Location of services: Service providers location
Accessibility: Wheelchair accessible, inc!. bathrooms;

~ 33.01
FES Application:
Circulatory/Skin treatments
Improving circulation in limbs
Description: FES leg trainer - one lower extrem. is
connected to the stimulator and electrodes are' placed
over the quads. A weight is usually placed around the
ankle. Movement produces an increase in circulation
for about 30 minutes. The other leg is then stimulated.
History: No information provided
Status: Clinical service
Candidate Description:
Spinal cord injury
Paraplegia
Tetraplegial Quadriplegia

Handicapped parking available; Near accessible public .


transport; CAT Paratransit arrangement can be made
Populations served: Adult (age 16 to 65)
Areas served: Anywhere in the U.S.A.
Referral required?Yes From: Physician
Billing info: Varies with ability to pay
Payment methods: Cash; Willbilt Insurance; Will bill
Medicaid; Will bill Medicare; Will biUOther third"party
payment
Type of facility: Privately supported; Non-profit;
Outpatient facility
Accreditation: No information provided
licensing/Certification: Not applicable

Restrictionsl Contraindications: Contraindications:


pacemaker.
Treatment course:
Evaluationl assessment
Outpatient fitting/implementation
Training
Requires evaluation at this facility? Yes
Requires local lodging? No information provided
Typical cost: No information provided
3rd party payers typically cover: No info. provided
Type of equipment: Clinic use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: No information provided

--

WHERE TO GET FES

97
USA-NEVADA/NEW JERSEY

'
'
'
'

1,

'
'
'

'

33.02
FES Application:
Neuromuscular treatments
Regaining voluntary function
Description: PCI 4000 is used with hemiplegic.
paraplegics. tetraplegics and quadriplegics (incomplete
lesions). Individual muscles or reciprocal muscles are
stimulated using weights as a form of resistance while
stimulation is applied for 10 to 30 minutes per muscle.
History: No information provided
Status: Clinical service
Candidate Description:
Spinal cord injury
Hemiplegia
Paraplegia - incomplete

33.03
FES Application:
Cardiovascular exercise
Bicycle ergometry
Description: ELA 2500 ergometer is used for
cardiovascular exercise with persons with paraplegia,
tetraplegia/quadriplegia. The participant pedals for 30
minutes and resistance is varied. There is sequential
stimulation of the gluteals. quadriceps and hamstrings.
History: No information provided
Status: Clinical service
Candidate Description:
Hemiplegia
Spinal cord injury
Paraplegia - incomplete
Tetraplegia! Quadriplegia - incomplete
Restrictions/ Contraindications: Contraindications:
pacemaker. Restrictions: No +HIV, we do not have the

Tetraplegia! Quadriplegia - incomplete


Restrictions/ Contraindications: Contraindications:
pacemaker, heart problems, high blood pressure
Treatment course:
Evaluationl assessment - 1 day
Training - 2 - 3 times a week
Requires evaluation at this facility? Yes
Requires local lodging? No information provided
Typical cost: No information provided
3rd party payers typically cover: No info. provided
Type of equipment: Clinic use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode{s)
Availability of equipment: Purchase; by insurance
company or participant

facilities to accommodate patients.


Treatment course:
Evaluation/ assessment - 1 day
Pre-implementation therapy/treatment- 3-6 months 3
times a week (varies with the individual)
Post-implementation therapy/treatment - 1-3 times a
week indefinitely for 30 minutes per session
Requires evaluation at this facility? Yes
Requires local lodging? No information provided
Typical cost: No information provided
3rd party payers typically cover: No information
provided
Type of equipment: Clinic use stimUlator; FDA
approved stimulator; Transcutaneous/surface
electrode{s)
Availability of equipment: Purchase; by insurance
company
I

NEW JERSEY

34.00

Universal Institute, Inc.


Rehabilitation and Fitness Center
383 Ridgedale Avenue
East Hanover NJ 07936
USA
Tel: 201-887-5881
Toll-free: 800-468-5440
FAX: 201-887-8917
E-Mail:
Ditector:.Jerry Lasso, Executive Director; Joanne
Witterschein, PT, Director of Rehabilitation
ContactPerson: Jerry Lasso. Executive Director;
Joanne Wrtterschein; PT, Director of Rehabilitation
Program Description: FES is used along,with other
services. We have a very aggressive, JUIl-time rehab
program: upto 35 hrsl wk,Primarily we see SCI Head
Injury and other neuromuscular cases.
'
Information available: PrintecHormat

Hours: 8:30 AM to 5:00 PM, Monday - Friday


Location ofservices: Service providers location
Accessibility: Wheelchair accessible, incLbathrooms;
Handicapped parking available; assist in securing local
housing; provide transportation to and from therapy.
Populations served: No restrictions
Areas served: Unlimited
Referral required? Yes From: PhYSician
Billing'info: Fixed rates
P.ayment methods: Cash; PaymentPlan Option~ Will
bill Insurance; Will bill Medicare; Will bill Other thfrd
party payment
Type of facility: Privately supported; For profit:
Outpatient facility; Rehab .. center; Rehab; program
Accreditation: No informati6nprovided
licenSing/Certification: Not applicable

98

FES RESOURCE GUIDE

USA - NEW JERSEY


ll
34.01
FES Application:

Tetraplegia! Quadriplegia

Neuromuscular treatments
Treating weak, atrophied muscles
Description: Muscle re-education and strengthening
of: upper and lower extrem., back extensors.
History: History of 5 years, used with other therapies.
Status: Clinical service

Restrictions' Contraindications: Pace maker,

Candidate Description:

Multiple sclerosis
Spinal cord injury
Spinal levels: depends on completeness of the injury
Cervical
Thoracic
Lumbar
Sacral
Hemiplegia
ParapleQia
ll
34 .02
FES Application:

Neuromuscular treatments
Treating weak, atrophied muscles
Description: REGYS Electrical Stim bike - for use in
stimulating quadriceps to increase strength, improve
circulation. REGYS bike used before starting ERGYS
electrical stim bike.
History: Used for approximately 5 years on many
clients. Used in conjunction with other therapies.
Status: Clinical service
Candidate Description:

Spinal cord injury


Varies depending on complete vs. incomplete injury
Cervical: Motor: varies
Thoracic: Motor: varies
Lumbar: Motor: varies
Sacral: Motor: varies
Hemiplegia
Paraplegia
ll
34 .03
FES Application:

Cardiovascular exercise
Bicycle ergometry
Description: The ERGYS bike provides electrical stim
to muscle groups for "cycle-type" 1)10vement. Benefits
are: cardiovascular: increased: muscle girth and
circulation; decreased osteoporosis.
HiStory: About 5 years. Used with other therapies.
Status: Clinical service
Candidate Description:

Spinal cord injury


Varies depending on incompleteness of injury
Cervical: Motor: varies
Thoracic: Motor: varies
Lumbar: Motor: varies
Sacral: Motor: varies
Paraplegia
Tetraplegia/ Quadriplegia

---

metastatic disease
Treatment course:

Evaluationl assessment - once


2 - 3 times a week to various appropriate muscles
Approximate number of visits required in total: varies
Requires eval. at this facility? Yes; done by a PT
Requires local lodging? No; Not a portable unit
Typical cost: No information provided
3rd party payers typically cover: Some costs;
depends on the insurance policy
Type of eqUipment: Clinic use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of eqUipment: No information provided

Tetraplegia! Quadriplegia
Time elapsed post-injury/onset varies
Restrictionsl Contra indications: Standard FES
contraindications: Pacemaker, metastatic disease
Treatment course:

Evaluation/ assessment - 1 initial evaluation /


assessment use of machine 1-2 xlwk for strengthening
Approximate number of visits required in total: varies
Requires evaluation at this facility? Yes; by therapist
Requires local lodging? No; Not a portable unit,
home-use unit
Typical cost: No information provided
3rd party payers typically cover: Some costs;
depends on insurance policy and disability
Type of equipment: Home use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of eqUipment: Purchase

Time elapsed post-injury/onset: any time post injury


Restrictionsl Contraindications: Standard FES
contraindications: Pacemaker, metastatic disease.
Some find stim uncomfortable.
Treatment course:

Evaluation/ assessment - one time


sessions 1-2 times a week
Approximate number of visits required in total: varies
Requires evaluation at this facility? Yes; Evaluation
to be completed by a therapist
Requires local lodging? Yes; On site sessions
Typical cost: No information provided
3rd party payers typically cover: Some costs,;
depends on the insurance policy
Type of eqUipment: Clinic use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: Purchase

WHERE TO GET FES

99
USA - NEW JERSEY

l
34.04
FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Description: Stim. of upper and lower extrem, and
back musculature, strengthening / re-training muscles.
History: Used for approximately 5 years. Used in
conjunction with other therapies.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Cervical
Thoracic
Lumbar
Sacral
Hemiplegia
Paraplegia
~
35.00
Kessler Institute for Rehabilitation, Inc.

Tetraplegia! Quadriplegia
Restrictionsl Contraindications: Standard FES
contraindications: Pacemaker, metastatic disease.
Treatment course:
Evaluation/ assessment - one time
Sessions 2-3 times a week
Approximate number of visits required in total: varies
Requires evaluation at this facility? Yes; Needs
evaluation by a physical therapist
Requires local lodging? No; Can train for home use
Typical cost: No information provided
3rd party payers typically cover: Some costs,;
depends on the insurance policy
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimUlator;
Transcutaneous/surface electrode(s)
Availability of equipment: Purchase; Rental

1199 Pleasant Valley Way


West Orange NJ 07052
USA
Tel: 201-731-3600
Toll-free: 800-648-0296
FAX: 201-243-6842
E-Mail:
Director: Dr. Marcalee Sipski, Medical Director
Contact Person: Sue Schweer, PT, Physical Therapy
Director
Program Description: Provide FES rehab in areas of
cardiovascular exercise, skin treatment for pressure
ulcers, ambulating and standing, muscle reeducation
and strengthening and sexual functioning.
Information available: Printed format
Hours: 8:00 AM to 8:00 PM, Mon. - Fri., Outpatient
therapy; 8:00 AM to 12:00 PM, Sat., Outpatient therapy

Location of services: Service providers location


Accessibility: Wheelchair accessible, incl. bathrooms;
Handicapped parking available
Populations served: Adult (age 16 to 65)
Areas served: New Jersey area
Referral required? Yes From: Physician
8i11inginfo: Fixed rates
Paymentmethods: Cash; Charge/Credit Card;
Payment Plan Option; Will bill Insurance; Will bill
Medicaid; Will bill Medicare; Will bill Other third-party
payment
Type of facility: Non-profit; Inpatient facility;
Outpatient facility; Rehabilitation center; Rehabilitation
program; Research & development center
Accreditation: CARF Accredited;.JCAHO Accredited
Licensing/Certification: Not applicable

l
35.01
FES Application:
Cardiovascular exercise
Bicycle ergometry
Description: REGYS / ERGYS computerized bicycle
program available for cardiovascular exercise.
Involves application of surface electrodes on gluteals,
hamstrings and quadriceps, through computer
sequencing individual cycles for about 30 minutes.
History: Available for 11 years" have seen over 100
individuals, no limit on number can accommodate
Status: Clinical service
Candidate Description:
Spinal cord injury
C4 to T11-12
Cervical
Thoracic
ASIA International Impairment Scale: A B
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: any time post injury
Restrictionsl Contraindications: cardiac/phrenic
pacemakers; severe cardiac or respiratory disease;

severe osteoporosis or joint instability; pregnancy;


insensate to pain at electrode sites.
Treatment course:
Evaluation/ assessment - 1 session
Pre-implementation therapy/treatment - leg training 3
times a week for 4 weeks (approximately)
Training - cycle ergometry 3 xl wk for 8 wks
Post-implementation therapy/treatment - can either
cycle 3 times a week at satellite clinic - indefinitely OR
Maintenance / check-ups - purchase home bike and
cycle 3 xl wk at home with follow-up 2 xlyr at the clinic.
Approximate number of visits required in total: - at least
36 in order to cycle at home or satellite clinic
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: More than $20,000
3rd party payers typically cover: Some costs
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimUlator;
Transcutaneous/surface electrode( s)
Availability of equipment: Purchase; or use at
satellite center for gym membership fee

100

FES RESOURCE GUIDE

USA - NEW JERSEY


]
35.02
FES Application:
Circulatory/Skin treatments
Treating pressure sores
Description: Saline soaked gauze applied over
electrode placed on top of wound area with high volt
stim. applied for 1 hr / day.
History: Available for at least 15 years, have seen
hundreds, no accommodation limit.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Cervical
Thoracic
Lumbar
Sacral
ASIA International Impairment Scale: A 8
Other spinal disorder

Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: any time post injury
Restrictions! Contraindications: pacemaker;
pregnancy; intolerance to stimulation / sensation.
Treatment course:
Evaluation/ assessment - 1 session
Pre-implementation therapy/treatment - 1 hr
Approx. number of visits required in total: as needed
Requires evaluation at this facility? Yes
Requires local lodging? Yes; Done as an inpatient
Typical cost: $1,000-$5,000
3rd party payers typically cover: Some costs;
depends on length of treatment
Type of equipment: Clinic use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of equip.: No charge; in-house use only

~
35.03
FES Application:
Lower limb movement
Stepping and walking
Description: Parastep computerized ambulation
system allows for standing and walking through the use
of surface electrodes stimulating the quadricep muscle
and peroneal nerve.
History: Approximately 2 years (during investigational
period prior to FDA approval) 12 individuals have
received this treatment, no accommodation limit.
Status: Clinical service
Candidate Description:
Spinal cord injury
Thoracic: Motor level: T4-12
ASIA International Impairment Scale: A 8
Paraplegia
Time elapsed post-injury/onset: any time post injury
Restrictions! Contraindications: cardiac/phrenic

nerve pacemakers; significant osteoporosis or joint


instability; pregnancy; must be insensate to pain
sensation in lower extremities.
Treatment course:
Evaluation/ assessment - 1 session
Training - 2 - 3 times a week for 36 sessions total
Maintenance / check-ups - yearly
Approximate number of visits required in total: - 36
Requires evaluation at this facility? Yes
Requires local lodging? Yes; Logistically makes
more sense for persons to be relocated in the area for
20% frequency of treatment
Typical cost: $10,000-$20,000
3rd party payers typically cover: Some costs
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;
Transcutaneous/surface electrode( s)
Availability of equipment: Purchase

~
35.04
FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Regaining voluntary function
Description: Neuromuscular reeducation and
strengthening for any diagnosis requiring this
treatment. Typically use portable stimulators, apply
surface electrodes to muscle requiring retraining.
History: Available for 15+ years, no accommodation
limit
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Cervical
Thoracic
Lumbar
ASIA International Impairment Scale: ABC
Hemiplegia
Paraplegia

Tetraplegia/ Quadriplegia
Time elapsed post-injury/onset: typically after 8 weeks
Restrictions! Contraindications: cardiac and/or
phrenic nerve pacemakers; pregnancy; no placement
over cancerous lesions
Treatment course:
Evaluation/ assessment - 1 session
Treatment - for 2 - 3 x/ wk till the goal is achieved
Approximate number of visits required in total: varies
dependent upon the response
Requires evaluation at this facility? Yes
Requires local lodging? Yes, but could perform this
treatment at home with training and periodic check-up
Typical cost: $1,000-$5,000
3rd party payers typically cover: Some costs
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;

Transcutaneous/surface electrode( s)

Availability of equipment: Purchase, No charge while


in clinic; Rent or purchase after clinic use

--

--

--

WHERE TO GET FES

101
USA - NEW ~IERSEY / NEW YORK

Il

35.05
FES Application:
Sexual function
Electroejaculation
Description: Men undergo electroejaculation for the
purpose of obtaining semen in order to father children.
History: No information provided
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Multiple sclerosis
Spinal cord injury
Cervical
Thoracic
Lumbar

Sacral
Paraplegia
Tetraplegia! Quadriplegia

Restrictions/ Contraindications: (1) rectal lesions;

(2) less than 18 years old; (3) significant psychological


impairment
Treatment course:
No information provided
Requires evaluation at this facility? Yes
Requires local lodging? No; May drive to our facility
Typical cost: $1,000-$5,000
3rd party payers typically cover: No information
provided
Type of equipment: Research prototype stimulator
Availability of eqUipment: Purchase

NEW YORK

l.:.I .36JOO
FESlriduced.LowerExtremity;;Emometry

The Mount Sinai MedicaPCenter


Asphalt Greel'l, Fourth Floor
555 E. 90th Street
New York NY 10128
USA
Tel: 212,;.9B7-3171
Toft.free:
FA>C:212,-:987-3175
E;.lIIaU:
Director:Susall.Pollacl<\eldman
Contact.Pel'Son:Susan;POllack Feldman
Progral11 Description: Il'IdividtialMNith SCI e!(ercise
their loWer extremities usjng computerized FES
induced ergometry (REGYS andERGYS bicycles) as
well as hybrid training (voluntary upper extremity
ergometryin conjunction with FES-inducedlower
extremity ergometry).
IJJ
36.01
FES Apptication:
Cardiovascular exercise
Bicycle ergometry
Description: Surface electrodes are applied to the
quadriceps, hamstrings and gluteal muscle groups.
Sequential electrical stim. under computer control is
supplied by the REGYS and ERGYS bicycle
ergometers.
History: Involved in FES applications for 10 years.
Many have been treated; 10 may be treated per day.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: any time post injury
Restrictions/ Contraindications: Contraindications:
metallic implants in lower extrem. Restrictions:

Informatton avaUable: Printed format


Hours: 8:30AMtb 4:30PM, Monday-Friday
Location of services: Service. prOViders location
Acce$SibiUty: Wheelchair accessible,jnck bathrooms;
Handicappedparking available; Near accessible public
transport
Populationsserved:.Adult (age 16 to 65)
Areas served: New)(ork tri-statearea
Referralrequired?Yes From: Physician
Billing info; Fixed. rates
Payment methods: Gash; Charge/CreditGard; Willlaill
Medicaidi WiII.bill Medicare
Type of facility: Outpatient facility; Rehabilitation
center
Accreditation: JCAHO Accredited
Licensing/Certification: Notapplicable

inability to tolerate noxious stimulus due to intact


sensation; abnormalities at hips, knees and ankles,
such as hip dislocations.
Treatment course:
Evaluationl assessment - 1 session
Training - 2-3 times a week for 12-18 weeks
Maintenance I check-ups - appropriate for those with
home units, every 36 sessions
Approximate number of visits required in total: 39
Requires evaluation at this facility? Yes; To ensure
safety and appropriateness of partiCipation
Requires local lodging? Yes; Treatments are
administered at our facility
Typical cost: $5,000-$10,000
3rd party payers typically cover: Some costs; with
private insurance companies
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator,
T ranscutaneouslsu rface electrode( s)
Availability of equipment: Purchase

102

FES RESOURCE GUIDE

USA - NEW YORK

.' aff,ero
Malei,,.ipro
~

Q~~nhati()OlipirOVtrJed

The Mount
5 East 98th.Street.;J.~'
Box.1272
Ne\iV:Vork NY 1d9
USA .
............ ..
Tel:212.,241~~?11

....... .'. J~leilncl:ibath~n1s; .

.ilable;;.~(~araoce$Siti[~i:public.

To.l-free:

Oonta.'gerson;.. Nafjll~BarChamaf!Ml)

P
Male ReproducWe

m;. Off~nMfe~~l.Inseling,

elec~jacu(~tfon, vibratoiy~dlfug~~lOn,mal~

rep~~ctivemedici~&'iand surgery; anclassisted

reprodtfctivelechnologies.

Information available: PrintedJormat

Hours: No information.provided

37.01
FES Application:
Sexual function
Electroejaculation
Description: Electroejaculation for sperm retrieval and
use with other assisted reproductive technologies.
History: No information provided
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Multiple sclerosis
Spinal cord injury
Restrictionsl Contraindications: Diabetes,
psychogenic problems, idiopathic problems,

. ...s sel'V~Male.qt:lly,

A.reas~ed:

FA~.:.2't2-8!:~;'~~6 ... ( .E-Mail:


DirectOr. N~tiar.r..gnamaiM~)'

Re .. '.' .......' .. '.' ....

38.00

ElectroejacUlation
The New York Hospital I ComeliMedical Center
525 East 68th Street, Box 29
New York NY 10021
USA
Tel: 212-746-5473
Tollfree:
FAX: 212-746-0468
E-Mail:
Direct():t: J.FrancoisEid, MD
Contact Persom.J;. Francois Eid, MD
Program Desenption: Electro.:ejaculation(EEJ)is the
application of rectal electrostimulation inanejaculatory
men .t~ producesemen.Althoughthe EEJ.procedure
was Initially developed in men in order to produce'
sernen in spinal cord injured (SCI) males, the technique
finds application in all cases ofaneJaeulation. Other
groups oimen who are candidates for this procedure
are men with myelodysplasia, mUltiple sclerosis, men

.....

4nt~'t!~SA

Refe~lIqui

Billing\info:V~ri~~(Wil:ti.abifity to pay .. ' '.

Pa~nt m~Qds:.Gash; ChargelCrediU3ard'

PaYfTl8nt Plan Option; Will bill Insurance


'

TypeOffaci;I~Q~~Ij(;IYSU~ported; VA ag~~;

College / UnlVersity'program;Hospital; Rehabilitation


center; Rehabilitationp/'.()gram; Research:&:
development c~nter
ACCfetiitati.on: NQcinformatipn provided
LicensingiCertlfiiatlon: Not applicable

retroperitoneal lymph node dissection


Treatment course:
Evaluation/ assessment - 1 time
Pre-implementation therapy/treatment - 1 time
Post-implementation therapy/treatment - 1 time
Approximate number of visits required in total: 3
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: No information provided
3rd party payers typically cover: No info provided
Type of equipment: Clinic use stimulator; Research
prototype stimulator
Availability of equipment: No charge; in-house use
only

following retoperitoneallymph node dissection, diabetic


neuropathic men with aperistaltic'vasdeferens and
men with idiopathic and psychogenic anorgasmia and
anejaculation who have failed sex therapy.
Information available: Printed format
Hours: 9:00 AM to 4:00 PM, Mohdays and
Wednesdays
Location of services: Service providers location
Accessibility: Wheelchair accessible, incl. bathrooms;
Near accessible public transport
Populations served: Male Only; Adult (age 16 to 65)
Areas served: Unlimited
Ref.:.rral required?No
Billing info: No information provided
Pjtyment methods: Cash; Cnarge/CreditCard
Type of facility: Hospital
Accreditation: No information proVided
LicenSing/Certification: Not applicable

--

WHERE TO GET FES

103
USA - NEW YORK

38.01

FES Application:
Sexual function
Electroejaculation
Description: Electro-ejaculation is an outpatient
procedure for inducing ejaculation in men who are
unable to ejaculate on their own. Proctoscopy before
and after the electro-ejaculation procedure will be
performed. A probe is then inserted into the rectum
adjacent to the prostrate gland. Using a low level
current, electrical stimulation is applied to the tissues
which often results in ejaculation. The strength and
duration of the electrical stimulation will be limited so as
to minimize the possibility of rectal injury. Semen will
be collected, examined and when appropriate, used for
artificial insemination. If ejaculation occurs retrograde
the sperm can be retrieved by flushing out the bladder.
History: Electro-ejaculations were first performed at
the New York Hospital I Comell Medical Center in
1990. To date we have 45 participants with 16
pregnancies and 12 births.
Status: Experimental research; Feasibility study; Multi
center clinical trial

39.00
Strong Mernotial Hospital

University of RocflesterMedical Center


Box 664, 601 Elmwood Avenue
Rochester NY 14642
USA
TOil-free:
Tel: 716-275-3281
FAX:
E-Mail:
Director:Charies J. Gibson, MD
Contact Person: Cathy Flanagan, RN
Program Description: No information provided
Information available: Printed format
Hours: 8:30 AM - 5:00 PM, Monday - Friday
Location of services: Service providers location
Accessibility: Wheelchair accessible, incl. bathrooms;

39.01

FES Application:
Upper limb movement
Grasping
Description: Biofeedback used to improve hand
function in consumers with quadriplegia injury.
History: 5 plus years
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical
Tetraplegial Quadriplegia
Restrictions/ Contraindications: Not applicable

Candidate Description:
Multiple sclerosis
Spinal cord injury
Restrictions/ Contraindications: No info. provided
Treatment course:
Evaluationl assessment - one visit is needed for
evaluation
Pre-implementation therapyltreatment - preop visit 2
weeks before the procedure
Outpatient surgical procedure(s) - procedure is
outpatient, discharge the same day
~pproxim~te number of visits required in total: 2 every
time the chent has the procedure. Requires preop appt.
Requires evaluation at this facility? Yes
Requires local lodging? No; Electro-ejaculation is
done as an outpatient procedure, we have clients who
live out-of-state.
Typical cost: $1,000-$5,000
3rd party payers typically cover: Some costs
Type of eqUipment: Clinic use stimulator; Not FDA
approved stimulator
Availability of equipment: No charge; for outpatient

Handicappedparkingavaifable; Near: accessible public


transport
Populations serve~:Adulttage 161065)
Areas'Served: Unlimited
Referral required?Yes From:Physician
BUlinginfo: Fixed rates
Payment methods:WiH bUllnsurance; Will bill
Medicaid; Will bill Medicare; Will bill Other third ...party
payment
Type of facility: Non-profit; Inpatient facility;
Outpatient facUity; College I University program;
Hospital; Rehabilitation program
Accreditation: CARF Accredited; JCAHO Accredited
licensing/Certification: Not applicable

Treatment course:
Evaluationl assessment - 1 time per week
Pre-implementation therapy/treatment - 2 times per
week for at least 6 weeks
Approximate number of visits required in total: 12 +
Requires evaluation at this facility? Yes
Requires local lodging? No; Outpatient treatment
Typical cost: Less than $1,000
3rd party payers typically cover: Some costs
Type of eqUipment: Clinic use stimulator; FDA
approved stimulator
Availability of equipment: No information provided

104

FES RESOURCE GUIDE

USA- NEW YORK

~ 39.02
FES Application:
Sexual function
Erection / electroejaculation
Description: Electroejaculation technique available to
spinal cord injured males for fertility evaluation for
purpose of procreation.
History: New program, less than 1 year.
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Hemiplegia
Paraplegia

40.00

Parastep
Burke Rehabilitation Center
785 Mamaroneck Avenue
White Plains NY 10605
USA
Tel: 914-948"()050
Toll-free:
FAX: 914-684-0358
E-Mail:
Director: Vicki Clark
Contact Person: Vicki Clark
Program Description: The Parastep program is
designed to provide a means for standing and
ambulation for persons with spinal cord injuries. The
use is similar to long leg braces, in that it serves as an
adjunct to wheelchair mobility, but is not a replacement.
The use of FES makes the standing and ambulation

~ 40.01
FES Application:
Lower limb movement
Stepping and walking
Description: Use of Parastep System requires surface
electrodes applied to the quadriceps muscles and
lower legs. In conjunction with a computerized FES
delivery system and a modified walker, the user of the
syst~m can stand and walk. The use of the system
requires several Physical Therapy sessions and
.
purchase of the equipment.
History: New program as of 1/95; no one has yet
participated; capacity to be determined.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-8 / Sensory: incomplete
Thoracic: Motor: T1-8 / Sensory: incomplete
Thoracic: Motor: T4-11 / Sensory: complete
Paraplegia

---

Tetraplegia/ Quadriplegia
Time ~Ia?sed post-injury/onset: any time post injury
Restrictions/ Contraindications: No info. provided
Treatment course:
Evaluation/ assessment - 1 time per month
Approximate number of visits required in total: 4 - 6
Requires evaluation at this facility? Yes
Requires local lodging? No; 30 minute procedure
performed monthly
Typical cost: $1,000-$5,000
3rd party payers typically cover: Some costs
Type of equipment: Clinic use stimUlator; Research
prototype stimulator
Availability of equipment: No information provided

process much less cumbersome.


Infonnation available: Printed format
Hours: 5:00 PM to 7:00 PM, Tuesday and Thursday
Location of services: Service providers location
Accessibility: Wheelchair accessible, incl. bathrooms;
Handicapped parking available
Populations served: No restrictions
Areas served: Unlimited
Referral required? Yes From: PhYSician
Billing info: Fixed rates
Payment methods: Cash; Will bill Insurance; Will bill
Other third-party payment
Type of facility: For profit; Outpatient facility;
Rehabilitation center
Accreditation: FDA approved
Licensing/Certification: Not applicable

Tetraplegia/ Quadriplegia
Time elapsed post-injury/onset: 6 months
Restrictions/ Contraindications: Contraindications
are not judged individually but as a whole; will be
screened at initial evaluation.
Treatment course:
Evaluation/ assessment - one time
Pre-implementation treatment - 2x1wk for 16 wks
Training - coincides with treatment
Approximate number of visits required in total: 32
Requires evaluation at this facility? Yes; To
determine appropriateness of candidate
Requires local lodging? No; As long as the
participant can commute 2 times a week.
Typical cost: No information provided
3rd party payers typically cover: All costs; if
approved
Type of equipment: Home use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of eqUipment: Purchase

WHERE TO GET FES

105
USA-OHIO

ue
zG~tlcIMati.ii6H#f45220~2489

USA

Tel: 5ta-8;t2~2481iTo'l4'ree:

FAX: 51i3a12~31~3

Di~tor: ~~rY~~, MO

E4IIratf:

Coi'itact Be~llFNanCYl'f~k~, PT

.programilescnptionri:rheParastep (R)SYstern.isan
FESsystem thatenablesunbracedstanding and short
dJstance,walking by persons with. upper-motor neuron
parapJegia.iand . some~ersonswithiii~complet9

q~~Oiiplegi~; .Learnil'19to uselheiR!raslep'safelY

requires the coordinated effort oftttEruser, the

physician, and the clinical program staff.

Information available: Printed format

41 .01
FES Application:
Lower limb movement
Stepping and walking
Description: The Parastep(R) System consists of a
microcomputer controlled neuromuscular stimulator a
battery pack with a recharger, surface applied
'
electrodes, a control and stability walker with control
switches and physical therapy trainer. The system
operates based on the use of electrical stimulation to
actively control selected muscle groups in the legs.
History: Prior to FDA approval Good Samaritan
Hospital was involved in experimental research
clinical trials of the Parastep system for about 2 years,
followed by another year after FDA approval. Two
participants have been through the program.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Sensory: T12 or above
Thoracic: Motor: T6-12/ Sensory: T12 or above
Paraplegia
Tetraplegia! Quadriplegia
~estrictionsJ Contraindicatio~s: (1) joint instability,
hiP, knee or ankle; (2) skin intolerance to electrical
stimulation; (3) poor trunk controllbalance; (4) intact
sensation for lower extremities; (5) no muscle response

Hours:7:D.0 AM to 6:00 PM,Monday- Friday


Location of services: Service'providerslocation
ACcessibility: Wheelchairaecessible, jnet bathrooms;
Handicapped. parking~vaiIable;AccessibJe hotel
nearby
P~p~li~onsserved:Adult(~ge 16t(65)
Areasi~ed: .. QQ.jo;.t?diana;l<entucky
Referral req... iftjdi?\V'es From:Physfcian
.Billing info: Fixed rates
P~ymentmethQdS: Payment PfanOption; Will bill
Insurance; Wi" bill,Medicaid;Witl bill,Medicare
Type of facility: Forprofit; Inpatient facility; .Outpatient
facility; Hospital; Rehabilitation center; Rehabilitation
program
Ac~teditation: CARFAccredited;JCAHO;;A.ccredited
uc,ensingICerlification: licensed Physical Therapists
tramed by Sigmedfcs, Inc. in the use oftheParastep
system.

to electrical stimulation in the lower extremities; (6)


heterotopic ossification (active stage); (7) heart rate /
blood pressure that doesn't respond appropriately to an
upright stance; (8) poor upper body strength.
Treatment course:
Evaluationl assessment - 1-2 hours with a physician
and a physical therapist
Pre-implementation therapy/treatment - if required to
increase range of motion and strength
Outpatient fitting/implementation - 3 times a week
(along with training)
Training - 3 times a week
Approximate number of visits required in total: 33
Requires evaluation at this facility? Yes
Requires local lodging? Yes; This is the only center
for the Parastep system in the 3 states of Kentucky,
Indiana and Ohio (as of 3/95). Clients that live too far
away to drive have the option of living within the
hospital as an outpatient at reasonable nightly rates.
Typical cost: $10,000-$20,000
3rd party payers typically cover: All costs;
Sigmedics, Inc. works on pre-authorization.
Type of equipment: Home use stimulator, FDA
approved stimulator, Transcutaneous/surface
electrode(s)
Availability of equipment: Purchase

106

FES RESOURCE GUIDE

~ccessibility: Wheelchairacc~sible, incl.. ba~r;ns'

~i!'iandi~pped parkingavailablevl!.(~r accessiblSiP1rJ~~~

-8619216-444..8608 (voice mall)


223-2213,'ext 4-8619

.159.

E-Mail:

.&tidrg

Dlrector:.. RiCharcbR~i~M$I2}.

---

transport,

Populations se~ed~'Adult(a~~1!l?to 65)

Areas served:; Unlimited

R~~~ral ~qltil'ed?: No,;

ai~Ji~~. ill~}FlXed rates;::

Payment

Payment;

rv,edicaio; Win . .

re; Wi" bill.t9ITel'thjrd-paliy

payment

C!0ntaCtPersomDElniel ~lyi;.f!.:l.

Program DesCri~n.:. Pilot StUayfor use of Paras.


T~,pe~ facility.P;rivately sup ..' iNon;.profit;

system as a me .. of gait augmentation for pe~ns .


OutPatient faaifity;~I~.Rabllitation center'

Rehabi1itation'P~ram; Reseatch &dfWelopme~t

with parapl
result of multiple sclerosis.

center

Information,avai.le: No information provided


Accreditation: Noipformation provided

H~~~: 8:00 A~ to 4:30 PM, Mond.at.:Friday


Llcenslng/Certifin~n: Not applicable

Loclltion~;8ervices: Service providers . location

42.01

FES Application:
Neuromuscular treatments
Controlling spasticity
Description: Use of FES to decrease spasticity with
home Focus unit.
History: 10 years available, hundreds treated
Status: Clinical service
Candidate Description:
Multiple sclerosis
Restrictionsl Contraindications: No info. provided
Treatment course:
Evaluation/ assessment - physical therapy evaluation
Training - same day as evaluation

42.02

FES Application:
Lower limb movement
Stepping and walking
Description: This is a pilot study with clients with
multiple sclerosis who can transfer independently but
are unable to walk 25 feet in less than 1 minute. The
Parastep system is used which uses skin surface
electrodes with controls on a walker.
History: Available for 1 year, 3 participants completed,
10 total capacity
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Multiple sclerosis
Restrictionsl Contraindications: Candidates must be
able to independently transfer; may be able to take a
few steps but unable to walk 25 feet in less than one
minute; must have stable multiple sclerosis with no
change in Kurtzke EDSS in 6 months; absence of
cognitive defiCits, ataxia, orthopedic conditions,

Maintenance / check-ups - as needed


Home treatment by client: 3-5 times a week for 30 - 90
minutes a treatment
Approximate number of visits required in total: 1 - 2
~equlres evaluation at this facility? No; May be
Instructed by any physical therapy department
Requires local lodging? No
Typical cost: Less than $1,000
3rd party payers typically cover: Some costs
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;
Transcutaneous/surface electrode(s}
Availability of equipment: Purchase; Rental

cardiovascular conditions which would limit safe use of


the system.
Treatment course:
Evaluation/ assessment - 1 appOintment
Pre-implementation therapy/treatment - PT and eva!. 2
times a week for 5-15 sessions
Training - 10 sessions
Approximate number of visits required in total: 15 - 25
Requires evaluation at this facility? Yes
Requires local lodging? Yes; Must be able to attend
2 times a week
Typical cost: $1,000-$5,000
3rd party payers typically cover: Some costs;
participant is responsible for physical therapy charges
Type of equipment: No information provided; Not
FDA approved stimUlator; Transcutaneous/surface
electrode(s)
Availability of equipment: No charge; loaned to
participants; may purchase equipment after the study,
for about $10,000.

--

---

WHERE TO GET FES

107
USA-OHIO

I@

42.03

FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Description: Treatment of weak atrophied muscles
due to recent injury, disuse because of pain, disuse
because of recent episode of inactivity I bed rest, or
immobilization.
History: Common physical therapy treatment
Status: Clinical service
Candidate Description:
Multiple sclerosis
Restrictionsl Contraindications: No info. provided
Treatment course:

42.04

FES Application:
Neuromuscular treatments
Controlling pain
Description: Use of transneuromuscular electrical
stimulation for intractable pain in multiple sclerosis.
History: Common physical therapy treatment
Status: Clinical service
Candidate Description:
Multiple sclerosis
Restrictionsl Contraindications: No info. provided
Treatment course:
Evaluation/ assessment - 1

@
43.00
Cleveland FES Center
Cleveland VA Medical Center
Motion Study Laboratory 151 W
10701 East Boulevard
Cleveland OH 44106
USA
Tel: 216-791-3800 ext. 3099
Toll.;.free!
FAX: 216-231.;.a886
E-Mail:
cleve_fes@po.cwru.edu
Director: E.B. Marsolais. MD, Ph.D.
Contact Person: Jane Marek,RN, ext. 5109; Carol
Bieri, MS,PT, ext. 3834
Program Description: The ClevelandFESCenter is a
consortium in FES technology'including the Cleveland
VA Medical Center, CaseWestem Reserve University,
MetroHealthMedical Center,andEdison
BioTechnology Center. The Motion Study/Laboratory
conducts. research and development of FES
applications for the lower extremity. EmphaSis is

Evaluation/ assessment
Outpatient fitting/implementation
Training - 3 -10 sessions
Approximate number of visits required in total: 3 - 10
Requires evaluation at this facility? No; Common
treatment in physical therapy
Requires local lodging? No information provided
Typical cost: Less than $1,000
3rd party payers typically cover: Some costs
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;
Transcutaneous/surface electrode(s)
Availability of equipment: Purchase; Rental

Training
Maintenance / check-ups
Approximate number of visits required in total: 1 - 2
Requires evaluation at this facility? No
Requires local lodging? No
Typical cost: Less than $1,000
3rd party payers typically cover: Some costs
Type of equipment: Home use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: Purchase; Rental

placed on improvement of mobility for SCI persons and


gait for neurologically involvedpersolisdue to stroke or
head injury..
Information available: Printed and Videotape format
Hours: 8:00 AM to 4:30 PM, Monday - Friday
Locatiolt of services: Service providers location
Accessibility: Wheelchair accessible, incl, bathrooms;
Handicapped parking available; Near accessiblepubUc
transport; VAtransportfor Veterans
Populations served: Aged (age 65 or older); Adult
(age 16 to 65)
Areas served: Anywhere inthe U.S.A
Referral required? No
Billing info: No charge
Payment methods: No information provided
Type of facility: Publicly supported; VA agency;
Federal agency
Accreditation: No information provided
licenSing/Certification: Not applicable

108

FES RESOURCE GUIDE

USA-OHIO

43.01

FES Application:
Lower limb movement
Standing / transfer assistance
Description: FES-assisted standing and pivot
transfers for incomplete SCI. 8 channels of stimulation
to hip, trunk and knee extensors for exercise and
functional standingltransfers. A short trial of
percutaneous stimulation is followed by implantation of
an 8-channel receiver/stimulator. All procedures done
on an outpatient basis. One year follow-up required
post-implant.
History: 15 years history of FES for standing and
walking in persons with SCI, head trauma and stroke.
Over 30 volunteers. Currently 4 - 8 active standing
pivot transfer participants.
Status: Experimental research; Feasibility study
Candidate Description:
Spinal cord injury
Cervical: Motor: </= C5
Thoracic: Motor: >/= T 4
ASIA Intemationallmpairment Scale: ABC
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 6 months or
neurologically stable
Restrictionsl Contraindications: Must be able to
travel to Cleveland. No: history of other
orthopedic/medical problems; history of drug

43.02

FES Application:
Lower limb movement
Stepping and walking
Description: 16-Channel walking mobility. Short phase
of percutaneous stimulation via intramuscular
electrodes followed by implantation of 2 8-channel
receivers/stimulators. At least 1 year follow-up post
implant.
History: 15 year history of FES for standing and
walking in persons with SCI, head trauma and stroke.
Over 30 volunteers.
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Thoracic
ASIA International Impairment Scale: A
Paraplegia
Time elapsed post-injury/onset: 6 months or
neurologically stable
Restrictions/ Contraindications: No: cardiovascular,
skin, bone/joint problems (range of motion +/- 5
degrees of normal); history of drug dependency. Intact

dependen~; ~ower motor neuron damage; outstanding


ps~chosoclallnvolvement. Good sitting balance; grade

3 triceps; good support systems/family/assistant care.


Treatment course:
Evaluation/ assessment - 2 times a week for 2 weeks
Pre-implementation therapy/treatment - exercise with
surface FES 5 times a week for 6 weeks
Outpatient surgical procedure(s) - 1x1wk for 6 weeks
Outpatient fitting/implementation - 1 time a week for 6
weeks (concurrent with training)
Training - 2 times a week for 6 weeks
Post-implementation treatment - 2x1wk for 4 wks
Maintenance / check-ups - quarterly for one day
Approximate number of visits required in total: 36, over
18 months
Requires evaluation at this facility? Yes;
Physical/psychological examinations
Requires local lodging? No; Must be able to stay for
long visits if not within commuting distance
Typical cost: More than $20,000
3rd party payers typically cover: No costs; research
Type of eqUipment: Clinic use stimUlator; Home use
stimulator; Research prototype stimulator;
Transcutaneous/surface electrode(s); Implanted
electrode(s)
Availability of equipment: No charge; research study;
Purchase; surface stimulator for exercise

lower motor neuron; good psychosocial support; willing


to comply with follow-up.
Treatment course:
Evaluation/ assessment - 2 times a week for 2 weeks
Pre-implementation therapy/treatment - surface
exercise for 6 weeks
Outpatient surgical procedure(s) - electrode
implantation 1 time a week for 6 weeks
Outpatient implementation - 2x1wk for 3 months
Training - 2 times a week for 3 months
Post-implementation treatment - 1xlwk for 1 mo
Maintenance / check-ups - quarterly
Approximate number of visits required in total: - 48
Requires evaluation at this facility? Yes; Physical
and psychological testing
Requires local lodging? Yes
Typical cost: More than $20,000
3rd party payers typically cover: No costs; research
Type of equipment: Clinic use stimulator; Home use
stimulator; Research prototype stimulator;
Transcutaneous/surface electrode(s); Implanted
electrode(s )
Availability of equipment: No charge; loaned to
partiCipants

--

WHERE TO GET FES

109
USA-OHIO

43.03
FES Application:
Lower limb movement
Stepping and walking
Description: The FES and leg bracing mobility
system, in addition to supplying the stimulation to move
the lower extremities, operates the locking and
unlocking brace joint mechanisms. Locking and
unlocking is synchronized with stimulation to give
stability and eliminate continuous stimulation. The
brace is designed for extended wear. Proposed
functional activities include crutch walking, stair ascent
/ descent, rising from the floor or low chair, ingress and
egress of motor vehicles, maneuvering in tight spaces,
and extended hands-free standing.
His~ory: Initial year of a 3 year study. Currently 3
subjects are participating with 3 more to be added.
Status: Experimental research; Feasibility study
Candidate Description:
Spinal cord injury
Thoracic: Motor: T4-12
Thoracic: Motor: will evaluate T1-4 on a case by case
basis

,44.00
nd:,~a.ter

.. . ", ." .......... .. .

MEiiElalCenfet

\ RellatliJif.lii0nEngjn~ring Center Hamann<S'C 1

Paraplegia
Time elapsed post-injury/onset: evaluated on a case by
case basis, no set time Restrictionsl
Contraindications: Candidate must have unimpaired
upper extremities and good balance (balance not
impaired by head il1.iury).
Treatment course:
Evaluationl assessment - over approximately 3 one
hour visits
Training - more than required for use, due to research
Maintenance / check-ups - 1 hour a week
Experimental Protocol - requires 2 yrs of 2-3 visits/wk
Approximate number of visits required in total: 200
Requires evaluation at this facility? Yes
Requires local lodging? Yes; Must be able to visit the
laboratory several times a week for 2 years minimum
Typical cost: More than $20,000
3rd party payers typically cover: No costs; research
Type of equipment: Home use stimUlator; Not FDA
approved stimulator; Implanted electrode(s}
Availability of equipment: No charge; research study

Iriformati~fl;avaiiable:Printed aildVide9tli~format.
Hours:a:09~M to5:~~Pf!A' w~d~YS)<

Location.'()fi~,rvice&:~O:Stlmers~residence; S~ce
Providers location

2500 Metr()blealth!!>rive

Atcessibilnr:~eelchairaqces~i~l~i' incl~,~room~;

usA

transport "

cl~velandeH44109

Tel:i\216q"8~3480

Handicap~~pmingavaifable;. Neara~ssiblepUbUo

Toll;'free~

FA)t:216-778-4259E-Mall:
cleve::..fes@po.cwru.edu
Director! P;Hul'lterPeckham, Ph.D.
ContaClilJerson: I<evin Kilgore,. Ph.D.
Program Des1,iption: The Clevelaf]d' FES Center is a
co".sortium in functionalelecfficall$tirnulation .inclUding
the Cleveland VA~edical Center,.~:Westem
R~servel:Jniversity, MetroHealthM~iealCenterand

EdisonBioTechnoldgy.Center. ThisprOgrain2incI1l4es;a
vari~ of(jinicalandre~'FESap:~lica~$, .
primarily.fdrpers~ns:lNith..sPinaloordinjuries;~ut.l!IISO

for personswho Have had a stroke. We uS~if11planted


FEStechnalogy to"impro\teupperextFemity,functton"'ln
conjunction with other alJgmentativesllrgeFiesl'such as
tendon transfers.

.. ..

Populationsserved: No restrictioQs
Area.sserved:Untimited
.

Refem.1 fequired~~O

Bllllnginfo:iS,farie~vvitH.~bility topay;.~lthough w~~dQ

!!l'

not chafgeforthe resear.cn t(J$pec~.t11emajo~.


consu~rrs un
I Pn;reedUrestlmect:to
eas~jthatpar:ticiparrts
thirdpan:ypayers;
provide.iheir own transportation:
Payrneotmethods:Wi1lbmlnsurance; Will bill
Medicaid; Will bill Medicare
Type offaCIIH:y: Publicly supported;VA.a~ncy;
~ederal agency; County. agency; Non-pl'Pfit;!npa~~nt
facility; Outpatient facility; CollegeIOniversityt.:JfIlgrami
Hospital; Rehabilitation center; Rehabilftation.pro~~i!l
Accreditation CARF Accredited;:J'GAHOAooteditea
Licensing/Certification: Notapplicat;llerc

110

FES RESOURCE GUIDE

USA OHIO

44 .01

FES Application:
Upper limb movement
Grasping
Reaching
Description: Electrical stimulation of the triceps is
used to provide elbow extension. Control is provided by
a gravity sensor or MES derived from the posterior
deltoid muscle. A neuroprosthesis provides hand
opening and closing.
History: 4 partiCipants have been treated
Status: Experimental research; Feasibility study
Candidate DeSCription:
Spinal cord injury
Cervical: Motor: C5-6
Tetraplegial Quadriplegia
Restrictions/ Contraindications: No info. provided
Treatment course:
Evaluation/ assessment - 4 days
Pre-implementation therapy/treatment - 4 - 16 wks as
an outpatient

~ 45.00
Hand Grasp,BladderSttfnuJation and

Inpatient surgical procedure(s) - 1 day during a 3 day


admission
Inpatient fitting/implementation - 3 - 4 weeks for 4 - 6
hours of therapy a day OR
Outpatient fitting/implementation - 3 - 4 weeks for 4 - 6
hours oftherapy a day (15 days)
Training - see "in/out patient fitting/implementation"
Maintenance / check-ups - 1 day every 6 months
Approximate number of visits required in total: 10 -15
the first year, 1 - 2 subsequent years
Requires evaluation at this facility? Yes
Requires local lodging? No; But there will be a lot of
trips to the hospital
Typical cost: Less than $1,000
3rd party payers typically cover: No costs; research
Type of equipment: No information provided;
Research prototype stimulator; Implanted electrode(s)
Availability of equipment: No charge; supported by
government grants

Bowel andsexualfimctlon are also being studied. The


Freehand System, which provides hand grasp.to .
Respiratol)'M~le;Pacing@mgrams
persons with quadriplegia is availablethroughtb-e
MetroHealth Medical Center I CaseWestem .Reserve
Orthopedics DepaJ:ttrtent and is a collaborative effort
UniverSity 2500 MetroHealthDrive
.
. ..
with the.ClevelandFESQehter.
Cleve.land OH441 09
Informationavailablef Printed format
USA
Hours: 8:00 AM 165:00 PM, Monday - Friday
Tel: 2160459-36.12 - respiratory musclepaeing;
Location of services: Consumer's residence; Service
216-778-8802 - bladder stimulatiOl'\; 216-778-3801 - hand
providers location
grasp
Accessibility:Wheelohairaccessible,.incl..bathrocirrrs;
FAX: 216-778-8215 - respiratory muscle pacing;
Handicapped parking available; Near accessible public
216-778-4499 - bladder stimulation; 216-778-8409- hand
transport; Wheelchairac.cessiblelodging
grasp
Populations served: Adult(age 16 to 50);. Aged (age.
E.Mail: ghC@po.cwru.edu - bladder program;
65 or older)
kkilgore@mhl1et.mhmc,org - hand grasp
Director: Anthony F. DiMarco, MD - respiratory muscle Areas served: Anywhere.in the U.S.A.
pacing;G.H. Creasey. M.D. - bladder stimulation;
Referralrequired? No
Kevin Kilgore, Ph.D. - hand grasp .
Billing info: No charge; Varies With Clbility to pay;
Contact Person: JanetPetro - respiratory muscle
ReqUi~dOCtlO'lentation of financial'need
Payme t methods: Payment Plan Option; Will bill .
pacing; G.H. Creasey, M.D. - bladder stimulation;
Insuran e; Will Dill Medicaid; Will bill Medicare; Will bill
Kevin Kilgore, Ph.D. - hand grasp
Program DescriPtion: Three programs are available
Other I ird-party payment
at MetroHealth Medical Center and are affiliated with
Type(offacility:!?rivatelysupported; Publicly
various hOSpital departments. In respiratory muscle
. suppo~~.aQency; Federal agency; Non-profit;
Inpatient facility; Outpatient facility; College / University
pacing methods are applied to electrically activate
program; Consultant I Private practice; Hospital;
inspiratory muscles to provide artlflcialrespiration for
Rehabilitation center; Rehabilitation program; Research
persons with ventilatory dependent quadriplegia. The
bladderstimulation program, affiliated with the Spinal
& development center
Accreditation: CARF Accredited; JCAHO Accredited
Cord Injury Unit (NE Ohio Regional System) aims to
improve bladder functioning follOwing spinal cord injury. Licensing/Certification: Not applicable

--'-"

---

--

WHERE TO GET FES

111
USA-OHIO

II

45.01

FES Application:
Respiratory treatments
Breathing assistance
Description: Combined intercostal and unilateral
diaphragm and respiratory muscle pacing for artificial
ventilation.
History: Used in 2 persons.
Status: Experimental research; Feasibility study
Candidate Description:
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 3 - 6 months
Restrictionsl Contraindications: Traumatic
quadriplegia, ventilator dependent, unilateral phrenic
function
@]

45 .02

FES Application:
Upper limb movement
Grasping
Description: Voluntary movement of shoulder or wrist
position is used to control the degree of grasp opening
/ closing. An 8-channel implanted stimulator is used.
History: FES has been researched for approximately
25 years. Approximately 50 have received
percutaneous systems, 11 have received implants and
14 have been implanted outside of Cleveland.
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-6
Tetraplegia! Quadriplegia
Restrictionsl Contraindications: Must have the
appropriate stimulatable muscles.
Treatment course:
Evaluationl assessment - 4 days
Pre-implementation treatment - 4-16 wks as outpatient
l

Treatment course:
Evaluation/ assessment - 2 - 3 days
Pre-implementation therapy/treatment - 2 weeks
Inpatient surgical procedure(s) - 10 day admission
Training - 6 weeks
Approximate number of visits required in total: variable
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: More than $20,000
3rd party payers typically cover: No info. provided
Type of equipment: Not FDA approved stimUlator;
Implanted electrode(s)
Availability of equipment: Purchase

Inpatient surgical procedure(s) - 1 day during a 3 day


admission OR
Outpatient implementation - 3-4 wks for 4-6 hrs/day
Training - during fitting/implementation
Maintenance I check-ups - 1 day every 6 months
Approximate number of visits required in total: 10 -15
the first year, 1 - 2 subsequent years
Requires evaluation at this facility? Yes; We can
use other evaluations, but there are some things we
must do at our facility
Requires local lodging? No; However the participant
will be in the hospital for a one week period plus a 3
week period. They must have MD and therapy follow
up where they live for all other treatments.
Typical cost: More than $20,000
3rd party payers typically cover: Some costs; for
tendon transfer procedures
Type of equipment: Home use stimulator; Research
prototype stimulator; Implanted electrode(s)
Availability of equipment: No charge

45 .03

FES Application:
Bladder control
Bladder emptying
Description: For people with spinal cord injury, an
electrical stimulator implanted surgically in the body
produces emptying of the bladder reducing infection,
medication and catheter usage.
History: Available for 3 years in Cleveland and for 17
years in Europe. Seven participants have been treated
in Cleveland, over 1,000 worldwide.
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Cervical
Thoracic: Motor: T121 Sensory: T12
ASIA International Impairment Scale: A
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 1 year

Restrictions! Contraindications: Must have intact


nerves between sacral spinal cord and bladder. This
can be tested at the facility.
Treatment course:
Evaluation! assessment - 3 times a week for 2 weeks
Inpatient surgical procedure(s) - one week
Inpatient fitting/implementation - during wk of surgery
Outpatient fitting/implementation - review at 2 weeks
Maintenance / check-ups - 3 months then annually
Approximate number of visits required in total: 6-8 in
the first year
Requires evaluation at this facility? No; May also be
at the Veterans Hospital
Requires local lodging? No
Typical cost: $10,000-$20,000
3rd party payers typically cover: Some costs; May
cover surgery, admission and investigation; Veterans
may be covered federally
Type of eqUipment: Clinic use stimulator; Home use
stimUlator; Not FDA approved stimUlator
Availability of equipment: No charge

112

FES RESOURCE GUIDE

USA-OHIO

@
48.00
The!OhloiState'tI:~v~.rSity
2154DQcfdHail
480 W.9tffAvenue
Columbus OH 43210.
USA
Tel: 614-293\..561a
Toll-free:
FAX:
E-Mail:
Director: James e.iBaldi,PIID
ContactPer&on:James c.'Bald~PhB
Program Description: FES9yclej:Srgometty'and
TENS unitstimulationare.proviaed.topersons within
the Qrst two months after spina1cordj;jnjury:
Mainten~nce of musclemass andbbne minerS~density
are monitored over a1 year trainingperio(j.
Information available: No information .provided

46.01
FES Application:
Cardiovascular exercise
Bicycle ergometry
Description: No information provided
History: This has been underway approximately 3
years, about 40 persons have been involved.
Status: Experimental research; Feasibility study
Candidate Description:
Spinal cord injury
Restrictionsl Contraindications: Candidates include
individuals who have been injured less than three
months. No chronic injury studies are presently being
conducted.

~~rs: S~30'~M~5~OO PM~rrvlond~,,,,, Friday

LOcation2~,!,rvlces~s

'providerslocation

A~~essib~litt;JJVheefsh' . . . . . . . . . ssible. inctbathrooms:

Haftdieal;)p'edparkingavailable;.Near acce$SibIePUbli~
transport
'
populati0mJ'served:Nc);in~rrnati0f1"provided
Areas'seJ"l:~d,;iQhio, FrE:lnkfin>and.Neighboring

Counties

,.

Referral'l'eqmred? Yes Ffom;imuStmeetstudy


criteria
.
Bff'ingin~~\NO Charge
Paymentl1!ethods!~~~information provided
Type of fat:i1it;y: PubliclysuPPQrted; Federal agency
AccreditatiomCARF.Accredited;JCAHOAccredited .',
L.icensing/Certificition:Not applicable

Treatment course:
Training - 3 times a week for 15 months
Requires evaluation at this facility? Yes
Requires local lodging? Yes; Must be within driving
distance
Typical cost: More than $20,000
3rd party payers typically cover: All costs; research;
government funding
Type of equipment: Clinic use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode( s)
Availability of equipment: No charge; to research
partiCipants

~ 47.00
Wright State University Institute for
Rehabilitation Research and Medicine

ergometers for cardiopulmonary fitness training and


weight lifting devices for muscle strengthening.
Information available: Printed format
Wright State University
Hours: 8:00 AM to 5:00 PM, Monday - Friday
3171 Research Boulevard
Location of services: Service providers location
Dayton OH 45420
Accessibility: VVheelchair accessible, incL bathrooms:
USA
Handicapped parking available
Tel: 513-259-1326
Toll-free:

Populations served: Adult (age 16 to 65)


FAX: 513-259-1310
E-Mail:

Areas served: Unlimited


rglaser@desire.wright.edu

Referral required? No
Direct()r: ROger M. Glaser, Ph.D.

Billing info: No charge


Contact Person: Traci Humble .

Payment methods: No information provided


Program Description: The Institute for Rehabilitation
Type offacilit;y: Publicly supported; VA agency; Non
Research and Medicine conducts FES research aimed
profit; Outpatient facility; College! University program;
at improving health, fitness and rehabilitation potential
Research & devefbpmentcenter
of !ndividua~s .with neuromuscular impairments (eg.

Accreditation: No information provided


spinal cord InJUry, stroke and multiple sclerosis);

Licensing/Certification: Not applicable


Therapeutic FES exercise is conducted on leg cycle

..

...

WHERE TO GET FES

113
USA-OHIO

47.01

FES Application:
Cardiovascular exercise
Bicycle ergometry
Description: Hybrid exercise, FES leg cycling
performed simultaneously with arm cranking, is able to
promote higher levels of hemodynamic, metabolic and
cardiopulmonary responses than either mode
performed separately. We consider this exercise to be
the state-of-the-art for upper-body and lower-body
conditioning and for the development of aerobic
(cardiopulmonary) fitness.
History: We have been performing research on hybrid
exercise since 1987. It may be used in conjunction with
other FES training modalities.
Status: Experimental research; Feasibility study
Candidate Description:
Spinal cord injury
Paraplegia
l

47.02

FES Application:
Cardiovascular exercise
Bicycle ergometry
Description: FES-induced leg cycle ergometry
promotes peripheral and central hemodynamic
responses, and elicits magnitudes of metabolic and
cardiopulmonary responses for aerobic training. Also
effective in reducing the secondary medical
complications caused by a sedentary lifestyle. We are
performing research on the efficacy of this induced
exercise, and on how to advance this technology.
History: We were involved in the development of the
original FES leg cycle ergometer and its
commercialization. The original prototype was
constructed in 1982. Over 100 have been involved in
our FES cycling research.
Status: Experimental research; Feasibility study
Candidate Description:
Spinal cord injury
Paraplegia
l

Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 6 months
Restrictionsl Contraindications: No significant lower
motor neuron damage. If subject has sensate skin,
need to tolerate the FES without undue discomfort.
Treatment course:
Evaluation/ assessment - 2-3 days
Training -12 week period
Post-training Evaluation - 2-3 days
Approx. # of visits required in total: 40 / training period
Requires evaluation at this faCility? Yes
Requires local lodging? Yes
Typical cost: No information provided
3rd party payers typically cover: No costs; research
Type of eqUipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;
T ranscutaneous/su rface electrode( s)
Availability of equipment: Purchase

Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 6 months
Restrictionsl Contraindications: No significant lower
motor neuron damage. If research subject has sensate
skin, need to be able to tolerate the FES sensation
without undue discomfort.
Treatment course:
Evaluation! assessment - 2-3 days
Training - 12 week period
Post training evaluation - 2-3 days
Approximate number of visits required in total: 40 per
training period
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: No information provided
3rd party payers typically cover: No costs; research
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;
TranscutaneouS/surface electrode(s)
Availability of equipment: Purchase

47.03

FES Application:
Orthopaedic treatments
Circulatory/Skin treatments
Preventing/treating osteoporosiS
Description: Use of strong, rhythmiC. pulsed isometric
(static) contractions of the paralyzed calf and thigh
muscles following spinal cord injury may provide
beneficial effects to the muscles, bones and Circulatory
system. May also be useful for preventing deep venous
thrombosis since it enhances blood flow in the legs.
History: Used since 1988.
Status: Experimental research; Feasibility study
Candidate Description:
Spinal cord injury
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: immediately post-injury

Restrictions/ Contraindications: No Significant lower


motor neuron damage. If research subject has sensate
skin, need to be able to tolerate the FES sensation
without undue discomfort.
Treatment course:
Evaluation/ assessment - 1 day
Inpatient fitting/implementation
Training - 3-5 days per week while an inpatient
Post training evaluation - 1 day
Approximate number of visits required in total: variable
Requires eva!. at this faCility? Yes; In the hospital
Requires local lodging? Yes; In the hospital
Typical cost: No information provided
3rd party payers typically cover: No costs; research
Type of equipment: Clinic use stimulator; Research
prototype stimUlator; Transcutaneous/surface
electrode(s)
Availability of equipment: No charge

114

FES RESOURCE GUIDE

USA-OHIO

ll

47.04

FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Description: FES knee extension resistance (weight
training) exercise used to increase strength and
endurance of paralyzed leg muscles for maintaining the
integrity of the lower-limb and improving muscle
function for other FES applications. Beneficial effects in
the activated muscles and possibly the bones of the
paralyzed limbs. Cardiovascular benefits - minimal.
History: Used since 1982. Many have been
successfully trained.
Status: Experimental research; Feasibility study
Candidate Description:
Spinal cord injury
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset 6 months

Restrictionsl Contraindications: No Significant lower


motor neuron damage. If have sensate skin, need to be
able to tolerate the FES without undue discomfort.
Treatment course:
Evaluation/ assessment - 2-3 days
Training - 12 week periods
Post training evaluation - 2-3 days
Approximate number of visits required in total: 40 per
training period
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: No information provided
3rd party payers typically cover: No costs; research
Type of equipment: Clinic use stimulator; Research
prototype stimulator; Transcutaneous/surface
electrode{s)
Availability of equipment: No charge

48.00
Ptlysic;I;.iThefapyDepartment

st. Francis Health Care Center


401 N.Srqadway

Green Springs OH 44870


USA
Tel: 419-639-2626
Toll-free: 800-248..2552
FAX: 419-639-3412
E-Mail:
Director: Laraine A. Bauer, P.T.
Contact Person: LaraineA Bauer, P:IT".
ProQ.,am"DescriptiGn:. We have REG~S I clinical
system forbicycleergamet{'y. We utilize various
electrical stimulation eqUipment includingl~.i;lssian
stimulation, Interferential, MENS, AlC, ole (eg. ES
180, Dynatron, Medcollator, MENS).
Information available: Printed format
Hours: 8:0(} AM to 5:30 PM, Monday - Friday; 7:00 AM
to 12:00 PM, Saturtlay
Location of services: Service roviders location
I]

Accefi$ibility: V\lheelc~air~fcessible,ifiel .. bathrGoms;


Handicapped paifdngsvailaote
Populations served:;Aged (age 65 or older) ... in or
out-patient; Adult (age 16 to 65) .. inor out-patient;
Child (up to age 16)-onfy asout-patienf
Al'4iNIsserved: Anywhere in the U,SA
ReMrralrequiredlYes From: Physician - MD,Dt:J:
Chiropractor or POdiatrist
Billing info: Fixed rates
PayrrientmethOds~ Cash;. Charge/Credit Card; Will bill
Insurance;WillbilfMedieaid; Will bill Medicare; WillbiU
Otherthird-partypayfnent.
Type of facility}cfi,Jon-profit;lnpatient raCllftVi
OutpatientfacHitY: NurSing home; RehabU'
ncenter;
Rehabilitation program
Accreditation: CARFAccredited;.JCAHO Accredited
Licensing/Certification: Not applicable

48 .01

FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Description: Use electrical stimulation to assist with
sensory feedback to increase control of muscles and
strength, used with bio-feedback.
History: Used for 20 years. Have treated
approximately 15-20 / day with electrical stimulation.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Cervical: Motor: all levels / Sensory: all levels
Thoracic: Motor: all levels / Sensory: all levels
Lumbar: Motor: all levels/ Sensory: all levels
Sacral: Motor: all levels/ Sensory: all levels
ASIA International Impairment Scale
Hemiplegia

Paraplegia
Tetraplegia/ Quadriplegia
Other spinal disorder: stenosis, compression
Time elapsed post-injury/onset: any time post injury
Restrictions! Contraindications: Pacemaker, open
skin lesions
Treatment course:
Evaluationl assessment - 1 time
Training - daily 3-4 weeks
Approximate number of visits required in total: 20
Requires evaluation at this facility? Yes
Requires local lodging? No; Could be continued in
home area by referral.
Typical cost: Less than $1,000
3rd party payers typically cover: All costs
Type of eqUipment: Clinic use stimulator; Home use
stimulator; FDA approved stimUlator;
Transcutaneous/surface electrode(s)
Availability of equipment: Purchase; Rental

--

WHERE TO GET FES

115
USA-OHIO

ll

48.02

FES Application:
Cardiovascular exercise
Bicycle ergometry
Description: REGYS I Bicycle Ergometry System
used particularly with persons with SCI to increase
fitness and facilitate function in persons with
incomplete SCI.
History: Available since 1982 - used with persons with
SCI (high levels).
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C2-7 / Sensory: C2-7
Thoracic: Motor: T1-10 / Sensory: T1-10
Hemiplegia
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: any time post injury

ll

Restrlctionsl Contralndications: Pacemaker, must


have intact reflex, low SCI complete not good
candidates, not used with sensory hypersensitivity,
persons with hemiplegia use leg trainer only.
Treatment course:
Evaluation/ assessment - 1 time
Training - 3 x / week until a goal is accomplished.
Requires evaluation at this facility? Yes
Requires local lodging? Yes; If want to continue, or
referred to another REGYS Center
Typical cost: $1,000-$5,000
3rd party payers typically cover: All costs
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;
Transcutaneous/surface electrode( s)
Availability of equipment: Purchase; only home unit
is available

49.01

FES Application:
Lower limb movement
Stepping and walking
Standing I transfer assistance
Description: FES is used on a "case by case basis"
after physical therapy evaluation and client's response
and motivation. Prescription for ongoing use often
includes home usage and remote heel switch for
assisted ambulation.
History: FES has been used with the outpatient
population for 2+ years.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Other spinal disorder: incomplete spinal lesions,
neuropathy Hemiplegia
Paraplegia
Tetraplegia! Quadriplegia
Restrictions! Contraindications: Participant reQuires

prescription for a medical doctor; need transportation to


outpatient clinic; appropriate cognitive status.
Contra indications: standard. pacemaker. skin
condition, etc.
Treatment course:
Evaluationl assessment - 1st visit
Training - 3 times a week for 3-12 weeks
Approximate number of visits required in total: as
needed. 3-36 average sessions.
Requires evaluation at this facility? Yes; PT or OT
after a doctor's prescription
Requires local lodging? Yes; For usually 3 x / week
Typical cost: No information provided
3rd party payers typically cover: All costs; at least
80%, but costs vary
Type of equipment: Clinic use stimulator; Home use
stimulator
Availability of equipment: Purchase; Rental;
depends on the duration of the need

116

FES RESOURCE GUIDE

USA-OHIO

49.02

FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
ContrOlling tremor
Regaining voluntary function
Enhancing neural regeneration
Description: FES is used on a "case by case basis"
when seen potentially beneficial via physical therapy
evaluation and client's response and/or motivation.
Prescription for ongoing use often includes home
usage. It is provided in the context of a physical
therapy program.
History: FES has been used with the outpatient
population for 2+ years.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Other spinal disorder: incomplete spinal lesions,
neuropathy Hemiplegia
Paraplegia
Tetraplegia! Quadriplegia
Restrictionsl Contraindications: Participant requires
a prescription for a medical doctor; needs to be able to

49.03
FES Application:
Neuromuscular treatments
Regaining voluntary function
Description: FES is used when seen potentially
beneficial on the basis of a physical therapy evaluation
and client's response. FES is used along with or in
conj~nction with other PT treatments. Voluntary
functions could include upper limb movement,
grasping, reaching and weight bearing on upper
extremities.
History: FES has been used with the outpatient
population for about 2.5 years.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Other spinal disorder: incomplete spinal lesions,
neuropathy Hemiplegia
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: varies
Restrictions/ Contraindications: Prescription

get to the outpatient clinic with their own or arranged


transportation; cognitive status needs to be
appropriate. Contraindications: standard, pacemaker,
skin condition, pregnancy, etc.
Treatment course:
Evaluation/ assessment - 1st visit
Training - 3 times a week for 3-12 weeks
Approximate number of visits required in total: as
needed, 3-36 average sessions.
Requires evaluation at this facility? Yes; By a
physical or occupational therapist after a doctor's
prescription
Requires local lodging? Yes; For usually 3 times a
week
Typical cost: No information provided
3rd party payers typically cover: Some costs; at
least 80%, but costs vary
Type of equipment: Home use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode( s)
Availability of equipment: Purchase; Rental;
depends on the duration of the need and home
stimulation set-up

required from a medical doctor; client needs to be able


to transport to the outpatient clinic; cognition must be
appropriate. (Contraindications: standard, pacemaker,
pregnancy, skin condition, etc.)
Treatment course:
Evaluation/ assessment - 1st visit
Training - 3 times a week for 3-12 weeks
Approximate number of visits required in total: as
needed, 3-36 average sessions.
Requires evaluation at this facility? Yes; Bya
physical or occupational therapist after a doctor's
prescription
Requires local lodging? Yes; For usually 3 times a
week
Typical cost: No information provided
3rd party payers typically cover: Some costs; at
least 80%, but costs vary
Type of eqUipment: Home use stimulator; FDA
approved stimUlator; Transcutaneous/surface
electrode(s)
Availability of equipment: Purchase; Rental;
depends on the duration of the need

-'

WHERE TO GET FES

117

'Handicat:JPed parking available


pulations served: No n:u:,t"i",tl".....
as served: Unlimited

:z~~fe~1 required;?tYes/F"fom:'GQVemment~gency;
~xslclan

..

. ..~~qng info:Varies~tI1 ability to pay,.,

<'~~I)th'l~nt m~~!Cashf Char~e/qf@dil~;


~';"'ayment PI~!lOptioni
$UI"8J:l~NI.'I:W},
. ,,:Me~ieaidi~lf.biIlMe
f~iW(;}tb~rtblrO~tty

Pl1iymellt. .

50.01

FES Application:
Upper limb movement
Grasping
Description: Participating in FDA multicenter study for
FES grasp device in persons with quadriplegia.
History: Beginning the program, evaluating first
participant. (as of 5/95)
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Cervical: Motor: C4-51 Sensory: C4-5

[~ 51.00
FES. Research'Progratn
Sh~ners

Hospitals Philadelphia Unit


8400'RoOseveIt'Boulevard
Philadelphia PA 19152

USA
TeJt215-332-4500

. FAX~215-332:Jj766

Toll-free: 800-"281'-4050
E"lllall:

mUlcahey@astro;ocis~temple;edu

Djt(!Cfor:RandalR. .Be12:,'Mo
GOfitact P..-son: M.J. MtitdShey, M.B:,.OTRIL
p.,aram Description: The ResearehF"rGgram at the
PhdadelphiaWnit ofShriner's'HoSpftalS"forerippJed
Children is dedicated toenhancing'th~iridependence
of children with spinal cord injury or cere6tal palsy
through the use of Functional Electrical'Slfmulation for
walking, ,stepping and hand andarm function.

'.... '

.'

...."

Tetraplegial Quadriplegia
Restrictions/ Contraindications: No info. provided
Treatment course:
No information provided
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: More than $20,000
3rd party payers typically cover: No costs
Type of equipment: Clinic use stimUlator; Home use
stimulator; Not FDA approved stimulator; Implanted
electrode(s)
Availability of equipment: Purchase

Information available~ No informatiOtrprovided


Hours: Ntfinformation provided
Locatton of services: Service providers'lbcation
A~ibility: Wheelchair accessible;incl.
Handicapped parking available; Nearaccessi
tran~port

populations;.Served: Child (up to age,. 16); Scflool,age;


Adolescent
Areas served: Unlimited
~effrraf required? Yes From: Physician
Billingtnfo: No charge
Payment methods: No information provided
Type offacitity: Privately supported; NOn-profit;
Inpatient facility; Outpatient facility; Home heC1t1th
agency
Accreditation: CARFAccredited;JCAHO Accreditedw
LicensilJg/~ertification:. Notapplicable

118

FES RESOURCE GUIDE

USA- PENNSYLVANIA

51.01

FES Application:
Upper limb movement
Grasping
Description: The FES system is designed to provide
two grasps: a "key pinch" to hold objects such as a
pencil or fork and "palmar grasp" to hold large objects
like a soda can. FES grasps are controlled with
motions of the opposite shoulder. Stimulation is
delivered to hand muscles with percutaneous
intramuscular electrodes.
H~story: Sinc~ the program began in 1989, 14 persons
With SCI ranging from 8-18 years have participated in
the FES program. Five persons with C5 SCI will be
added to the program over the next two years.
Status: Experimental research; Feasibility study
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-6/ Sensory: C5-6
Tetraplegia! Quadriplegia
Restri~tionsl Contraindications: 6-13 years of age.
No: eVidence of active medical complications;
limitations in upper extremity joint range that interferes
with system use; lower motor neuron damage of target

51 .02
FES Application:
Upper limb movement
Grasping
Description: This system is designed to provide
stimulated grasp and arm movements to be employed
for everyday tasks such as eating, drinking and
grooming. Percutaneous intramuscular electrodes are
implanted in hand and arm muscles. The user controls
stimulated movements with motions of the opposite
shoulder.
History: Since the program began in 1989, 14 persons
with SCI ranging from 8-18 years of age have
participated in the FES program. Two persons with C4
SCI will be added to the program over the next two
years.
Status: Experimental research; Feasibility study
Candidate Description:
Spinal cord injury
Cervical: Motor: C4 / Sensory: C4
Tetraplegia! Quadriplegia
Restrictionsl Contraindications: 6-18 years of age.
No limitations in upper extremity jOint range that

muscles. Willingness to participate in program for at


least 2 years.
Treatment course:
Evaluationl assessment - 2 times a week for 2 weeks
Inpatient surgical procedure(s) - if indicated 1 time
Inpatient fitting/implementation - 2 times a week for 4
weeks (includes electrode implants)
Training - 2 times a week for 4 - 8 weeks
Post-implementation therapy/treatment - 5 times a
week for 8 - 10 weeks
Maintenance I check-ups - 1 week every 6 months
Approximate number of visits required in total: 2-3
months as an inpatient, then 1 week inpatient follow-up
every 2 years
Requires evaluation at this facility? Yes
Requires local lodging? No; Outpatient use of the
system
Typical cost: Less than $1,000
3rd party payers typically cover: No costs; research
Type of equipment: Home use stimulator; Research
prototype stimulator; Implanted electrode(s)
Availability of equipment: No charge; loaned to
partiCipants

interfere with system use; lower motor neuron damage


of target muscles. Willingness to participate in program
for at least 2 years.
Treatment course:
Evaluation/ assessment - 2 times a week for 2 weeks
Inpatient surgical procedure(s) - if indicated 1 time
Inpatient fitting/implementation - 2 times a week for 4
weeks (includes electrode implants)
Training - 2 times a week for 6 month
Post-implementation therapy/treatment - 5 times a
week for 8 - 10 weeks
Maintenance / check-ups - 1 week every 6 months
Requires evaluation at this facility? Yes
Requires local lodging? No; Outpatient use of the
system
Typical cost: Less than $1,000
3rd party payers typically cover: No costs; research
Type of eqUipment: Home use stimulator; Research
prototype stimulator; Implanted electrode(s)
Availability of equipment: No charge; loaned to
participants

,.,.
,.,.

--

,.,.

--

--

WHERE TO GET FES

119
USA- PENNSYLVANIA

~ 51 .03
FES Application:
Upper limb movement
Grasping
~escription: This system is designed to provide key
pinch and palmar grasp. Key pinch provides the ability
to hold a pencil or fork and palmar grasp to hold larger
objects like a soda can. FES grasps are controlled with
movement of the opposite shoulder. Stimulation is
delivered via completely implanted electrodes and
stimulator.
History: Since 1993, 5 participants with C5 SCI have
had the FES hand grasp system implemented. Fifteen
more individuals will be added, pending approval of
funding.
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-6 / Sensory: C5-6
ASIA International Impairment Scale: A B
Tetraplegia! Quadriplegia
Restrictions/ Contraindications: Skeletally mature
(approximately 16 to 18 years of age). No lower motor

neuron damage of target muscles; limitations in upper


extremity joint range. Willingness to participate in
procedures to release joint limitations.
Treatment course:
Evaluation/ assessment - 2 times a week for 2 weeks
Pre-implementation therapyltreatment - 5 times a week
for 4 weeks Inpatient surgical procedure(s) - 1 time
Inpatient fitting/implementation - 2 times a week for 4
weeks Training - 3 times a week for 6 weeks
Post-implementation therapy/treatment - 5 times a
week for 8 - 10 weeks
Maintenance I check-ups - 1 week every 6 months
Approximate number of visits required in total: 3-4
months as an inpatient then one week inpatient follow
ups every 6 months for 2 years.
Requires evaluation at this facility? Yes
Requires local lodging? No; Outpatient use of the
system
Typical cost: Less than $1,000
3rd party payers typically cover: No costs; research
Type of equipment: Home use stimulator; Research
prototype stimulator; Implanted electrode(s)
Availability of equipment: No charge

51 .04
FES Application:
Lower limb movement
Stepping and walking
Description: The FES system is used to provide
standing up from the wheelchair to allow reaching and
one-handed activities, and limited mobility away from
the wheelchair, including transfers into cars or other
seats, hopping or stepping (using a walker or
crutches), maneuvering into inaccessible places, and
ascending or descending stairs.
History: Since the research program began in 1986
we have worked with over 30 individuals. Fourteen
participated in standing or mobility training; the
remainder contributed to the study of exercise effects.
In a typical three-year grant cycle we accept at least
five participants into the program.
Status: Experimental research; Feasibility study
Candidate Description:
Spinal cord injury
.
Thoracic: Motor: T1-12/ Sensory: T1-12
Paraplegia
Time elapsed post-injury/onset: 1 year
Restrictions/ Contraindications: Children between
the ages of 13-18. Previous training in knee-ankle-foot
orthosis and functional independence in self-care and
wheelchair mobility skills desired. Contraindications:
Lower motor neuron damage to quadriceps and/or

gluteal muscles; uncorrected orthopaediC or medical


complications that may limit participation (heterotopic
ossification, history of non-traumatic fractures, joint
dislocation, muscle flap
reconstructive surgery).
Treatment course:
Evaluation/ assessment - total of 4 weeks for pre- post
interim testing
Inpatient surgical procedure(s) - (electrode implants)
varies: 2 x a week for 2 wks to 6 x a week for 6 weeks
Inpatient fittinglimplementation - exercise: 5 times a
week for 4 weeks
Training - 3 - 5 times a week for 6 - 14 weeks
Maintenance / check-ups - 2 times a year for 1 to 5
days, or as needed
Approximate number of visits required in total: 5 - 6
months inpatient program plus twice yearly check-up
Requires evaluation at this facility? Yes
Requires local lodging? No; Home use of the system
as part of the study
Typical cost: Less than $1,000
3rd party payers typically cover: No costs; research
Type of equipment: Home use stimulator; Research
prototype stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: No charge; loaned to
partiCipants

120

FES RESOURCE GUIDE

USA- TEXAS

52.00'

Parast,p
DatiasiR.

.."

ilitation Institute.~ltlealtbSbuth

91q.s Harry!JfinesBoulevard
DallasTX 76220
USA
Tel: 214-351-2014
FAX~

fl1~rmationayailable: Printed format

HOurs: 8:30 PM to 5:00 PM, Monc:iiY ..., Friday

P()pulatf~"s

214-35j-4012

~tions'

P~m~riptioq:Th
system is a
neu~useuIEaffunctional~mulation progr~m for

Area
..... ihtheU;$,f..
Referrafreq
Frotn:~lCian
Billing infG:
.....
. . ..
Pa
methods: Cflarge/CredilCalii.f: Will hill

persons(with:& inal coroil"ljElry. It enablespersons to


sta
beensI'iIWnto

4yp~Of.facilifJ!t:fQPatient

... . .... .

<

.' .'. .

., .... ..... ......

Locationof<sBJ!ViCe$: Serviceprovld~ location


Accessibili
hair accessible.;if:lcl.batnrooms.~'~
Handicapped
available; NearaecessibI&4J)Y.QIic "q
trat'J~Port

.,

Director: Geti)rgeWharton,MD
Con~Cf~P~: Patricia, .

be,

ari'd~vefSing

muscularatrop~y,iina-~asing.ldcatbl()od.flmt~1"I

stimulated' muscles, anqJncreasing therang(!JQf


motion' at inactive ointi:J.

..

iouq,afientfaeility;
.' . ..... deveIOptl1el1t~ntelr
ReHabilitation ~nter; .
Accreditation: CARF Accredited;JQAHOAccredlfE!cl'
Licensing/CerlfflcatiOn,.Not appficabfe~

--

52.01
FES Application:
Lower limb movement
Stepping and walking
Description: The user of the Parastep system controls
it by initiating commands to the microcomputer
controlled stimulator which in turn activates electrical
impulses to the lower extremities to enable standing
and walking. Once standing has been achieved, users
progress to walking with a walker adapted with control
switches. The walker assists in balance.
History: This program was started in March, 1994.
Four have entered into the program so far.
Status: Clinical service
Candidate Description:
Spinal cord injury
Thoracic: Motor: T1-12/ Sensory: T1-12
ASIA International Impairment Scale: A
Paraplegia
Time elapsed post-injury/onset: any time post injury

Restrictions/ Contraindications: Must be in generally


good health and have the ability to demonstrate
adequate trunk control and balance in order to maintain
an upright position. Contraindicated for persons with
severe scoliosis and osteoporOSiS, autonomic
dysreflexia, cardiovascular or pulmonary disease,
epilepsy, irreversible contractu res, and morbid obesity.
Treatment course:
Inpatient fitting/implementation - 1 time
Training - 2-3 times a week for 10-15 weeks
Maintenance / check-ups - every 3 months
Approximate number of visits required in total: 33
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $10,000-$20,000
3rd party payers typically cover: Some costs
Type of equipment: Clinic use stimltr; Home use
stimltr; FDA approved stimltr; Transcutan.lsurface
electrode(s)
Availabili of e ul ment: Purchase

53.00

Scott Deparbnent of Urology


Baylor College of Medicine
6560 Fannin, Suite 1004
Houston TX 77030
USA
Tel: 713-798-4Q01
Toll-free:
FAX: 713-798-7900
E-Mail:
Director: Dr. Larry Lipshultz
Contact,Person: Dr; Larry Lipshultz; Paige Simon, RN
Program Description: Provide electroejaculation for
men with ejaculatory failure. Other Assisted
Reproductive Technologies are available for couples
wishing to initiate pregnancy.
Infonnatlon avallablef No information provided
Hours: 8:00 AMto 4:00 PM,Monday - Friday, oncall
Saturday and Sunday

Location of services: Service providers location


Accessibility: Wheelchair accessible, inc!. bathrooms;
Handicapped parking available; Near accessible publiC
transport
Populations served: Male Only; Adult (age 16 to 65)
Areas served: No information provided
Referral required? Yes Fr'Oat Dr. lipshUtz
Billing info: Fixed rates; Varies with ablllty.to)pay
Payment methods: Cash; Charge/Credit:~~rd;
Payment Plan OptiomWillbill Medicaid; Wlllbili.
Medicare
Type of facility: Privately supported; Publicly ...... .
supported; VA agency; Federal agency; Non-profit;
Inpatient facility; Outpatient facility; Hospital
Accreditation: No information provided
Licensing/Certification: Not applicable

WHERE TO GET FES

121
USA- TEXAS

53.01

FES Application:
Sexual function
Electroejaculation
Description: Our group specializes in assisted
reproductive procedures. We perform
electroejaculation for men with ejaculatory failure. The
~peci~en. is collected, processed and usually used for
insemInation. Other assisted reproductive technologies
are available.
History: Electroejaculation has been available at our
facility for 10 years. We have treated over 250 persons
during this time.
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Multiple sclerosis
Spinal cord injury
Cervical: Motor: all levels! Sensory: all levels
Thoracic: Motor: all levels I Sensory: all levels
Lumbar: Motor: all levels! Sensory: all levels
Sacral: Motor: all levels! Sensory: all levels

t\w

54

1;S5ut
1717

lft,Yf~enter'.. ..
Road.~ Suite;1 0.3'

'Hurst T
USA'
Tel:81Toll~lree:
FAX: 81
344
E"1I!Iail:

Director: Alfred J. RodrigaeZi>lVJ:O.

Contact'PetSon:SaranGoadrich

. Prog@mDescription:>Electroejaculation Programfor
insemination, in vitrofertilitation and microinjection.
Initial EEJrecommended for semen analysis.or
cryopreservation.
Information: available~Printed format

54.01

FES Application:
Sexual function
Electroejaculation
Description: For men with infertility only. Rectal
stimulation to produce semen for insemination or in
vitro fertilization.
History: Performing EEJ since 1991 for infertility
services.
Status: Clinical service
Candidate Description:
Spinal cord injury

Retroperitoneal Node disections resulting in ejaculatory


failure
Hemiplegia
Paraplegia
Tetraplegia! Quadriplegia
Restrictions/ Contra Indications: No info. provided
Treatment course:
Evaluation! assessment - 1 day
Inpatient surgical procedure(s) - 1 day
Outpatient surgical procedure(s) -1 day
Approximate number of visits required in total: 3 +
Requires evaluation at this facility? Yes
Requires local lodging? No; The specimen could be
shipped for insemination of partner.
Typical cost: No information provided
3rd party payers typically cover: Some costs; varies
Type of equipment: Clinic use stimUlator; Research
prototype stimulator
Availability of equipment: No information provided

Ho

L
Ae
2)'.,

'.
alf:

Handi~;~ngavallable ....

Popul~SerVed. MaleoOnty:
Areas dJjed:tJnlifnited .
......
Refet'rafrJiqulred? .Yes Ftom;}PhySieian
,Silling Info:FlXeorates
PaymenUnethods:Cash; Char~/Gtedi~,eatdPlviltblll
Insurance
.
Type of facility: Privately. supported~ For pn1Ifiij'" .
OutpatienHacillly
...
..
Accreditation:;6ARFAccredited ...
Ucensing/Celtifleatio"; Doctor FACOG

Restrictions/ Contraindications: No info. provided


Treatment course:
Outpatient surgical procedure(s)
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: Less than $1,000
3rd party payers typically cover: No costs
Type of equipment: Clinic use stimUlator; Research
prototype stimulator
Availability of equipment: No information provided

122

FES RESOURCE GUIDE

5.5.10:';

pfovide~/Iocation

t[.iy,efSity!~

A=:esslii1ttY: V\lheelchair accessible.in~I;~tiathrRms;

U~ersity of'Ulah

SON. MeqiCatDrivex;~:
Salt Lake;Clty UT 84:'fj~
USA

...

Tel: 801'-5814705
x4705

FAX: 801~a1-6127e~MllJr
Director~ Stewart T. Landau,. MD
ContactPerison: StewartT: LandauMD
program:D~ription:

Hand~fl)ped parking available; Nearaccessible pt!Jblic

-
-

transp'Qif'

P(JpuratiOftS .served: No restrictions


Areae aerved:Unlimited
R~il'al required? No
Billing info: Fixed rates
Payment methods: Cash; Charge/CreditCard'
Payment Plan Option; Will bill Insuranc.~WirJbiil
M~lcal9Jf'Will billMedicare; Will bill ottrertn~1'arty

q"'......._. ',' 7:arJ~I~~"..


cilly: College} universityprog~~fotospital
Hours: g:d1f~MJ5:1
Accreditation:
JCAHO Accredited
to 10:30 AM~ saturday.,~Sund~y
Licensing/Certification:
Not applicable
Location ofs~ceai'e:onsymers resid~nce;,,~ioe

55.01

FES Application:
Sexual function
Electroejaculation
Description: This program involves vibratory
stimulation and electroejaculation.

History: Has been available for 2 years; have treated

30 persons in over 100 stimulation procedures;


program capacity is unlimited.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Cervical
Thoracic
Lumbar
Sacral
Hemiplegia
Paraplegia

55.02
FES Application:
Lower limb movement
Stepping and walking
Description: Stimulate sacral or superficial peroneal
(sensory) nerve at constant low level to elicit flexion
reflex which aids in walking.
History: Limited use, no one else uses the system
described.
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Multiple sclerosis
Spinal cord injury
Other spinal disorder: myelopathy with spastic
paraparesis or monoparesis.

Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 6 months
Restrictionsl Contraindications: Should not have
evidence of active infection.
Treatment course:
Evaluationl assessment - one time
Post-implementation therapy/treatment - oncel month
Approximate number of visits required in total: 5-6
Requires evaluation at this facility? No; Can be
done at other facility office
Requires local lodging? No; Treatment is intermittent
and participant can return home between visits
Typical cost: $1,000-$5,000
3rd party payers typically cover: No costs; insurance
only sometimes covers costs
Type of equipment: Home use stimulator; Not FDA
approved stimulator
Availability of equipment: No charge

Restrictionsl Contraindications: Must have enough


strength to stand
Treatment course:
Evaluationl assessment - < 1 week
Pre-implementation therapy/treatment - 2 weeks
Maintenance / check-ups - every 2 - 3 months
Approximate number of visits required in total: 3 - 6
Requires evaluation at this facility? Yes
Requires local lodging? No; Many travel long
distances to visit the clinic
Typical cost: Less than $1,000
3rd party payers typically cover: Some costs
Type of equipment: Not FDA approved stimulator;
Research prototype stimulator,
Transcutaneous/surface electrode(s}
Availability of equipment: Purchase; No charge;
research study

..."

--

WHERE TO GET FES

123
USA - VIRGINIA

56.01
FES Application:
Lower limb movement
Stepping and walking
Description: We are training appropriate candidates
for use of the Parastep(R} System by Sigmedics
surface electrodes are applied to lower extremities and
commands to stand and walk are delivered by the user
via a specially wired walker and microprocessor.
History: We have had our program since 1992
(summer). We have enrolled 5 people into the "active"
phase of the program. We can treat up to 3 at a time.
Status: Clinical service
Candidate Description:
Spinal cord injury
Thoracic: Motor. T2-12/ Sensory: T2-12
ASIA International Impairment Scale: A
Paraplegia

[i:J

57.00

Hunter HolmesNlc$UiteVA Medical Center


1201 Broad Rock Boulevard
Richmond VA 23249
USA
Tel: 804-230-1328
TOJli:ft,ee:
.. F;:AX:804;;23Q.;1459
E-MaIl:
Director: Or. Meeha Midha
Conlci<:t Person: Or. Meena~Midha

~f09ra,m Description:~p,,:lnfoi'matiDn provided

Informationavailab1e:pnnteftcformat

Time elapsed post-injury/onset: 6 months


Restrictionsl Contraindications: No info. provided
Treatment course:
Evaluation/ assessment - 1 day
Post-implementation therapyltreatment - varies from
user to user, if needed at all
Training - 32 1 hour sessions over 10 - 16 weeks
Approximate number of visits required in total: 33
Requires evaluation at this facility? Yes
Requires local lodging? Yes; Ideally or be able to
commute easily for sessions 3 times a week
Typical cost: $10,000~20,OOO
3rd party payers typically cover: Some costs; varies
Type of equipment: Home use stimulator' FDA
approved stimulator; Transcutaneous/surfuce
electrode(s}
Availability of equipment: Purchase

Hours: No information proVided


Location~oJ;'S~Nt~: NoinformatiQogrOvided
Accessil:iili"!;.~looaifi'accessibfe\, ihcl. bathropms
Populations..,.vec:b U.S~Veten1r1jOnly
Areasse1"#ect. Virginia
Referralrequired? ;NG1nfotmati(jnpro~ided
.'

Billing info!;Requj~.;documentationofcflnancialneeck

Payment methods: No information provided


Type of facility: VA agency; Hospital'
Accreditation:..JCAHG\Accredited

LicensingleertificattDn~No;imformati9tprovided

L
124

FES RESOURCE GUIDE

USA - VIRGINIA
I
57.01
FES Application:
Respiratory treatments
Breathing assistance
Description: Diaphragmatic pacemaker to both right
and left diaphragms, Pacer by Avery Labs.
History: Not a program as such. Eligibility made on a
case by case basis by attending physician or request.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C3 / Sensory: C3
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 2 years
Restrictionsl Contraindications: No info. provided

Treatment course:
Evaluation! assessment - 9 months
Inpatient surgical procedure(s) - 1 day
Training - 6 months
Maintenance! check-ups - on going
Requires evaluation at this facility? Yes
Requires local lodging? No; Can be an outpatient
Typical cost: More than $20,000
3rd party payers typically cover: No costs; VA pays
for pacemaker, surgeon, and hospital stay;
manufacturer provides some support
Type of equipment: FDA approved stimUlator;
Implanted electrode(s)
Availability of equipment: No information provided

I
57.02
FES Application:
Lower limb movement
Stepping and walking
Description: The system allows persons to walk
without the use of traditional long leg braces. Mounted
electrodes are placed on the thighs and legs to
stimulate the muscles and nerves to produce
movement. A battery powered stimulator is worn
around the waist and connected to an adapted walker
with hand controls.
History: Available as of 2/95, 4 persons screened with
one deemed a candidate. Candidate to begin 10/95.
No more than 2 persons at the same point in time.
Status: Clinical service
Candidate Description:
Spinal cord injury
Intact motor unit L1 and below
ASIA International Impairment Scale: A, B
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 6 months
Restrictions/ Contraindications: Cardiovascular
disease, pulmonary insufficiency, epilepsy, severe

scoliosis or osteoporosis which precludes standing,


pregnancy, skin disease at stimulation sites,
irreversible contracture, vision or hearing impairments
which interfere with training, morbid obesity, frequent or
severe autonomic dysreflexia, inability to attend.
Treatment course:
Evaluation! assessment - 1 - 1.5 hours
Inpatient fitting/implementation - varies
Outpatient fittinglimplementation - 1 hour
Training - 2 - 3 xl week for 20 min. - 1 hr. sessions; 32
sessions needed
Maintenance / check-ups - at 3,6, and 12 months
Approximate number of visits required in total: 32
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $1,000-$5,000
3rd party payers typically cover: No information
provided; New to system, recent FDA approval
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;
Transcutaneous/surface electrode(s)
Availability of equipment: Purchase

--..

--'

..,

58;00

Rehabilitation and Research Center


MedicalCollege of Virginia
Box 980677
Richmond VA 23298-0677
USA
Toll-free:
Tel: 804.,.828~861
FAX: 804-828-5074
aMatl:
Dlrectf.)r: Dr. William O. McKinley
Contact Person: Dr. William O. McKinley
Program Description: Parastep . functional electrical
stimulation in persons withparaplegia;,designed to
enhance ability to stand and ambulate.
Information available: Printed format
Hours: 8:00AM to 5:00 PM, Monday - Friday
Location ofservices: Service providers location

Accessibility: Wheelchair accessible, .incl;bathroo~


Handicapped parking available; Near"accessible public:
transport
Populations served: No restrictions
Areas served: Unlimited
'Referralrequired? No
BlUing info: Fixed rates
Payment methods: Cash; Charge/Credit QJd; WiIHjill
Insurance; Will bill MedicaidiWiII bill Medicare; Will bili
Other third"partypayment
.
Type of faCility: Publicly supported; State agency;
.'
Inpatient facility; Outpatient,facility;College I University ,
program; Hospital; Rehabilitation center; Research &
development center
Accreditation~ CARF Accredited
Licensing/Certification: Not applicable

---

WHERE TO GET FES

125
USA - VIRGINIA! WISCONSIN

58.01

FES Application:
Lower limb movement
Stepping and walking
Standing! transfer assistance
Description: Parastep - FES in persons with
paraplegia, for enhancing ability to stand and ambulate.
History: Has been available for 1 year.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Thoracic

Lumbar
Paraplegia
Restrictionsl Contraindications: No info. provided
Treatment course:
No information provided
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $10,000-$20,000
3rd party payers typically cover: All costs
Type of equipment: Home use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: Purchase

WISCONSIN

'l;;.5g,,~OO

Neui()muscu'~r Retraining Clinic


University of WI$t;QI:l~inl1ospitakandClinics
2710 Marshaltceun
.
.
Madison WI 53711
USA
Tel:<608":"263-2935c

'-26540~~1 ~

E~

D
.. Stenberg. PT; Arthur Rodfiquez. MD
Contact:fJerson:Setl1 Stellberg;:PT
Program Descrlpli_'Motor reli'iilinmgclinicWith .
emphasis on isolated motorrecrt.litment1acilitated'by
feedback mechanisms. Deveiophomep~yt;l!Ims:
Information available: Printed format; .Videotape
format; Phone contaet .
Hours.: 8:00 AM to 5:00 PM, weekdays
Location of services: Service providers location;
Home ro rams

Accessibility: Wheelchair accessible; incLbathrooms;


Handicapped parking available; Near acces~ibIe.;.public
transport
..... ,.
Pj)pulations.s~~: Aged (ag~f3S9r olderlf"AtIQIt
(age 16 tQ~};Saboolage; Adol~'
AreasseWecl~hlrinn'lited
.

\Jred~~l'lIo

Billing ill
for service
Payment methoCfS: Cash; Charge/Credit Card;
PaYl1lent Plan Optio~;Will oilllnsllrance; Will,lili"
Medicaid; WIll bill Medicare; Will bill Othertkl~rty
pl!iyment
TYpe of facility: Publicly supported; State agency;
Non-profit; Outpatient facility;Fedetal agency;
Rehabilitation .program
Accreditation: -.lCAHO Accredited
Liceri.in ICertification: Not a licable

59.01

FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Description: Feedback used to help learn motor
control; increase movement ! muscle proprioception;
strengthen muscles; increase endurance; and reduce
shoulder subluxation. It is used as part of an
individualized home program. It may be used in
exercise and!or a functional activity.
History: FES has been used since 1983. 10-15% of
client load is SCI. About 250 persons seen per year.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical
Thoracic
Lumbar
Sacral
Hemiplegia
Paraplegia
Tetraplegia/ Quadriplegia
Incomplete

Time elapsed post-injury/onset 6 months - 1 year


when other therapies have been discontinued.
Restrictionsl Contraindications: Incomplete SCI ,
innervation at target area., medically stable.
Treatment course:
Evaluation! assessment - 1 - 2 days
Pre-implementation therapy/treatment - 1 - 2 days
(related therapy with other types of feedback)
Training - 2 days
Post-implementation therapy/treatment - 1 day
(complimentary therapy)
Check-ups - 1 - 2 days every 2 - 3 months
Approximate number of visits required in total: - 1 week
plus check-ups 3 x / year, 3 wks / year approximately.
Requires evaluation at this facility? Yes
Requires local lodging? No; part of a home exercise
Typical cost: $5,000-$10,000;$10,000-$20,000
3rd party payers typically cover: Some costs;
Authorization / contact is helpful
Type of equipment: Home use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: Purchase; Rental; through
EMPI, Inc. Ph sician rescri tion r uired.

126

FES RESOURCE GUIDE

USA - WISCONSIN

59.02

FES Application:

Upper limb movement


Grasping
Description: FES is one of a variety of types of
feedback used to facilitate grasp by initially warming up
muscle (ie. finger flexors) followed by transferring
o~jects using a remote switch (in a grasp-release task).
History: FES used since 1983. Approximately 5% of
the caseload may use FES as one part of a home
exercise program for facilitating grasp. Program
capacity is 250 persons (various diagnoses) per year.
Status: Clinical service
Candidate Description:

Spinal cord injury


Cervical
Hemiplegia
Tetraplegia/ Quadriplegia
Time elapsed post-injury/onset: 6 months - 1 year.
Restrictionsl Contraindications: Must have
documented incomplete SCI and innervation to the
target area. Medically stable.

59.03

FES Application:

Neuromuscular treatments
Regaining voluntary function
Description: FES is one of a variety of types of
feed~ack used to assist a person in regaining voluntary
function (often in conjunction with biofeedback
sessions; neuromuscular retraining). We most often
use single joint movement applications like triceps
activity in upper extremity weightbearing, or reaching;
ankle dorsiflexion during gait.
History: FES used since 1983. 10-15% of client load is
SCI. A total of approximately 250 persons (all
diagnoses) are seen per year.
Status: Clinical service
Candidate Description:

Multiple sclerosis
Spinal cord injury
Cervical
Thoracic
Lumbar
Sacral
Paraplegia
Tetraplegia/ Quadriplegia
Time elapsed post-injury/onset: 6 months - 1 year or
when other therapies have been discontinued.

Treatment course:

Evaluation/ assessment - 1 - 2 days


Pre-implementation therapy/treatment - 1 - 2 days
(time spent in related therapy)
Training - 2 days
Post-implementation therapy/treatment - 1 day (time
spent in complimentary therapy)
Check-ups - 1 - 2 days every 2 to 3 months
Approximate number of visits required in total:
approximately 3 weeks per year
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: $5,000-$10,000
3rd party payers typically cover: Some costs;
Authorization / contact with insurance company is
helpful
Type of equipment: Home use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: Purchase; Rental;
Physician prescription required.

Restrictionsl Contraindications: Must have


documented incomplete SCI and innervation to the
target area. Medically stable.
Treatment course:

Evaluation/ assessment - 1 - 2 days


Pre-implementation therapy/treatment -1 - 2 days
(time spent in related therapy)
Training - 2 days
Post-implementation therapyltreatment - 1 day (time
spent in complimentary therapy)
Check-ups
Approximate number of visits required in total:
approximately 3 weeks per year
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: $5,000-$10,000;$10,000-$20,000
3rd party payers typically cover: Some costs;
Authorization / contact with insurance company is
helpful
Type of equipment: Home use stimulator' FDA
approved stimulator; Transcutaneous/surfuce
electrode(s)
Availability of equipment: Purchase; Rental;
Physician preSCription required.

WHERE TO GET FES

127
ARGENTINA

.[~]

6Q:iUo

Loca~nof services: No informatfonprovided,


Ac~l)ility: Wheelchair accessible;.incl.bathr6oms;
Near~ble public transport
o restrictions

F"~IEleCtncal;

"MarGeld~. FiteiReh~buitatr

Av: Spnta!Fe5380~1'4"E:"

Aires 1425

rit

, ,:Tlt:J~
Tel: 54-1,"7:7~
F~f~l~E";Mail:

,. Di~:~ft'eeha

St1mtn~ltklh - exerCise'~ .. ... ..............' . . . . . ..


rological
.di~iI~~;,includjng stahdifi9;;anttwalking.

Information available: Noinfol'n'1ation provided

Hoy.,..; 8:30 AM toA:30 PM, daily

Blmijg~.jjfo: Fixed rates


P~~methods: Cash; Will bill other third-party
ppy~nt

Contact,Perifoo:

pro9~tftDesctipti

'~~,.quired? No

60.01

FES Application:
Lower limb movement
Stepping and walking
Description: Surface stimulation of quadriceps and
peroneal nerve for standing and walking; sometimes an
ankle foot orthosis (AFO) is used in combination with
FES.
History: This program is 6 years old. Eighty persons
have been treated. The capacity of the program is 6-10
persons a day.
Status: Clinical service
Candidate Description:
Spinal cord injury
Thoracic: Motor: T4-10 / Sensory: T4-10
ASIA International Impairment Scale: A. B, C
Hemiplegia
Paraplegia

60.02
FES Application:
Lower limb movement
Stepping and walking
Description: Stimulation of the knee extensor and/or
peroneal nerve for assisted walking.
History: No information provided
Status: Clinical service
Candidate Description:
Multiple sclerosis
Restrictionsl Contraindications: Articular limitation'
strong spasticity; cardiovascular diseases.
'

Jjpjof"facility: Non-profit; "npatient facility;

~utpatient facility; Consultant I Private practice;

Rehabilitation center

Accreditation: No information provided

Licensing/Certification: Not applicable

Restrictionsl Contraindications: Articular limitation'


strong spasticity; clinical complication.
'
Treatment course:
Evaluation/ assessment - 2 hours
Pre-implementation therapy/treatment - 5 times a week
for 4 - 5 weeks
Inpatient implementation - 5 times a week for 1 week
Outpatient implementation - 5 times a week for 1 week
Training - 5 times a week for 4 weeks
Approximate number of visits required in total: 52
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $1,000-$5,000
3rd party payers typically cover: No costs
Type of equipment: Clinic use stimulator; Home use
stimulator; Not FDA approved stimulator;
Transcutaneous/surface electrode( s)
Availability of equipment: Purchase

Treatment course:
Evaluationl assessment - 2 hours
Pre-implementation therapy/treatment - 3 - 5 times a
week for 2 weeks
Training - 3 - 5 times a week for 4 weeks
Maintenance I check-ups - every 2 months
Approximate number of visits required in total: 30 - 40
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $1,000-$5,000
3rd party payers typically cover: No costs
Type of equipment: Clinic use stimUlator; Home use
stimUlator; Not FDA approved stimUlator;
T ranscutaneous/su rface electrode( s)
Availability of equipment: Purchase

128

FES RESOURCE GUIDE

ARGENTINA

60.03

FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Description: Used for persons with atrophied muscle
because of long term rest, to prevent / improve
contractures, or for partially denervated muscles to
improve muscle power.
History: This is a new treatment implemented in 1993.
There are a few persons in the program and the
preliminary results are good.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C4-8
Thoracic: Motor: T1-12
ASIA Intemationallmpairment Scale: A, B, C
Paraplegia

60.04
FES Application:
Neuromuscular treatments
Controlling spasticity
Description: Surface stimulation to the lower limbs for
persons with upper neuron lesions. Thirty minutes of
daily exercise to the quadriceps and gastrocnemius
muscle for 5 seconds on and 6 seconds off.
History: Since 1990 we've treated many persons with
a severe degree of spasticity because of SCI or MS
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
ASIA International Impairment Scale: A, B, C
Time elapsed post-injury/onset: any time post injury

60.05

FES Application:
Upper limb movement
Other - shoulder and forearm
Description: Stimulation to the shoulder and forearm
muscle to reduce spasticity, edema and increase range
of motion. Sometimes used in coml:!ination with
biofeedback.
History: No information provided
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C4-8 / Sensory: C6-8
ASIA International Impairment Scale: A, B
Tetraplegia! Quadriplegia

..-

Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: any time post injury
Restrictionsl Contraindications: Cardiovascular
diseases
Treatment course:
Evaluation! assessment - 1 hour
Training - about 5 times a week for 5 weeks
Approximate number of visits required in total: 25
Requires evaluation at this facility? Yes
Requires local lodging? No; It is possible to have the
treatment at home
Typical cost: $1,000-$5,000
3rd party payers typically cover: No information
provided
Type of equipment: Not FDA approved stimulator;
Transcutaneouslsurface electrode(s)
Availability of equipment: Purchase

Restrictionsl Contraindications: Strong spasticity,


cardiovascular diseases
Treatment course:
Evaluation/ assessment - 2 hours
Training - about 5 times a week for 2 weeks
Approximate number of visits required in total: 12
Requires evaluation at this facility? Yes
Requires local lodging? No; If the treatment is useful
can continue at home
'
Typical cost: $1,000-$5,000
3rd party payers typically cover: No costs
Type of equipment: Clinic use stimulator; Home use
stimUlator; Not FDA approved stimUlator;
Transcutaneouslsurface electrode(s)
Availability of equipment: Purchase

Restrictionsl Contraindications: Cardiovascular


diseases
Treatment course:
Evaluation! assessment - 1 hour
Training - about 5 times a week for 4 weeks
Maintenance / check-ups - every 2 months
Approximate number of visits required in total: 20
Requires evaluation at this facility? No
Requires local lodging? Yes
Typical cost: $1,000-$5,000
3rd party payers typically cover: No costs
Type of equipment: Clinic use stimulator; Home use
stimulator; Not FDA approved stimulator;
Transcutaneouslsurface electrode(s)
Availability of equipment: Purchase

--

---

WHERE TO GET FES

129
AUSTRALIA

In~rmation~yailable: Printed format


Jfl)ul'S!i9tOOAMto 4:00 PM, Tuesday, Wednesday,
)fservices::.!i:;e"rice nrn1,mu",,.., location
i_I~J::'ir~ctE~SliI:lJe~inrbl batl;J~ooms;

Tet:'08

)FA'K= 61 . . .
14
EilII/Iiil:

.Oirector~Jf:: Miranda;delf)sjftjit:>r, Rufh Marcllall

Contact~,rson:Hello/

Ith, Physiotherapist
ProgramJ;tescription:C>i / ... ns with SCI or
disease",I!ES gaitlistanaitfgrf'J!itagramme; FESdriVen
hybrid exerci~e device "Power Trainer"; eXJYerimental
study of. FES fitness/aerobic training; and assessment
of FES for (assure areas/decubiti revention; . .
l]
61 .01
FES Application:
Circulatory/Skin treatments
Improving circulation in limbs
Preventing/treating pressure sores
Upper limb movement
Neuromuscular treatments
Treating weak, atrophied muscles
Controlling spasticity
Description: FES may be implemented via surface
electrodes on an individual basis.
History: Used clinically as physiotherapy tool for >6
years; specific use for gait/standing/stepping for 4 yrs.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C4->

information provided
Type .PriVately.supported; Publicly
supported; Non"'profit; Outpatient facility; Home health
agency; Rehabifitation center
Accreditation: No information provided
LicensinglGertification: Not applicable

Thoracic: Motor: <- T12


Lumbar: if incomplete
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: acute rehab phase
Restrictionsl Contraindications: Individually
assessed.
Treatment course: Individually assessed.
Requires evaluation at this faCility? Yes; In-patient
facilities used for ward residents only.
Requires local lodging? Yes; as above
Typical cost: $1,000-$5,000
3rd party payers typically cover: No costs
Type of equipment: FDA approved stimUlator;
Transcutaneous/surface electrode{s}
Availability of equipment: No charge; in-house use
only

61 .02

FES Application:
Cardiovascular exercise
Bicycle ergometry
Description: Surface electrodes and lower limb FES
using Power Trainer to obtain hybrid exercise workout,
following a period of home-based muscle conditioning.
History: Available for about 2 years. Six treated so far.
Power Trainer (Sinties, USA model) plans to expand
programme to provide alternative venue for fully trained
persons in the community, dependent upon funds.
Status: Experimental research
Candidate Description:
Spinal cord injury
Thoracic: Motor: T4-12
Paraplegia
Time elapsed post-injury/onset: 1 year
Restrictionsl Contraindications: Restrictions: age 18
to 55. No: active medical problems; substance abuse;
autonomic dysrefJexia; active heterotrophic ossification;
peripheral vascular insufficiency. Contraindications:
osteoporosis> 30% loss via bone density studies;

malignancies/metastases; severe spasticity; cognitive


impairment ego head injury.
Treatment course:
Evaluationl assessment- 2 times a week for 3 weeks
Pre-implementation therapy/treatment - 3 wks muscle
conditioning (3 x / day at home) and clinic visits 1 xl wk.
Training - 2 times a week for 6 months minimum
Post-implementation therapy/treatment - respiratory
studies once every three months {4 studies in total}
Maintenance / check-ups - 1 time every three months
Other - specific medical diagnostic tests ego bone
density arrays, as part of evaluation procedures
Approximate number of visits required in total: 60 - 80
Requires evaluation at this facility? Yes; Only
available staff and equipment are on-site
Requires local lodging? Yes; However residential
programmes available for interstate visitors
Typical cost: $10,000-$20,000
3rd party payers typically cover: No costs; research
Type of equipment: FDA approved stimUlator;
Transcutaneous/surface electrode( s)
Availabili of e ui ment: No char e

br

130

FES RESOURCE GUIDE

AUSTRALIA
61 .03
FES Application:
Lower limb movement
Stepping and walking
Description: 2 dual channel stimulator system using
external electrodes and commercial stimulators.
Stepping and gait and exercise / muscle conditioning
only. Regular clinic attendance required to upgrade
parameters. Used in acute spinal rehab unit.
History: Available for 4 yrs, individuals treated: 4 (3
higher than T6) of these 1 has continued to manage
steppage gait plus rollator walking frame at home.
Status: Clinical service
Candidate Description:
Spinal cord injury
. Thoracic: Motor: T6-12
Paraplegia
Timeela sed

Fli

pro\iiders IOeati()nrconstJ~~s Workplace


Accessibility:WJ!jeelchairiaccessible,it1Cl, bathrooms;
lisi'ldicappedparking availai'Je;: Near:aeeeSsible publiC
transport; H()$pital flats. avaiiabte~~lOng)stay
PQJlul~o. .sel'V~d: .No'rest.rictions

A
St
H
ictoria 3081
'AUSTRAL~IA
Tel: Qa-4~91

41easse.ve : Atistraria

FAX:~96;t3626.

. ..." mire
info. ...

Ditijtol';'Or

C
.

PfOQram0~ . . ' 10...=.

Restrictions/ Contraindications: see 61.02


Treatment course:
Evaluation/ assessment- 2 times a week for 3 weeks
Pre-implementation therapy/treatment - home muscle
conditioning 3 times daily.
Training - clinic weekly for minimum of 6 mos.
Maintenance / check-ups - quarterly
ApprOXimate number of visits required in total: 40 - 80
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $10,000-$20,000
3rd party payers typically cover: No costs; private
funding
Type of equipment: FDA approved stimulator;
Transcutaneous/surface electrode(s)
Availabili of e ui ment: No char e; loaned

y-fo

........... . ",.. ecHo ~~jor

Spinal UljUrie~ Unital\Jd wepl'()'yide'CI~ean&f6rour.

t'l

patientstobeh:mn:aM adVaneesinFES teehnQfogy.


Information.av.liable:Printed>forrl'lat
HourS: 10:00 AM to 4:00 PM, Wednesday and~tidsy
location of services: Consumer's residence; Service
~
62.01
FES Application:
Upper limb movement
Grasping
Description: Trial center for the NeuroControl
Freehand System which provides pinch grip and
palmar grasp for persons with C5 quadriplegia. It
involves the implantation of electrodes, leads and a
stimUlator and is usually performed ,in conjunction with
tendon transfer / reconstructive surgery.
History: Operating since 1994. To date 3 individuals
have received the implanted FES device.
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Cervical: Motor: C5 / Sensory: no limit
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 1 year
Restrictionsl Contraindications: Good strength and
control of elbow flexion and shoulder movement; not
suitable for tendon transfers to restore grasp; forearm

No";~,> <
..,.' .',. ,
. .
..

... e~lf6rmajor itims; Varie~th

or it

--

Paytneth

elCredltfG'ilttji
Payment Plan O}'
Type of facility: Privatelysupported:"PubltaJy'
supported; Non;;;profit; Inpatient facility; Outpatient
facility; Hospital;R.ehabtlitation center
A@reditation: No informati.on provided
Licensjn . . Ce~on: Nota licable

muscles / nerves intact.


Treatment course:
Evaluationl assessment - 2 times, 2 days
Pre-implementation therapy/treatment
Inpatient surgical procedure(s) - 1 - 3 wks on the ward,
Outpatient implementation - 3 - 5 times over 6 weeks
Training - 5 times a week for 3 weeks
Maintenance / check-ups - as needed and at 6 and 12
months post training
ApprOXimate number of visits required in total: about 10
as an outpatient, 2 inpatient stays of up to 3 weeks.
Requires evaluation at this facility? Yes; According
to Institutional Review Board criteria
Requires local lodging? No; But able to travel to the
facility as needed
Typical cost: More than $20,000
3rd party payers typically cover: No costs; research
Type of equipment: Clinic use stimulator; Home use
stimUlator; Research prototype stimulator; Implanted
electrode(s)

Availability of equipment: No charge; loaned

---

WHERE TO GET FES

131
AUSTRALIA
asrehabllita:60n for adtiftsandchildroo'Withphysical
dl~abilities, a:ndprovisi?n ofresec;trch~chol~rShipsfor
pr&doctol'~;aJ1d post-idocto~1 trainee$.at the
oe .

~,

slatlQn,tb .langUSiges:,o

:f6f1ml!;.Sp~ifio

ancErigtisn upon
request
HOUrsl2~:POAM to 8;OOPM. Monday - Saturday
Toll.o:free :
Loc~,9fsel"{i~.s::Gonsumer's residence; Service
E"Maib
v i.get'S'!ocation
Qro
.8lJ
Accessibility: Whe~fch
essible incL bathrooms'
nQBvisj.. FACSM
HandiCapped pal'kir'lg<:Jv ilable; Near accessible public
'!llr,.Glenn Davis,[A9SM
transport
crrptk)n:Th~. Sha~e-B-I~ .
f'opUla~ionsserved:AduJqage15 to 55)
I$; . " .'
exercise\~~oi1y~~~dfunCtio
A.reas served: New$outh Wales; Austratia; New
. inQepenclenceofp~rsofl~;With~l~~rl:lfml:)
..Zeala
South PacIfiCRim Countries
J~seactjVi(I~~in~i~de: . (i)~~~E~ndtJGe9up4p~r Refe ..... ui~d1NojnfmmSltion provided
an '. Jw~rJimtY'musGl.llar~ntracti?nsfor augnjenting""
Billing info:No charge;Varies with ability to pay
exereiseoapacity;{ii)AeSiiijnduceaioWer..ritnb
Payment met~d~:WiIl biJIl.flSOrance'WiIl bill
mtJsc~Ia:~ co~ . . .....
. .. . . '. . s; ant;f!(ilii)
Medicare; Wnrbinbther third;;;,panypa?ment ....
rese~~and d~vel
:'of "fcdlf~nt~nr'(lfJ~
Type of facility~Privatelysuppbrt~d;PublfcJy
AU$trala$i~ Paci(IC..
) inexpensiveNMESand
suppo~~; Federa.,agency;~II~e' Univel'Sity
FESElppljanoes. sl.Ippertit'l{ithe priortocL TheShake..a
pr?gramiResearch & devel?pmentcenter
Leg I?roject.alS()'supports researchanddevel.opment of
Accreditation: NointormatiM provided
IOwer':'lirTltl~~Os~, education of health care
Licensin:g{6'eFtiffca:tion: Not applicable
professionals.conceming exercise therapy
""',

@l

63.01

FES Application:
Cardiovascular exercise
Bicycle ergometry
Description: Use of concentric and isokinetic lower
I~mb cyclin~, by itself, or in concert with voluntary upper
11mb exercise (usually arm cranking or wheelchair
propulsion) for the improvement of cardiovascular
fitness and general health. As experimental research
we follow WHO guidelines with WHO monitoring via
institutional ethics committee.
History: Availability since 1989; 68 total individuals;
capacity of 6 participants per week.
Status: Experimental research
Candidate Description:
Spinal cord injury
Cervical: Motor: C7 (incomplete.) / Sensory: T1
Thoracic: Motor: T4/ Sensory: T1
Lumbar: Motor: all levels / Sensory: varies
Paraplegia
Tetraplegia/ Quadriplegia
Time elapsed post-injury/onset: 1 year

-- -'-

','

Restrictions/ Contraindications: Restricted by age


(see above); restricted by neuromuscular efficacy
response to NMES/FES. Contraindicated by
osteoporosis and recent or poorly-healed fractures
(determined by planar x-rays); contraindicated for
some other conditions.
Treatment course:
Evaluation/ assessment - usually 4 weeks of
assessment
Training - minimum 12 weeks (normal billing period) to
6 months (variable with payment method)
Approximate number of visits required in total: 36
(minimum course)
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: $1,000-$5,000
3rd party payers typically cover: No costs
Type of equipment: Home use stimUlator; FDA
approved stimUlator; Not FDA approved stimulator;
Research prototype stimulator;
Transcutaneous/surface electrode( s)
Availability of equipment: No charge

132

FES RESOURCE GUIDE

AUSTRALIA

63.02

FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Controlling spasticity
Description: Use of concentric and isokinetic lower
I~mb cyclin~, by itself, or in concert with voluntary upper
11mb exercise (usually arm cranking or wheelchair
propulsion) for the improvement of cardiovascular
fitness and general health. As experimental research
we follow WHO guidelines with WHO monitoring via
institutional ethics committee.
History: Availability since 1989; 16 total individuals;
capacity of 3 participants per week.
Status: Experimental research
Candidate Description:
Spinal cord injury
Cervical: Motor: C7 (incomplete) I Sensory: T1
Thoracic: Motor: T4/ Sensory: T1
Lumbar: Motor: all levels / Sensory: varies
Paraplegia
Tetraplegia! Quadriplegia

63.03

FES Application:
Lower limb movement
Stepping and walking
Standing / transfer assistance
Description: Use of concentric and isokinetic lower
I~mb cyclin~, by itself, or in concert with voluntary upper
11mb exercise (usually arm cranking or wheelchair
propulsion) for the improvement of cardiovascular
fitness and general health. Offered as an in-patient and
out-patient clinical service. As experimental research
we follow WHO guidelines with WHO monitoring via
institutional ethics committee.
History: Availability since 1994; 5 total individuals;
capacity of 5 partiCipants per week.
Status: Clinical service; Experimental research
Candidate Description:
Spinal cord injury
Cervical: Motor: C7 (incomplete) / Sensory: T1
Thoracic: Motor: T10 / Sensory: T8.
Lumbar: Motor: L2 I Sensory: varies
Paraplegia

Time elapsed post-injury/onset: 2 months


Restrictionsl Contraindications: Restricted by age
(see above); restricted by neuromuscular efficacy
response to NMES/FES. Contraindicated by
osteoporosis and recent or poorly-healed fractures
(determined by planar x-rays); contraindicated for
some other conditions.
Treatment course:
Evaluation/ assessment - usually 2 weeks of
assessment
Training - usually 10 weeks
Approximate number of visits required in total: 30
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: Less than $1,000
3rd party payers typically cover: Some costs
Type of eqUipment: Home use stimUlator; FDA
approved stimUlator; Not FDA approved stimulator;
Research prototype stimUlator;
Transcutaneous/surface electrode(s)
Availability of equipment: No charge

--
-----

Tetraplegia/ Quadriplegia
Time elapsed post-injury/onset: 1 year
Restrictionsl Contraindications: Restricted by age
(see above); restricted by neuromuscular efficacy
response to NMES/FES. Contraindicated by
osteoporosiS and recent or poorly-healed fractures
(determined by planar x-rays); contraindicated for
some other conditions.
Treatment course:
Evaluation/ assessment - usually 2 weeks of
assessment
Pre-implementation therapy/treatment - 12 weeks
Training - minimum 14 weeks
Post-implementation therapy/treatment - 14 weeks
Maintenance / check-ups - as needed
Approximate number of visits required in total: = 60
Requires evaluation at this facility? No
Requires local lodging? Yes
Typical cost: $5,000-$10,000
3rd party payers typically cover: No costs
Type of equipment: Research prototype stimulator;
Transcutaneous/surface electrode(s)
Availability of equipment: No charge

---

WHERE TO GET FES

133
AUSTRALIA I AUSTRIA

Sj~oo
R~fortitidnOf,,;

p and Release UsinJl Inftmnationavailable: pnntedanGlVideofape.format

floors: NOinformatiol'l provided


Location ofhfv~s:Serviceproviderslocation
RoyaINort"~l1ore.HosP~I(SPinallnjUries .Unitand
. . .. AccesSibility: Wl'ieeiOhairaccessible, il'lct,bathroomsi
Biamed i
. ..9;';"

HandicappedpaoongavaUable; Near accessible public


PaCifiC Highway .. . . t(!dnaros

transport
Sydney ~SW2(je2

Populationsserv~NO' restrictions
.AUS1;"'All~> . .~.

Areuservetl:Ausualia
Tel:02~92~7226

Referral required? No
FAX:02:.906..1685e"MitU:
lJillinginfo:.NO charge
trsb@cortex~physiol.su.oz.ati
Payment methods:NQihformatlonprovided
Director:l3r,~TI'imScott; Dr. James Middleton
Type Of facilitY: privately supported; Inpatient facility;
ContacfPerson:Or. TirnScott; Dr. James Middleton
Outpatient faciliJM; College I University. program;
Program OeScription;.~esearch investigatiOnsofthe
Hospital; Rehabilitation center
applications offunCtional electricalstimulationt9the
Accreditation: No information provided
upper eXtremity.
Licensing/C~rtification; Not applicable

FE~

................... /. . . . . .........

. ' .. .

~ 64.01
FES Application:
Upper limb movement
Grasping
Description: Investigations are being made into new
configurations of hand grasp and release and the uses
of control of these.
History: This is a new research program.
Status: Experimental research; Feasibility study
Candidate Description:
Spinal cord injury
Cervical: C5 I weak C6
Tetraplegia/ Quadriplegia
Time elapsed post-injury/onset: 1 year

Restrictionsl Contralndications: Need enough


electrically stimulatable muscles for hand grasp and
release, stable health and skin condition, social
requirements and support.
Treatment course:
under development, not available at this time
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: No information provided
3rd party payers typically cover: No costs; research
Type of equipment: Clinic use stimulator; Research
prototype stimUlator; Transcutaneous/surface
electrode(s); Implanted electrode(s)
Availability of equipment: No charge

AUSTRIA

~ 65.00
Electrostimulation/Electromodulationjnthe
Re-education of Bladder-dysfunction
University Hospitals
Neuro-Urology Unit, Department of Urology
35 AnichstrtaBe
Innsbruck A-6020
AUSTRIA
TolI::free:
Tel! 0..512-'504",,2010
FAx:.loCO~512-504-2017
E:.Mail:
Dlrector.;Prot: Dr. H. Madersbacher, Urological
Surgeon
Contact:Person: Prof. Dr. H..Madersbacher,
UtologicalSurgeon
Program Description: This unilprovides for persons
with lowe('tractdysfunction (1) intravesical
elec;trostifnuiation,(2) transcu.taneous electrical
stimUlatiOn oUheN/pudendtls\\ (3) electrostijnulationof
the pelvic floor, (4)anteriorsacral root stimulation by

implanted stimulator (Brindley) and (5) direct


stimulation of the sacral nerves (Schmidt/Tanagho)
according to the individual needs of the person:
Information available: Printed format; Videotape
format
..
Hours: 8:00 AM to 5:00 PM, Monday,.. Friday
Location ofselVlces:No information provided
Accessibility: Wheelcha.ll!accessible, inctbathrooms; .
...
Handicapped parking avaltable
PopulatiOns served: No restrictions
Areas seIVed: Unlimited
Referra1 required~ Yes From: Physician
.
Billing info: Within the "social security" or privately.
.
Payment methods: Will bill Insurance
Type of facility: State agency; County agency; Non
profit; Inpatient facility; Outpatient faCility; College /
University program; Hospital
Accreditation: No information provfded
licensing/Certification: Not applicable

134

FES RESOURCE GUIDE

AUSTRIA

65.01

FES Application:
Bladder control
Bowel control
Sexual function
Description: 1.) Intravesical electrostimulation of
bladder; 2.) transcutaneous electrostimulation of the
perineal nerve combined with biofeedback; 3.)
transrectal electroejaculation; 4.) transvaginal pelvic
floor re-education; 5.) anterior sacral root bladder
stimulation (Brindley); 6.) sacral root stimulation
(Schmi?t). Applications can include bladder emptying,
controlling bladder incontinence, bowel emptying,
contrOlling bowel incontinence, and erection /
electroejaculation.
History: Intravesicular electrostimulation since 1978
peri~her~1 nerve stimulation since 1985; Brindley ,
deVice since 1985; transrectal since 1974.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury

ViennaWo
University of
Department of BtornedicalEilgineerfng:andRhysies
AKHEbene 4/L
Waehringerguertel18-20
Vienna A;.1 097
AUSTRIA
Te~: 0043-1-40400'-1984 (secretary)
Toll-"fte&:.
FAX: 0043440400-3988
EMall:
m:9ijak@bmtp.akh-wien.ac.at
Director: Univ. Prof. Herwig Yhoma,.Ph.D.
ContactPerson: H. Thoma;A!1.Bljak
Ptograr:n Description:The~$rmaWorking6r.o!'Jp
FES ~dlrectors H. ThomaandJ.Holle -isYactivein
phrenic nerve pacing since 1973. Carrousel
stimulation (aSPS 330.342/75) viitepil'!~ural
electrodes has.been clinicafly,ijsedinipijrenfcnEaf!'\ie
stimulation via{externallycontmned~hanf:\elttr!~nts
aSiwen:~sfor stimulation of 1~;~re~1<jn
persons with paraplegia (since 1982),. The~enna
Working GrOup FESis leading inmul~annel FES
implants: (1) externally controlled 8-cnanneLsystemin
the European market since 1983 (2) externally
controlled>2O-Channelsystem tested in animal studies

--

Restrictionsl Contraindications: For intravesicular


peripheral nerve stimulation (including
biofeedback) only persons with incomplete lesions are
suitable; for the Brindley device only persons with
complete lesions (with some exceptions) are suitable.
Treatment course:
Evaluation/ assessment
Pre-implementation therapyltreatment
Inpatient surgical procedure(s)
Inpatient fitting/implementation
Maintenance / check-ups
This is different for each of the available procedures.
Requires evaluation at this facility? Yes; Preferably,
but not necessarily
Requires local lodging? No
Typical cost: No information provided
3rd party payers typically cover: All costs
Type of equipment: Not FDA approved stimulator;
Transcutaneous/surface electrode(s); Implanted
electrode( s)
Availability of equipment: Purchase
a~d

for cumulative> 4,5 year$H~)ift/ny implantable


externally programmable 8-cHarmel irnplant (first
animal stUdies}.
Information;8val'able: Printed f6ni1at; Videotape
format; Languages other than English - German
Hours: 10:00 AMto4:00 PM, Monday - Friday
Location Of'services: Consumer's residence' Service
providerslocatioli
.
Acc~sibility: WheelchairaccessiOie,incl. bathrooms;
Handicapped parking available; Near'accessltilepubtic
transport
PopulatiOt1&!fierved: No restrictions; Infant- (>6 kg
bodyweignt)
Areas served!cEurope
Referral required? Yes From: Physician
BiUing info: Varieswith ability to pay~and program
Payment methods! PaymenLPlan Option; Win bill
Insurance
Type,of facility: Privately/supportedi Publicly
sUPPO~ed; State agency; For profit;lnpatienlfaCility;
Outpatient faCility; College I UnhlersityprQgmrn;
. Consultant IPrivatepractice;>H.ospital; RehaDilitat10n
program; Research &developmenlcenter
Accreditation: No information provided
LicensinglCettification:Not appl1cabte,
t

.....
WHERE TO GET FES

135
AUSTRIA! BELGIUM

66.01

FES Application:
Lower limb movement
Stepping and walking
Description: Two 8-channel implants (+16 channels)
are used for extension of knee and hip joints (4
electrodes for each nerve). The implants are externally
controlled and RF powered. The participant adjusts the
stimulation mode (standing up - walking - sitting down)
and gait by switches which are integrated in one of the
two forearm crutches.
History: Since 19821834 participants - have been
implanted
Status: Experimental research
Candidate Description:
Spinal cord injury
Thoracic: Motor: T3-12 / Sensory: open
Paraplegia
l1

Restrictionsl Contraindications: At the moment a


high level of selection of participants in respect of
health and motivation are necessary.
Treatment course:
Evaluation! assessment - selection, neuromusc. status
Inpatient fittinglimplementation - train of muscle strngth
Outpatient fittinglimplementation - train at home
Maintenance / check-ups - 4 per year
Approximate number of visits required in total: 10
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: More than $20,000
3rd party payers typically cover: No costs
Type of equipment: Home use stimulator; Research
prototype stimulator; Implanted electrode(s)
Availability of equipment: Purchase

66.02

FES Application:
Respiratory treatments
Phrenic Pacemaker
Description: Externally controlled 8-channel implant
with epineural electrodes, implantation of electrodes
either inside the chest or in the neck area. Normal or
hyper ventilation of both lungs for 24 hours a day is
possible. Closure of trachesotoma. Clinical service
according to TUEV (Europe).
History: 1 operation 1981, commercialized 1983, 30
participants, operation service free in Europe,
rehabilitation strategy essential for good results
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: CO-3! Sensory: open
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: any time post inju~

Restrictionsl Contraindications: Autoaggression,


<6kg body weight, possibility of rehabilitation
Treatment course:
Evaluation! assessment - 1 day
Pre-implementation therapy/treatment - auxiliary
breathing if possible
Inpatient fitting/implementation - adjustment for up to 3
months
Post-implementation therapyltreatment - general
Maintenance / check-ups - 2 each year
Approximate number of visits required in total: 4
Requires evaluation at this faCility? No
Requires local lodging? No
Typical cost: More than $20,000
3rd party payers typically cover: Some costs
Type of equipment: Home use stimulator; Not FDA
approved stimUlator; Implanted electrode(s)
Availability of equipment: Purchase

BELGIUM

L.::J

67.00

Phrenic Stimulati()n,~Handmastel!lJnit and


ElectroejaculationCenter'.for Motor
Rehabilitation

u.z. Pellenberg
Weligerveld1
LubbeekB"'-3212
BELGIUM
Tel: 32":16-338700
TolIfree:
FAX: 32-16-338703
EMail:
Director: Dr. CarlotteKiekens, MD
ContactPerson~Dr. Carlotte Kiekens,MD
Program Descrlption: Phrenic nerve pacemaker
(Atrotectl(R; Gli~ical trial with superficial FES
(Handmaster,NESS) in . persons with stroke and SCI;
Rectal probe' electrostimulation ~Seager).

Information available: No information provided


Hours: No information provided
Location . of services: Noinforrnationprovided
Accessibility: Wheelchairaccessible. ineL bathrooms;
Handicapped parking available
Populations served: Aged (age 65 or older); Ad.ult
(age>16 to 65)
Areas served: No information provided
Referral required? No
BilUnginfo: No.fnformation provided
Payment methods! NO information provided
Typ&of facility: Non-profit; Inpatientfa~ility; eollege I
University program; Rehabilitation center
Accreditation: No information provided
LicensinglCertification: Notapplicable . .

...... ---

---------------------136

FES RESOURCE GUIDE

BELGIUM

~ 67.01
FES Application:
Upper limb movement
Grasping
Description: Handmaster superficial FES device
NESS (R), Israel. Clinical trial for Dr. Weingarden
History: 1 person with tetraplegia; 2 persons with
hemiplegia; in use for about 6 months.
Status: Experimental research; Multi-center clinical
trial
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-6
ASIA Intemationallmpairment Scale: A, B
Hemiplegia

Tetraplegia/ Quadriplegia
Restrictions/ Contra indications: No info. provided
Treatment course:
Evaluation! assessment - 1 time
Inpatient fitting/implementation - outpatient possible
Training - 3 - 5 times a week for 3 months
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: No information provided
3rd party payers typically cover: No information
provided
Type of equipment: Home use stimulator; Not FDA
approved stimulator
Availability of eqUipment: No charge

67 .02
FES Application:
Respiratory treatments
Breathing assistance
Description: Diaphragm pacemaker through bilateral
phrenic nerve stimulation.
History: Available since 1994, one individual
successfully treated (24 hour stimulation) using
Atrotech (R) stimulator.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C2
Tetraplegia/ Quadriplegia
Time elapsed post-injury/onset: 6 months

Restrictions/ Contraindications: No info. provided


Treatment course:
Evaluation/ assessment - monthly for 2 - 3 months
Inpatient surgical procedure(s) - electrode implantation
Inpatient fitting/implementation - progressive
stimulation over 7 months
Training - several months to one year
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: More than $20,000
3rd party payers typically cover: Some costs
Type of equipment: Home use stimulator; FDA
approved stimulator; Implanted electrode(s)
Availability of equipment: Purchase

~ 67.03
FES Application:
Sensory aids
Electroejaculation
Description: Rectal probe electrostimulation with
Seager device for electro-ejaculation.
History: Available for three years. About 15 individuals
treated.
Status: Clinical service
Candidate Description:
Spinal cord injury
Paraplegia
T etraplegial Quadriplegia
Time elapsed post-injury/onset: any time post injury

--

Restrictions! Contraindications: If sensibility spared


anesthesia is needed. If susceptible to autonomic
dysreflexia, use medication.
Treatment course:
Evaluation/ assessment 1 time
Outpatient fitting/implementation
Requires evaluation at this facility? Yes
Requires local lodging? No information provided
Typical cost: No information provided
3rd party payers typically cover: No info. provided
Type of equipment: Clinic use stimUlator; Not FDA
approved stimulator
Availability of eqUipment: No charge; pay only for the
consultation

WHERE TO GET FES

!]
68.01
FES Application:
Lower limb movement
Stepping and walking
Description: Portable, microcontrolled "N" channel
(4,8 or 16 channels) surface stimulation towards
restoring gait. Artificial neural networks and sensor
based strategies (strain gauge, FSRs, EMG, etc.).
History: Available as an experimental as well as
clinical set-up since January 1989.
Status: Experimental research
Candidate Description:
Spinal cord injury
Cervical: Sensory: C3-8
Thoracic: Sensory: T1-11
Hemiplegia
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 1 year

!]
68.02
FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Description: Experimental trials on triggering spinal
cord capability of controlling movement: repetition of
gait characteristics through neuromuscular electrical
stimulation training.
History: Research and development for 7 years, about
300 persons treated.
Status: Experimental research
Candidate Description:
Spinal cord injury
Cervical: Sensory: C3-8
Thoracic: Sensory: T1-11
Hemiplegia
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 1 year

137

Restrictionsl Contraindications: High degree of


osteoporoSiS, cardiovascular deficits, etc.
Treatment course:
Evaluation/ assessment - 1 week
Pre-implementation therapy/treatment - 1 week
Inpatient fitting/implementation - 2-3 times a week
Outpatient fitting/implementation - 2-3 times a week
Training - 2 times a week
Approximate number of visits required in total: 2 times
a week for as long as necessary
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: $5,000-$10,000
3rd party payers typically cover: No costs
Type of equipment: Clinic use stimulator; Home use
stimulator; Research prototype stimulator;
Transcutaneous/surface electrode(s)
Availability of equipment: No charge

Restrictionsl Contraindications: Those that apply to


any use of neuromuscular electrical stimulation
(cardiovascular deficits; osteoporosis; excessive
spasticity, etc.).
Treatment course:
Evaluation/ assessment - 4 weeks
Inpatient fitting/implementation - 3x1 week for a month
Outpatient fitting/implementation - 3x1 week for a month
Post-implementation therapy/treatment - 2 timeslweek
Approximate number of visits required in total: close to
a couple of years
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $5,000-$10,000
3rd party payers typically cover: No costs
Type of equipment: Home use stimulator; Research
prototype stimulator; Transcutaneous/surface
electrode(s}
Availability of equipment: No charge

138

FES RESOURCE GUIDE

BRAZIL

68.03

FES Application:
Sensory aids
Sensation / feedback
Description: Artificial proprioception: Eletrotactile
stimulation -electrode matrices and phi phenomena.
History: This has been available for 2 years; 5
individuals have participated.
Status: Experimental research
Candidate Description:
Spinal cord injury
Cervical: Sensory: C5
Thoracic
Lumbar
Sacral
Hemiplegia
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 1 year

68.04

FES Application:
Upper limb movement
Grasping
Description: Microcomputer controlled stimulation (5-6
channels) for C4 - C6 tetraplegics. Control via open
loop, finger sensors and neural networks for voice
activation system; instrumented glove for tetraplegics.
History: Available for 7 years; 20 participants.
Status: Experimental research
Candidate Description:
Spinal cord injury
Cervical: Sensory: C4
Tetraplegia! Quadriplegia
Restrictions! Contraindications: All general to
~Iectrical stimulation. No de nervation of upper limbs.

@
69.00
FES for Spinal Cord Injured Patients
HospitalDas Clinicas DaFaculdade de Medicina
Rua diderot, 43
Sao Paulo 04116-030
BRAZIL
Tel: 55;;-011-549"!.0111
Toll-free:
FAX.55-011..s49..0556 e"lIall:
Director: LinamaraRizzo Battistella.MD:; Ph.D.
Contact Person: Silvia Mazzali Souza; Luis Henrique
Cuzziol; Claudete Lourenco
Program Description: FESprograms started in 1989.
Our program is based on the l:jubljana tecfJl1ology yet
now has been improved with mixed methods.
Infotmattonavailable: Printed format; Languages
other than English - Portuguese

-
--

Restrictionsl Contraindications: Persons must have


sensation preserved above the level of lesion: cognitive
capabilities must be intact.
Treatment course:
Evaluation/ assessment - 3 days
Inpatient fitting/implementation - 1 week
Training - 3 times a week for 8 weeks
Approximate number of visits required in total: 66
Requires evaluation at this facility? No
Requires local lodging? Yes
Typical cost: $1,000-$5.000
3rd party payers typically cover: No costs
Type of equipment: Clinic use stimulator; Research
prototype stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: No charge

Treatment course:
Evaluation/ assessment - 1 week
Pre-implementation therapy/treatment - 1 week
Outpatient fitting/implementation - 2 times/wk for 2 wks
Training - 2 times a week for 2 months
Approximate number of visits required in total: at least
one year (100)
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: $5.000-$10,000
3rd party payers typically cover: No costs
Type of equipment: Clinic use stimUlator; Research
prototype stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: No charge; research
device

Hours: 8:00 AMto6:00PM, Sunday - Friday.


Location of serv1ces: servicellroviderslocation
Accessibility: Wheelchairaooessible, ihd.bathrootns;
Handicapped parking available?Near accessible/public
transport
Populations served: No restrictions
. Areas served: Brazil
Referral required? No
Billing info: No charge
Paymentrnethods;Nb informaijonprovided
Type of facility: Publiclysupportedf State agency;
Non-profit;.. ColJege'IUniversityprograrn~<;Reh~bilitatl()n
center; Rehabilitatidnprogram; Research &
development center'
Accreditation: Noinfbrmation provided
Licensing/CertificatiOn; Not applicable

--

---

WHERE TO GET FES

139
BRAZIL

69.01

Hemiplegia
Paraplegia
Tetraplegia! Quadriplegia
Restrictions/ Contraindications: No info. provided
Treatment course:
No information provided
Requires evaluation at this facility? Yes; By
physiatrist
Requires local lodging? No; Outpatient treatment 2
3 times per week
Typical cost: No information provided
3rd party payers typically cover: No information
provided
Type of equipment: Clinic use stimUlator; Home use
stimulator; FDA approved stimulator;
Transcutaneous/surface electrode(s)
Availability of equipment: No information provided

FES Application:
Circulatory/Skin treatments
Upper limb movement
Neuromuscular treatments
Orthopaedic treatments
Sensory aids
Description: Use of FES in clinical treatment as
support of the Rehabilitation Program. (These can
inclu?~ grasping, reaching, controlling spasticity,
regaining voluntary function, enhancing neural
regeneration, preventing/treating pressure sores,
preventing/treating contractu res, sensation and
feedback.)
History: No information provided
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury

tt~Y" 70;iOO.
\~~~;f()tf$Ri,oJI'Cord/lftjJjl!ed;'Patienm+".,

"

"

'~Bi6medtlinengrtieeririg:LabOr~tpry .. Polyt~chnical
/l~ool~;,ySP\?ivisao!D95ReaBlttamao. Hospfttal D~f

cFaculdadi!de'"Medicina Av. Prof. Luciano GualBerto


travessa 3, No; 158 ,
'
,Sa,oPaUIQ05Bba-900:J : '
"BRAziL"
'Tet: 55l Df1'#818-5718 Toll';Jree:
'FAX: 55;.;011;:81g;l5718 e..Mail: tbm@doc.poli.usp.br
Director: Jose Carols'TeixeitaCftfBarrosMoraes,
,Ph.D.
Contact Person: RogerioQuiarim''zarza
Program Oescription::FESprograms started in 1989.
Our program'is basedontheljubljana technology yet
now has been improved with mixed methods;
Information available: Printed format; Languages

70.01

FES Application:
Lower limb movement
Stepping and walking
Description: Provides stepping and walking
assistance.
History: Available for 5 years; 30 individuals treated;
capacity of 10 persons per year.
Status: Experimental research
Candidate Description:
Spinal cord injury
Cervical: Motor: C7 / Sensory: indifferent
Thoracic: Motor: T1-10 / Sensory: indifferent
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: varies

other than English - Portuguese


Hours: 8:00'AM to 6:00 PM, Sunday - Friday. . '
Location,of;sel'Vices: Service providers location
Accessibility:'Wheelchairaccessible;ril1cl. bathtboms;
Handicapped parking available; Neapsccesslblepublic
transport
Pophlations~served: No restrictionsi~
Areas served:, Braiil
'
Referral required? No
BiliinginJo:No charge
Payment methods: No information provided
Type of facility: Publicfy.supported; State agency;..
Non-profit; College f University program;' RehabilitatiOn
center; Rehabilitation program; Research &
development center
Accreditation: No information provided
Licensing/Certification: Not applicable

Restrictions! Contraindications: Limited range of


motion of lower limbs, flaccid paralysis, dysreflexia
related to FES, intolerable painful sensation with FES.
Treatment course:
Protocol form in development.
Requires evaluation at this facility? Yes; By
physiatrist at the Rehabilitation Center
Requires local lodging? No; 2 - 3 times per week
visits in the Rehabilitation Center are enough
Typical cost: No information provided
3rd party payers typically cover: No info. provided
Type of equipment: Clinic use stimulator; Home use
stimUlator; Research prototype stimUlator;
Transcutaneous/surface electrode(s)
Availability of equipment: No charge

140

FES RESOURCE GUIDE

BRAZIL / CANADA
~

70.02

FES Application:
Lower limb movement
Standing / transfer assistance
Description: Provides standing / transfer assistance.
History: Available for 5 years; 30 individuals treated;
capacity of 10 persons per year.
Status: Experimental research
Candidate Description:
Spinal cord injury
Cervical: Motor: C7 I Sensory: indifferent
Thoracic: Motor: T1-10 I Sensory: indifferent
Paraplegia
Tetraplegia/ Quadriplegia
Time elapsed post-injury/onset: varies

Restrictionsl Contraindications: Limited range of


motion of lower limbs, flaccid paralysis, dysreflexia
related to FES, intolerable painful sensation with FES.
Treatment course:
Protocol form in development.
Requires evaluation at this facility? Yes; By
physiatrist at the Rehabilitation Center
Requires local lodging? No; 2 - 3 times per week
visits in the Rehabilitation Center are enough
Typical cost: No information provided
3rd party payers typically cover: No info. provided
Type of equipment: Clinic use stimulator; Home use
stimulator; Research prototype stimulator;
Transcutaneous/surface electrode(s)
Availability of equipment: No charge

CANADA
~71

.00

Division of Neuroscience
University of Alberta
513 Heritage Medical Research Centre
University of Alberta
Edmonton Alberta T6G 252
CANABA
Totl..free:
Tel:403'-4~2-5t4S
FAX:4Q3-492-1617
S.MaU:
Olre.ctor: RiChard Stein
ContacfPer.son: Marguerite Wieler
Program De.cription: W'e;'liavebeen. doing research
with FESih Edmol1tonfor 9 years. Weare currently
running amulti'-Centl'eclinicaltrial using simple 1-4
channel surface stimulators to assessFES ahd the
changes in walking in persons with Incomplete 'Spinal
cord injury. [Division of NeUroscience, Edmonton; G:F.
Strong, Vancouver; Lyndhurst Spinal Cord Centre,
Toronto; University of MCGill, Montreal.] Edmonton is
also investi atin other s stems, includin anei ht
~

'H"

channelstimulatoranct:aself-contaitied,si~gJe channel
stimulator.andmoresoHhi~ticated:pontr61.strategies
than srmpleswi~hesandisenso'P"

Inforrnationaviilable:'.i?rint
Houl'f.t 8:30Af\I1 to 6:00
MRnda~7,Ffiday
Locationof~tvjc.,!'~~eiVice;BrC!ll"idersi~fi()n

P:IYI{ . . .

Accessjbility;Vheelcnair~ccessitJle,incl.bathroomsi ;.

ca

Handi l?pedparkingllvsilable;Near:accessible;:public
transport
PopulationS.'s.~J'Ve<J:;No restr:ictiorns
Areas s~ed:.xtanColJver; Torohto;Montfeal.

R..ferralreq..-irelt?;No
Billing'ffnfo:No cMrge
Paymentme~h(Jds:.No informatfonprovided
Type of faci.lity.Publ~1y supported; Canadian MRC
and AHFMR; Research & development center
Accreditation. No. information.provlded
LicensihgfCertification: Not applicable

71.01

FES Application:
Upper limb movement
Grasping
Description: Bionic Glove: Self-adhesive surface
electrodes are placed on two to four positions on
forearm and hand. A
self-contained garment (the Bionic Glove) makes
automatic contact with the electrodes and delivers
hand-opening and pinch grip stimulation based on wrist
movement.
History: 5 years development, 35 users by April 1995
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Cervical: Motor: C4-7
Hemiplegia
Tetraplegial Quadriplegia
Time elapsed post-injury/onset: 3 months

Restrictions/ Contraindications: No info. provided


Treatment course:
Evaluation/ assessment - 1 hour
Inpatient fitting/implementation - 2 hours a week for 6
weeks OR
Outpatient fitting/implementation - 2 hrslwk for 6 wks
Training
Post-implementation therapy/treatment - 1x I mo -1 st yr
Maintenance / check-ups - every six mos after the first
year Approximate number of visits required in total: 18
in the first year, then twice a year.
Requires evaluation at this facility? No; Distribution
being arranged at major rehabilitation centers
Requires local lodging? No; Distribution being
arranged at major rehabilitation centers
Typical cost: $1,000-$5,000
3rd party payers typically cover: Some costs; under
discussion
Type of equipment: Home use stimulator
Availability of equipment: Purchase

WHERE TO GET FES

141
CANADA

71 .02

FES Application:
Neuromuscular treatments
Controlling tremor
Description: Tremor attenuation system: we have
designed and evaluated both an analog and a digital
FES controller which attenuates tremor by stimulating
muscles in a syncopated manner. Slow voluntary
movements are unaffected. The device is being
implemented in a version of the Bionic Glove.
History: In progress since 1992
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Multiple sclerosis
Other spinal disorder: essential tremor, Parkinson's
disease
]

Restrictionsl Contraindications: Depression,


Circulatory problems, heart disease
Treatment course:
Evaluation/ assessment - 30 minutes
Inpatient fitting/implementation - 2 hours
Approximate number of visits required in total: 2
Requires evaluation at this facility? Yes; Still at
experimental stage
Requires local lodging? Yes
Typical cost: Less than $1,000
3rd party payers typically cover: No costs
Type of equipment: Clinic use stimulator; Research
prototype stimUlator; Transcutaneous/surface
electrode(s)
Availability of equipment: No charge; research study

71 .03

FES Application:
Lower limb movement
Stepping and walking
Description: FES systems have been built in
Edmonton and are CSA approved. They have 1-4
channels of stim. and can be controlled by hand / foot
switches, sensors or by computer. Most use surface
electrodes, a few use percutaneous wire electrodes.
History: We have been using FES for 9 years to
address gait problems. Our main focus is with those
with incomplete SCI. The multi-centre trial has allowed
Canadians to access simple surface systems.
Status: Experimental research; Feasibility study
Candidate Description:
Spinal cord injury
Cervical
Thoracic
ASIA International Impairment Scale: D
Paraplegia
Tetraplegia/ Quadriplegia
Hemiplegia
Restrictionsl Contraindications: Inclusion criteria
no lower motor neuron lesion, able to go from sit to
~
72.00
.
Therapeutic Electrical Stimulation

Magee Clinic / Mayatek Medical


5160Yonge Street, Suite 505
North York Ontario M2N 6L9
CANADA
Tel: 416,;.733-1783
Toll-free: 800-742-8173
FAX: 416-733-1721
E-Mail:
Director: Or. Karen Pape; Dr. Sarah C. Muttitt
Contact Person: Dr. Karen Pape; Dr. sarah C. Muttitt
Program'Description: The program offers a home
based treatment program using a portable, battery run
neuromuscular stimulator for treatment of disuse
muscle atrophya$sociatedWith neurological disorders.
Information available: Printed format; Videotape
format
Hours: 9:00AM to 5:00 PM, Monday - Friday
Location of services: Service providers location;

stand, walking for short distances or near threshold for


walking, gait deficits that can be addressed with
surface FES, realistic expectations. Exclusion criteria
walking speed less than 1 meter/sec., unstable medical
condition, severe spasms, joint contractu res , cognitive
impairment or osteoporosis.
Treatment course:
Evaluation/ assessment - 2 times
Pre-implementation treatment - depends on status
Outpatient implementation - 2x1week for 2-3 weeks
Training - as required
Maintenance / check-ups - as required
Approximate number of visits required in total: about 10
Requires evaluation at this facility? Yes; Or at a
designated trial centre: Toronto, Montreal or Vancouver
Requires local lodging? No; Dependent upon
individual needs, etc.
Typical cost: No information provided
3rd party payers typically cover: No costs; research
Type of equipment: Clinic use stimUlator; Research
prototype stimUlator; Transcutaneous/surface
electrode(s)
Availability of equipment: No charge

Consumer's residence
Accessibility: Wheelchair accessible, incl. bathrooms;
Handicapped parking available; Near accessible public
transport; Accessible hotel nearby
Populations served: Aged (age 65 or older); Adu!t,
(age 16 to 65); Child (up to age 16); Preschool, at feast
2 years old; School age; Adolescent
Areas served: Unlimited
Referral required? Yes From: Physician
Billing info: Fixed rates
Payment methods: Cash; Charge/Credit Card
Type of facility: Privately supported; Fofprofit;
Outpatient facility; Consultant / Private practice;
Research & development center
Accreditation: No information provided
LicenSing/Certification: Not applicable

....

142

FES RESOURCE GUIDE

CANADA

ll

72.01

FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Description: Therapeutic Electrical Stimulation (TES)
involves the use of night-time, low-level stimulation to
treat disuse atrophy of muscle. Following evaluation
and determination of functional goals, the client is
instructed in the use of the neuromuscular stimulator
and appropriate placement of the electrodes for on
going home-based TES therapy.
History: Available since 1989. It is also available in
Grand Rapids, MI (Dr. Chester Hoyt 616-458-1088).
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical
Thoracic
Lumbar
Sacral
Hemiplegia
Paraplegia
TetrapleQia! Quadriplegia

. 73.00
Urology Division
The Toronto Hospital- Western Division
399 BathurstStreet, M.P. 8-320
Toronto Ontario M5T 2S8
CANADA
Tel: 416-603-5018
Toll-free:
FAX: 4164303-1961
E-Mail:
Director: Magaly M. Hassouna,M:,[);, Ph.D.
ContadPerson: M. Hassouna, M:tl, Ph.D.
Program Description: Sacral Neurostim for voiding in
persons with voiding dysfunction -neurogenic and
functional. Electroejaculation for infertile men (SCI.)
Information available: Printed format; Languages
other than English-French
Hours:No information rovided

Time elapsed post-injury/onset: after acute rehab.


Other spinal disorder: Guillain Barre, Polio
Restrictions/ Contra indications: Need some residual
motor function, MRC muscle scale 2/5 or greater;
significant obesity, pacemakers or pregnancy is
contraindicated.
Treatment course:
Evaluation/ assessment - 1-2 hrs, initial visits occur
over a 3 day period.
Training - 1.5 hours
Maintenance / check-ups - 1-2 hours every 6-12
months; follow up visits in 1 day
Other - EMG Biofeedback, therapy, exercise
consultation 2-5 hours as indicated.
Requires evaluation at this facility? Yes
Requires local lodging? No; Home based therapy,
retum to the clinic for follow-up assessments.
Typical cost: $5,000-$10,000
3rd party payers typically cover: Some costs
Type of equipment: Home use stimulator; FDA
approved stimulator; Transcutan.lsurface electrode(s)
Availability of eQuipment: Purchase

Location ofservicQS:Service provia .


Accessibility::Wheelchaitaccessib:bathtoOn1$i
Handicappedparking~vailable; Near aceessiblepu~lic
transport- shuttleoeSes
Populations served: "No restrictions
Areas served: Unlimited
Referralrequirecf?Yes From: Physician
Billing info: Varies.withabllity to pay
Payment methods: Cash; Will bill Insurance; Wilrbill
Medicaid; Will bill Medicare
Type of facility:lnpatienUacility;0utpatientfaclllty.i '
College / University program;/f'losPifal; Research,&
development center
Accreditation: Canadian Hospital'P(ssociation
Licensln ICertification: Nota licabte

--

73.01

FES Application:
Bladder control
Bladder emptying
Bladder incontinence
Description: FES of sacral roots for bladder control.
Neuromodulation of the pelvic floor musculature can
ensure voiding and/or continence in those with severe
frequency, urgency and in urinary retention (non
mechanical obstruction).
History: Since 1985, capacity of 5 per day 5 dys/wk
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: > 6 months
Restrictionsl Contraindications: MS in flare ups

, acute spinal shock phases, dementia


Treatment course:
Evaluation/ assessment - 2 times a week for 4 weeks
Inpatient surgical procedure(s) - for 3 hours
Outpatient surgical procedure(s) - nerve eval- 1 hour
Post-implementation treatment - 1xlwk for 4 wks
Maintenance / check-ups - 1 time every six months
Approximate number of visits required in total: 6 then 1
time every 6 months
Requires evaluation at this facility? Yes; For nerve
testing and surgery
Requires local lodging? No
Typical cost: More than $20,000

3rd party payers typically cover: Some costs;

internal funds from the hospital budget


Type of equipment: Clinic use stimUlator; FDA
approved stimUlator; Implanted electrode(s)
Availability of equipment: Purchase

---

--

WHERE TO GET FES

143
CANADA

73.02
FES Application:
Bladder control
Bladder emptying
Bladder incontinence
Description: FES of sacral roots helps bladder control.
By neuromodulation of the pelvic floor musculature, it is
possible to ensure voiding and/or continence in
persons with severe frequency, urgency and in urinary
retention (non-mechanical obstruction).
History: Since 1985, capacity of 5 patients a day 5
days a week
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Multiple sclerosis
Spinal cord injury
Paraplegia
Tetraplegia/ Quadriplegia
Time elapsed post-injury/onset: > 6 months
[

[
73.03
FES Application:
Sexual function
Electroejaculation
Description: For achieving fertility in persons with
paraplegia/quadriplegia. Transrectal electroejaculation
to retrieve sperm followed by artificial insemination.
History: Available for 6 years - 38 persons have
participated with 3 successful pregnancies.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Cervical
Thoracic

Restrictionsl Contraindications: MS in flare ups,


acute spinal shock phases, dementia
Treatment course:
Evaluation/ assessment - 2 times a week for 4 weeks
Inpatient surgical procedure(s) - for 3 hours
Outpatient surgical procedure(s) - percutaneous nerve
evaluation - 1 hour
Post-implementation treatment - 1xl week for 4 weeks
Maintenance / check-ups - 1 time every six months
Approximate number of visits required in total: 6 then 1
time every 6 months
Requires evaluation at this facility? Yes; For nerve
testing and surgery
Requires local lodging? No
Typical cost: More than $20,000
3rd party payers typically cover: Some costs;
internal funds from the hospital budget
Type of eqUipment: Clinic use stimulator; FDA
approved stimulator; Implanted electrode(s)
Availability of equipment: Purchase

Lumbar
Paraplegia
Tetraplegia/ Quadriplegia
Restrictionsl Contraindications: Rectal anomalies
Treatment course:
Evaluation/ assessment - 1x every 4 wks, for 3-4 times
Approximate number of visits required in total: 5
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: Less than $1,000
3rd party payers typically cover: Some costs;
internal funds from the hospital budget
Type of equipment: Clinic use stimulator; FDA
approved stimulator
Availability of equipment: No information provided

74.00

G.F. Strong~f;~E;,,&::studv
Universi1ofAtberta
Brltish:~fumbia Rehabilitation Society
G. F. Strong Centre
425:5 laurelStreet
VanCouver British ColumbiaN5Z-2G9
CANADA
Tel: 604~737-6237'
Tollfree:
FAX::aO~737-6359
E"Nlail:
DlreetOt;Maura WhtttakerfB.Sc.R.; Dr. Richard Stein
ContactPerson: Maura:Wh:tttaker, B.Sc.R,
I'I'OgramDescriptfon:T
opulatiOfi:" inoomplete
SCI, 1 yearpostinjuryor . of disease, medicalry
stable. Canstand<aoo,pemaps take.a few steps>oslng
aid buHack hiplknee/dorsfflexiontotake a step" ie.
onelegdrags behind. Walklng~ir>eed about or less
than 3 meters a second: Extensor spasticity may
interfere with hi l;<nee flexion: Ind.ividual

has strong desire to walk even an a limited basis.


Inronnatioo;avaiiabl.e:::RrintedfQrmat7:
Hours:3:00>PM to 4;30 PM, Tuesday;;and Wednesday
Locationofiservices: Service providers location
Accessibility: Wheelchairaccessible, incl. bathrooms;
Handicapped parking available; Near accessible "uplic
transport; Lions Easter Seal ..House
Populations served: Adult (age 16 to 65)
Areas served: British Columbia
Referral required? Yes From: Physician .. ifaccepted,
not needed for initial screening
Bil6ng;info: No charge
Payment methods: No information provided
Type of facility: Publicly supported; Federal.agency,;
Non-profit; Inpatient faCility; OlltpatientfacilitY;
Rehabilitation center; Rehsoililation program
Accreditation: No information provided
licensin ICertification: Nota licable

144

Restrictionsl Contraindications: Candidate


restrictions: age, medical problems - heart etc., obesity,
cognitive problems.
Contra indications: osteoporosis, contractu res, poor
balance and upper extremity strength.
Treatment course:
Evaluation/ assessment - 4 times a week for 1 to 2
weeks depending on the severity
Pre-implementation therapy/treatment - 2 times a week
Outpatient fittinglimplementation - 2 times a week
Training - 3x1 wk for 6 to 12 weeks (if living locally)
Maintenance / check-ups - 2 times a week
Subjects if living locally are encouraged to
attend/practice walking on premises.
Approximate number of visits required in total: range:
10 - 30
Requires evaluation at this facility? Yes; Plus initial
training - 1-2 weeks generally
Requires local lodging? No; Can take stim. home
Typical cost: $1,000-$5,000
3rd party payers typically cover: Some costs; for
travel expenses / accommodations only
Type of equipment: Home use stimulator; FDA
approved stimulator; Transcutan./surface electrode(s)
Availability of equipment: No charge; research
device

--

CANADA

74.01

FES Application:
Lower limb movement
Stepping and walking
Description: Stimulation to the flexor withdrawal
response through surface electrodes on the common
peroneal nerve to illicit a stepping action in one or both
legs. Typically subject can stand with a walker or
crutches but walking is extremely slow (less than 3
meters/second). Subject cannot advance legs to take a
step. Incomplete SCI only; 1 - 4 channel stimulators.
History: Feb. 1992 G.F. Strong Physical Therapy
Department expressed interest in being part of a
~anadian multi-centre trial on FES. Oct. '92 accepted
Into the study, received funding. Jan. '93 1st subject.
12 (approximately) subjects - 6 appropriate. Program
capacity - uncertain but seeking participants.
Status: Experimental research; Multi-center clinical
trial
Candidate Description:
Spinal cord injury
Cervical: Motor: C6 / Sensory: Incomplete
Thoracic: Motor: T2-7/ Sensory: Incomplete
Paraplegia
Tetraplegia/ Quadriplegia
ASIA International Impairment Scale: C D
T2 epidural hematoma; transverse myelitis

74.02

FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Description: Therapeutic use in SCI as adjunct to
strengthening program. Commonly applied to muscles
such as wrist extensors, deltoids, biceps, triceps or in
lower extremities - quadriceps. With shortened duration
over weeks, depends on the participant and therapist.
History: No information provided
Status: Clinical service
Candidate Description: No info. provided

75.00

Acute Spinal Cord Injury Unit


Vancouver Hospital and Health Sciences Centre
855 West 12th Ave.
Vancouver British Columbia V6R 3C3
CANADA
Tel: 604-875-5805
Toll-free:
FAX: 604-875-5811
E-Mail:
Director: Hilary Jebson
Contact Person: Hilary Jebson
Program DeSCription: FES is used to re-educate and
strengthen partially innervated muscles of the
extremities(greaterthan grade 3) on an as needed
basis and at the discretion of the therapist.

---

FES RESOURCE GUIDE

-'

Restrictionsl Contraindications: No info. provided


Treatment course:
Inpatient implementation - 4 xlwk for about 1 - 4 wks
Training
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: No information provided
3rd party payers typically cover: No info provided
Type of equipment: No information provided
Availability of equipment: No information provided

Information available: No information provided


Hours: 8:00 AM to 4:00 PM, Monday - Friday
Location of services: Service providers location
Accessibility: Wheelchair accessible, incl. bathrooms
Populations served: Adult (age 16 to 65)
Areas served: No information provided
Referral required? No
Billing info: No charge
Payment methods: No information provided
Type offacility: Publicly supported; State agency;
Inpatient facility; Hospital
Accreditation: No information provided
Licensing/Certification: Not applicable

--

l
WHERE TO GET FES

145
CANADA/DENMARK

75.01

FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Regaining voluntary function
Description: Used for partially innervated muscles
(greater than grade 3) for strengthening and re
education to optimise functional movement.
History: Units have been available for 8+ years.
Separate data is not kept for persons who have been
treated with FES.
Status: Clinical service
Candidate Description:
Spinal cord injury
Paraplegia

Tetraplegia! QUadriplegia
Time elapsed post-injury/onset: acute and early rehab,
0-3 months
Restrictionsl Contraindications: No info. provided
Treatment course:
No information provided
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: No information provided
3rd party payers typically cover: All costs
Type of equipment: Clinic use stimUlator; FDA
approved stimUlator; Transcutaneous/surface
electrode(s)
Availability of eqUipment: No information provided

DENMARK
r::ot" ,> 16'
..

2,~.I.C

forS~hsory-Moto.r~.lnteraction
. activate theparaly:Zedmtl~~. Nerve cUff/electrodes.
Department of Medical Informatics and:lmage AnalysB .. ~te implantedt)n sensory nerves; these;neural
Aalbor:g:"University
recordings.ar;e. proceSsed and: then usedto control
Fteank Bajers Vej 70
stimUlation ofparatyzed mussles.
. . Aalborg9000
Information avail86te:Noinfonnation .provitfea

DENMARK
Hours: No information provided

Tef:45",98158522
Toll-free:
Location ofse~jces: No information provided

,E;:.Mail: ts@miba.auc.dk
Accessibility:N'tfinformation provided.

FAX: 45-98154008
Ditecto~'ThomasSinkjaertPh.D.
Po~ulationsserved~Ad~lfl(age 16 to 65}

Cofitact;'erson: Tho~fSinkjaer,. Ph.D! . .


Are~i~erved:No~il1fo~onprovided

Progtam"DescriptiOn: Thept.llposeofthisresearch is Referraliirequited? No inrormation provided:

to develop'individual. functional,andriliabledevices
Billing info: No information provided
....

(neural prostheses) which are fullyorpttltiallyinvisible


Payment method8'!~No information provided

to the participant. WithinFES research, SMI has


Type of facility: Privately sup~Federaiagency;
developed a technique by which the. information
Non-profit; College / University program

retained in the natural sensory-motor system is used to Accreditation: No information provided

licensing/Certification: Not applicable


~

76.01

FES Application:
Lower limb movement
Stepping and walking
Description: To date three subjects have had nerve
cuff electrodes chronically implanted. Two of these
persons have drop-foot (one has CP the other has
MS). The processed neural signal (obtained from either
the sural or tibial nerve) is used to indicate foot-floor
contact. Indication of foot contact triggers a stimulator
which stimulates the peroneal nerve using surface
electrodes, providing foot dorsiflexion. This system is
portable.
History: This application has been available for 5
years, it was started in 1990. Three persons have
participated, there is a very limited capacity and it is
only experimental research at this time.
Status: Experimental research

Candidate Description:
Spinal cord injury
Multiple sclerosis
Hemiplegia
Tetraplegia! Quadriplegia
Restrictionsl Contraindications: Sensory peripheral
nerves that are used to provide a feedback signal have
to be healthy in a neurophysiological term.
Treatment course: Varies as research is done on a
very limited number of persons.
Requires evaluation at this facility? No; At the
hospital
Requires locallodging1 No
Typical cost: No information provided
3rd party payers typically cover: No info. provided
Type of equipment: Research prototype stimulator;
Implanted electrode(s); Transcutaneous/surface
electrode(s)
Availability of equipment: No information provided

hrnr

146

FES RESOURCE GUIDE

DENMARK
rthanEnglish ~ Danish

--

. ers may come if

Payme

. . . :Nainfo

Type of facility: Publiclysu@


gency;
~or!ege I
.
program; Non"prCiflt; Inpatient
. pility; Collegeli..Jniversity program;
facility; ......
tlospitalrRenabilitation center; Rehabilitatian program;
Reseatcli3~developh1ent
Accreditation: ;Norinf.arl1''latfc::m l)ral1idegl.

center

~
77.01
FES Application:
Lower limb movement
Upper limb movement
Muscle strengthening
Description: A training branch with adjustable
resistance is developed. For stirn. a modified
commercially marketed stimulator (TENS) is used. The
goal is to test how FES should be used to be efficient
on M. quadriceps and M. extensor carpi radilias.
History: Recruiting 24 persons with paraplegia for m.
quadriceps stirn and 12 with tetraplegia for wrist
extensor stirn.
Status: Experimental research
Candidate Description:
Spinal cord injury
Cervical
Thoracic
Lumbar

Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: more than 3-6 months
Restrictionsl Contraindications: No info. provided
Treatment course:
Evaluation/ assessment - 3 times a week, pre-training
Inpatient fitting/implementation - 1 time
Training - 6 times a week for 12 weeks (at home)
Maintenance/check-ups -1x1wk every 2 wks for 12 wks
Evaluation/ assessment - 3 times a week, post-training
Approximate number of visits required in total: 6-8
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $1,000-$5,000
3rd party payers typically cover: All costs;
government or private funds
Type of equipment: Home use stimulator; Research
prototype stimulator; Transcutan.lsurface electrode(s)
Availability of equipment: No charge

77 .02

FES Application:
Upper limb movement
Grasping
Description: FES of a paretic muscle controlled by the
remaining voluntary myoelectrical signal from the same
muscle. Development of a device using said technique
on the forearm muscle(s) for restoration of grasp.
History: No information provided
Status: Experimental research
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-6
Tetraplegia! Quadriplegia
Restrictionsl Contraindications: Must have some

voluntary control over the muscle (.muscle strength


greater than grade 1.) The muscle must be susceptible
to electrical stim, (innervated, and be superficial.)
Treatment course:
Evaluationl assessment
Inpatient fitting/implementation
Requires evaluation at this facility? No info provided
Requires local lodging? No information provided
Typical cost: No information provided
3rd party payers typically cover: Some costs; costs
can't be determined
Type of equipment: Home use stimulator; Research
prototype stimulator; Transcutan/surface electrode(s)
Availability of equipment: Purchase

---

WHERE TO GET FES

147
DENMARK

"
"

"
\,...

\...

\...

"
I\.

"
"
"
"
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\.

~ 77 .03
FES Application:
Upper limb movement
Grasping
Description: The system uses EMG signal form
partially paralyzed wrist extensor muscles to control the
stimulation of the same muscle. By stimulating the
wrist extensor muscles and by using the tenodesis
effect, it is possible to restore a useful grip.
Hi~tory: A newly developed prototype is currently
being tested on selected subjects.
Status: Experimental research
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-6

Tetraplegia/ Quadriplegia
Restrictionsl Contraindications: No info. provided
Treatment course:
No information provided
Requires evaluation at this facility? No information
provided
Requires local lodging? No information provided
Typical cost: No information provided
3rd party payers typically cover: Some costs; Costs
can't be determined
Type of equipment: Clinic use stimUlator; Research
prototype stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: No information provided

77 .04
FES Application:
Sexual function
Electroejaculation
Description: Seager NRH model 12 and 12E,
electrostimulation power unit and temperature
monitoring probes with accessories. The system is
used in men with spinal cord injury and ejaculatory
dysfunction. An electrical probe is inserted in the
rectum and the procedure is performed with and
without anesthesia, depending on the completeness of
the cord lesion.
History: Has been available for 3 years; 30 individuals
have been treated, with a capacity of 40 per year.
Status: Clinical service
Candidate Description:
Spinal cord injury

Restrictionsl Contraindications: No info. provided


Treatment course:
Evaluation! assessment - 1 time
Inpatient surgical procedure(s) - 1-3 times or
Outpatient surgical procedure(s)-1-3 times
Post-implementation therapy/treatment - 1 time
Approximate number of visits required in total: 4-6
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: $1,000-$5,000
3rd party payers typically cover: All costs; part of the
public health service
Type of equipment: Clinic use stimulator; Not FDA
approved stimulator
Availability of equipment: No charge

~ 77 .05
FES Application:
Cardiovascular exercise
Bicycle ergometry
Description: The REGYS I bike: crank position
controlled stimulation of hamstrings, quadriceps,
gluteals.
History: Has been available since 1991; can treat 10
persons with SCI in one year
Status: Experimental research; Feasibility study
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-7/ Sensory: C5-7
Thoracic: Motor: T4-7 I Sensory: T4-7
Paraplegia

Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: minutes to 2 years
(max. 24)
Restrictions! Contraindications: Not yet determined
Treatment course:
Training - 1 year
Approximate number of visits required in total: 150
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: More than $20,000
3rd party payers typically cover: No costs; research
Type of equipment: Home use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: Purchase

148

FES RESOURCE GUIDE

tiO",l1S= No;l~afio~:pmVided
lJ.ocatio

046704

F:MC: 33;6i'0467ffO

b
C

h! Dr. E
Program Description:
p~raplegia(c1osed,JEJi!Jp,.l};:CALlES(GQ~ter
AldedL?co'oo.tion ... ' . .
Electrical StirntilStion):
prod"~QJ1of,~plantr:{44c.naml~ls) .fdr gajt1"~storation.
Information'8YzailatilelNOinfQrmation pr~

78.01
FES Application:
Bladder control
Lower limb movement
Neuromuscular treatments
Description: Bladder stimulation using the Brindley
system. Development of a full implantable system for
gait restoration. Standing up and standing. Use of
Parastep system. Other applications could include
bladder emptying. controlling incontinence, stepping
and walking, standing / transfer assistance, treating
weak. atrophied muscles, controlling spasticity, and
erection / electroejaculation.
History: 5 years, 15 participants for verticalization; 13
for bladder stimulation
Status: Clinical service; Experimental research
Candidate DeSCription:
Spinal cord injury
Thoracic: Motor: T6/ Sensory: T6
Paraplegia
T etraplegia/ Quadriplegia

ormation provided
.,.. .
... ssible, incl. bathrooms'
H~ndicapped>~ng available

~oPu..tio~.served: No restrictions
A.r_8e~Jt;.;EQfO~

l~edf1Yes,Prom;,Physician
e:::c ,

. . paYm,pt'
ds: N~informatio~provjded
",peof fa. .. Non-profit: 'Inpatient facility;
Outpatient facility; Rehabilitation center; Rehabilitation
program
Aooredltation.:No,informatton'provided
Ltcensing/Gertific8tlon: Notappfitable

Restrictions! Contraindications: Unrealistic


expectations, strong spasticity, peripheral lesions.
Treatment course:
Evaluation/ assessment - variable
Inpatient surgical procedure(s) - variable
Outpatient surgical procedure(s) - variable
Inpatient fittinglimplementation - variable
Outpatient fitting/implementation - variable
Post-implementation therapy/treatment - variable
Maintenance I check-ups - variable
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: No information provided
3rd party payers typically cover: No costs; research
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator; Not FDA
approved stimulator; Research prototype stimulator;
Transcutaneous/surface electrode(s); Implanted
electrode(s)
Availability of equipment: Purchase

GERMANY

@
79.00
FESfor Paraplegic Patients
Klinik Berlin
Department ofNeurologic Rehabilitation
Free UniversitjBeriin
Berlim140a9
GERMANY
Tel:49130136503..102 ToU'"free;
FAX: 49130136503-222 E~Mail:
Director:. Stefan Hesse; K.H. Mausitz
Contactl'Person:StefanHesse
PfogramiDescription: No informationpro'lided
Infonnation available: Printed format; Videotape
format

Hours: 1:00 PM to 2:00PM, 3 days a week


Location of services: Service providers location
Accessibility: Wheelchair accessible, incl. bathrooms;
Handicapped parking available; Near accessible public
. transport
Populations served: No restrictions
Areasserved:l.Inlimited
Referralrequiretlf1No
Billing Info: Varies withabilityto pay
Paymentmethods: No'information provided
TYPe'Of~cillty: Inpatient facility; Outpatient facility
Accreditation: No information provided
Licensing/Certlficafion:Notapplicable

--

WHERE TO GET FES

149
GERMANY

79.01

FES Application:
Lawer limb mavement
Stepping and walking
Description: Standing is provided byextemal
stimulatian 'Of bath quadriceps muscles, first trained in
a standing bar and later in a walker. Far stepping
f1exian is elicited by shart stimulatian 'Of the peroneal
nerve, cantralled by the participant, 4-8 weeks 'Out
patient pragramme recammended. Later participant
s~auld handle himself. Nate: FES is nat mability but a
vlgaraus physical training programme for persans with
paraplegia.
History: Started in 1993, presently 10 persans have
been treated, capacity 'Of 10 new participants per year.
Status: Experimental research

80.00
Restoration of Stance andsGait'fbV FES
NeOrologieal Clinics
Klinikum Grosshadeum ofUniversity
Marchioninistrasse 15
Munich 0-81377
GERMANY
Tolf~free:
Tel: 49..;89-70906.118
FAX: 49-89-70906101
E-Mail:
u73Iar@sunmail,lrz.munchen.de
Director: Dr. JochenQuintem
COntact Person: Dr. Joehen Quintem
Program Description: 1.)Training: Re'-strengthening
of muscles, stance andgaitwith FES in persans with
paraple~ia (commerciallY/available stimulatars); 2.)
Evaluatian of FESin rehabilitatianofpersons wha have
had a stroke; 3.) DevelopmentafclOsed-laop FES
systems for stance, gait, stair climbing.
Info available: Lang. other than English - German

80.01

FES Application:
Lawer limb mavement
Stepping and walking
Description: Restrengthening of muscles, stance and
gait with FES in persons with paraplegia.
History: Third year of research, 10 persans treated to
date, capacity of 50 participants.
Status: Clinical service
Candidate Description:
Spinal cord injury
Tharacic: Motar: T1-12
Paraplegia
. Time elapsed past-injury/anset: 3 manths - 20 years
Restrictions/ Contraindications: Drug abuse,

Candidate Description:
Spinal cord injury
Paraplegia
Restrictions/ Contraindications: Clinically camplete
persans with paraplegia below C7.
Treatment course:
Past-implementation therapy/treatment - 3-5 timeslwk
Requires evaluation at this facility? Na
Requires locallo~ging? Na
Typical cost: $1,000-$5,000
3rd party payers typically cover: Na casts
Type of equipment: Hame use stimulatar; Not FDA
approved stimulatar; Transcutaneous/surface
electrode(s)
Availability of equipment: Purchase; Na charge

Hours: 8:00 AM to 6:00 PM, Manday - Friday


Location ofservices: Service providers location
AccessibilityrWheelchair accessible, inct bathrooms;
HandiCl;lppetfparking available; Near accessible public
transport
Populations served: Adult (age 16 ta 65); Aged (age
65 or alder)
Areas served: Germany; Austria
Referral required? No
BiIIlng;lnfO:No charge
Paymeri~ds: Will bill Insurance' Will bill
Medicaid; WlllbillMedicare; Far jnpati~nt care and
equipment
Type of facility: Publicty supparted; Nan-prafit;
Outpatient faCility; College / University program; .;/
Hospital
....
Accreditation: No information provided
Licensing/Certification: Not applicable

'Obesity, severe contractures, unrealistic expectations,


cardiac pacemaker.
Treatment course:
Evaluation/ assessment - 2 times a year
Inpatient fitting/implementatian - 8 times a year
Training - at hame far 'One hour daily
Approximate number 'Of visits required in tatal: 20
Requires evaluation at this facility? Yes
Requires local lodging? Na
Typical cost: $5,000-$10,000
3rd party payers typically cover: All casts
Type of equipment: Hame use stimulatar; FDA
approved stimulator; Transcutaneaus/surface
electrode(s)
Availability of equipment: Purchase

L
150

FES RESOURCE GUIDE

GERMANY

80.02

FES Application:

Lower limb movement

Stair Climbing

Description: Development of closed-loop FES for

stance, gait, stair climbing; surface electrodes and

electromechanical sensors used; 8-16 channels.

History: First year of program, 3 persons treated,

program capacity 10 partiCipants.

Status: Experimental research; Feasibility study

Candidate Description:

Spinal cord injury

Thoracic: Motor: T1-12

Paraplegia

. Time elapsed post-injury/onset: 3 months - 20 years


Rest~ictions/ Contraindications: Drug abuse,
obeSity, severe contractu res, unrealistic expectations,

~81

.00'

Neurolog

eni
t
Heu~t1waBe'!4Q
Wuppertal422S3
GERM.AfiII
Tel~,0202;;gga..2263
TolI..free:
F~()202.:.s96-2139
E"Mail:
[)r~tGt'::J.W. Thurdoff,MD; Markus Hoheilfellner,MD

Contact,PenotH
ProgtamDejcrlptiol1: Saeralneuromodulation .and
sacral deaffefentation, Ventral sacral rootstimulation
for treatment of neurogenic bladder dysfunction.
Information avaitable: No information provided
Hours: No information'provided

81.01

FES Application:
Bladder control
Bladder incontinence
Description: No information provided
History: Sacral neuromodulation has been used since
1989, 110 test stimulators have been used and 30
implants have been performed. Sacral deafferentation
has been used since 1995, - 4 procedures completed.
Status: Clinical service; Experimental research; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Cervical: Motor: C5
Thoracic
Lumbar
Sacral
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: depends on the type of

cardiac pacemaker.
Treatment course:
Evaluation/ assessment - 2 x I month during the project
Pre-implementation therapy/treatment - 4-6 weeks
Inp~t~ent fitting/implementation - about every 2 months
Training - at home for one hour daily
Maintenance / check-ups - at each evaluation
Approximate number of visits required in total: 20 - 50
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: $5,000-$10,000
3rd party payers typically cover: Some costs; only
for the training stimulators
Type of equipment: Clinic use stimulator; Research
prototype stimUlator; Transcutan./surface electrode(s)
Availability of eqpmnt: No charge; research device

...,>:eationofse~ices:No information~Ovided
~cessibility:'Wheelchair accessible,lncl. bathrooms;
Ha!ldicappectj:l5irking available
POpJJJationsserved: Aged (age 65'6r older); Adult
(age'l6 to 65)
Areas.:Served:.LJnlimited
Ref,rral requli'ei.lt? No
BUIiI't!,.!nfo:Fixedrates
PaYnlentmethods: Ca5h;.Gharg~rectjtGard:. Wm~biil
Insurance
Type offacility!P~blicIY.supported;Fed~ralaQency;
No~-profit; Inpatientfacility" Outpatient.~; College!
Umv;prc>gram; Hosptl; Research>& dvlpliultcenter
Atcreditation:No informationprovided
Licensing/C,rtification:Not~ppncable .

injury Other spinal disorder: MMC


Restrictionsl Contraindications: Non-compliant
psychological profile, pregnancy.
Treatment course:
Evaluation/ assessment - 1 week
Pre-implementation therapyltreatment - body
disinfection, antibiotics
Inpatient surgical procedure(s) - 10 - 12 days
Training - 2 weeks
Post-implementation therapyltreatment - 10 days
Maintenance / check-ups - every 6 months
Approximate number of visits required in total: 23
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: $10,000-$20,000
3rd party payers typically cover: All costs
Type of equipment: Home use stimulator; FDA
approved stimulator; Implanted electrode(s)
Availability of equipment: Purchase; Rental

WHERE TO GET FES

151

',

ICELAND /ISRAEL

L.ocation ofservicese Service providerSJocatiOn;


COl"Isumer'sresidence
AccessibilitY:'No inform~tion provided
P.()pulatio._.):served: Adult (age 16 to 65)'Cnild l up to
~16)
,
\

10

1'~!r~3'54~560-1595" .;;!~n-free:

F~~;364-56o;;1291;. .;.ta;.;ft/Jail: thorclur@f'sp-is

DeThrdurHe1g:a~G!rr

..Pers(l)..~~~ordur Helgason .
,p ..... mDescriPlron:~~information pl1)}lided
1nformation avaiiable~:I.:.:anguagesot/1er;:~an EnglishIcelandic
.
Hours: 8:00 AM to 12:00 nbOn, MondlilY;' Friday

,"0

[@

82.01

FES Application:
Neuromuscular treatments
Controlling spasticity
Regaining voluntary function
DeSCription: We are treating a person with MS with
m.ultichannel electrical stimulation to reduce spasticity.
History: 5 years, 9 individuals serviced, capacity of 12
per year.
Status: Experimental research
Candidate Description:
Multiple sclerosis
Hemiplegia
Restrictionsl Contraindications: Has to be able to
walk with or without aid.

Area$served:lceland
Referraht;equired? No
Billing1limo:Noch~rge
Pay~e~t m~ods,N,o infol'n1ation provided
Type~';faCillty: Publit:lysupparted; Non-profit'

InpatienUaGifily; Outpatiehtfacility; Home health


agency
Accreditation: No information provided
LicensingtCertificati()I1:Not applicable

Treatment course:
Evaluation/ assessment - 1-2 times a week
Post-implementation therapy/treatment - 11-12 times a
week
Approximate number of visits required in total: 60
Requires evaluation at this facility? No
Requires local lodging? Yes; Treated each day at the
hospital
Typical cost: $10,000-$20,000
~rd part:Y payers typically cover: cost is per year; No
information provided
Type of eqUipment: Clinic use stimulator; Not FDA
approved stimulator; Research prototype stimulator;
Transcutaneous/surface electrode(s)
Availability of equipment: Purchase

ISRAEL

@
83.00
FESTIM
LoYienstein Rehabilitation Center
Department of Biomechanics
Lowenstein Rehabilitation Center
P.O. Box 3
Raanana 43100
ISRAEL
Tel: 972-9-909090
TolI"-free:
FAX: 972-9-446666
E-Mail: jm@biomecUechnion.ac.i1
Director: Dr. Eisakov (medical);Prot J., MiZrahi
(scientific)
Contact Person: Dr. E. Isakov
Program Description: The program deals with the
mobilization of paraplegicsby.;FES. Transcutaneous
stimulation is used by means ofa self desig'riedlmade
stimulator. The participant undergoes an extensive
evaluation program, before and during treatrhetit,f6r

the optimization of performance. ego minimization of


muscle fatigue.
Information available: Printed format; Languages
other than English - Hebrew
Hours: 8:00 AM to 4:0(JF?M, Sunday.;;; Thursday.
Location of.seryices: Service providers location
Accessibility: Wheelchair accessible, incl. bathrooms;
Handicapped parking available
Populations served: .No restrictions
Areas served: .Unlimited
Referral required? No
BIlling. info: No charge
Payment methods: No information provided
Type of facility: Hospital; Rehabilitation center;
Research & development center
Accreditation:,No information provided
Licensing/Certification: Not applicable

152

FES RESOURCE GUIDE

ISRAEL /ITALY
~

--

83.01

FES Application:
Lower limb movement
Stepping and walking
Description: Secondary benefits include lower limb
movements of standing / transference assistance, and
neuromuscular benefits of treating weak I atrophied
muscles and contrOlling spasticity. The system
combines a 6-channel electrical stimulator and an
instrumented walker. The stimulator is computer
controlled (microprocessor) and can be on-line
operated by a personal computer or in a remote mode,
with its own microprocessor.
History: 13 years of research; over 45 persons with
SCI have been treated; capacity is 3 to 4 participants.
Status: Experimental research
Candidate Description:
Spinal cord injury
Thoracic: Motor: TS-12/ Sensory: TS-12

Paraplegia
Restrictionsl Contraindications: Age above 50 yrs;
severe spasticity; or contractures; chronic disease
Treatment course:
Evaluation! assessment - 2 times a week for 2 weeks
Pre-implementation treatment - 2 timeslwk for 2 weeks
Outpatient fitting/implementation - 2 times/wk for 1 wk
Training - 3 times a week for 12 weeks
Post-implementation therapyltreatment - 1 x! month
Maintenance / check-ups - 1 time every 6 months
Approximate number of visits required in total: 50
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $10,000-$20,000
3rd party payers typically cover: All costs
Type of equipment: Home use stimulator; Research
prototype stimulator; Transcutan/surface electrode(s)
Availability of equipment: Purchase

ITALY
7:.84i.:~OQ

N.ESsi!G5.~e61FEsS.ystemi>Multi..centR$tud"
NES 'Unite' Spinelec
..
AZle
alieraCart!Q!i-C.T.O,l.,Jnlta' 51081$
Largo>palagi 1
.
Firenze 50100
ITALY
TeJ:()03g.;,55-.4278417 Ton..fr$e:
FAX:"i6039.l:55-4278417 "!":Mail:'
Director: Dr. HaroldWetngarden
Contact.Person:0r. Aito Sergio - Unita'Spinalel: ~.
Firenze
Progi1llftDescnptibn: We ara studying a single
channel, portable FES device to obtain the
rehabilitation of lost functions in persons witheS

tetraplegia. Thedeviceisp()rtable and easy t?use


1.l1 fo
le:ieriO~for:rltat; Videotape format
Hou
PM to 6~OO PM, Mon. and Wed.
ll)cation"of:services~1:SefViceproviders location'
Accessibility: V\If1eelChair.accessible, incl. bathrGloms;
Handicapped parking 'available
Pbpulations:served: Adult'(age16 to 65)
Areas served::Jtaly
Referral required? No
eiJIing!info:Noicharge
Paymentmethods: No information provided
Type offacifity:Priva.tely supported~Non"profit;
Hospital; RehabilitaOOn center
.
Accreditation: No information provided
Licensin ICertification: Not ap licable

84.01

FES Application:
Upper limb movement
Grasping
Description: The device is portable and can be used
by the participant. After a 3 week training period, the
participant continues the exercises at home. We have
obtained some satisfactory results.
History: Available for 1 year; 14 persons treated; 40
persons can be treated.
Status: Exprmntl research; Multi-center clinical trial
Candidate Description:
Spinal cord injury
Cervical: Motor: CS-6 / Sensory: CS-6
ASIA International Impairment Scale: A
Tetraplecgiai Quadriplecgia
Restrictionsl Contraindications: Only CS or C6 level
injuries, aged 18 to 65. Contraindications: pace

makers, cardia-respiratory problems, psychological


disorders, phobia to electrical stimulation, spasticity,
open skin lesions on upper arms.
Treatment course:
Evaluation! assessment - 1 day
Pre-implementation therapy/treatment - 1 day
Training - 3 weeks
Post-implementation therapy/treatment - 12 weeks
Approximate number of visits required in total: 6
Requires evaluation atthis facility? Yes
Requires local lodging? No; done in day hospital
Typical cost: No information provided
3rd party payers typically cover: All costs; NESS Co.
covers the cost of the devices
Type of equipment: Home use stimulator; Research
prototype stimulator
Availability of equipment: No charge

--

...
WHERE TO GET FES

153
ITALY

85.00

Spasti~ita. &' FESinPqtenti,Mielolesi

Public!ftospital

Ospedc:lIedi l.onato-O~~o

Oivisione;'(Ii;;NeuroriabilitSzione

Lonato($tesda) 25017

ITALY

Tel: 3Q..991;:e933

F~3Q..99~1:39 3a

Di~/f)r:~'VittoriO }\lfieii~~~D~.

Contact!Pers,on::9r"Ruggero Ptati,.M.D.; Dr.' VIttOrio


Alfieri
.
PrOgram Des
t
tyPEm,,'e;ur cu
, , ; > , tal WQ~fj.directe1:to;
<o~~, prognostic criteri~X9rfheappliGabi1ity
'(therapeutic electricaJ;cstfhlu latiori)~nd. F.
indivj~yal with.SCI.

85.01
FES Application:
Lower limb movement
Stepping and walking
Description: Use FES and Reciprocating Gait
Orthosis (RGO). Sometimes persons prefer to use
RGO without FES. In any case electrical stimulation is
always applied for preparation to standing and walking
with RGO in order to reduce spasticity and tremors.
History: Dr. Alferi started using TES in 1973 at
S.Gerardo Hospital in Monza for persons with
hemiplegia. In 1989 started using TES and FES for
persons with SCI again in Monza and from 1993 in the
Rehab. Center in Lonato-Brescia in collaboration with
Dr. Ruggero Prati and Dr. Stefano Visconti. A total of
18 persons treated.
Status: Experimental research
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-7
Thoracic: Motor: T1-12
ASIA International Impairment Scale: A B
Paraplegia

Infonnation~~i.lQbleiNo~information provided
Hours: 8:0O::AMto5:0{)
' a week
Location of servicet~;Co
ence; Service
proviClet"$~tioP',
'

ACC~iJJI1rllY:wfleelchairafceSSi6!\J~incl..bathrooms;
Han

p~ng

.'

available ....

~ Ad~lt (El9f,J :{Sct065),

AreasS,fl'V:ed:Jtaly, Norlt'iem0:~,

R e f e . " 1 YesFrom:~e':hmentAgency;
Physl

8iltin

..

. . . . . . ..... .. arge

Paymen,f>J'I'I~s: National<~faijtlService, Italy

Typeoffjcil_!;~n~profit; Inpatient faCility;

Outpatientfaejlity; Hospitat:
Accreditation: No informatibnp1pVlded
Licensing/Certification: Not applicable

Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: from 4 weeks - 12
months
Restrictionsl Contraindications: Compromised
general conditions, pace-maker (cardiac and
respiratory), some types of uncontrollable spasticity.
Treatment course:
Evaluation/ assessment - once a week for 6 weeks
Training - twice a day, 5 days a week for 6 weeks
Post-implementation therapyltreatment - once a day, 5
days a week for 6 weeks
Maintenance / check-ups - bimonthly for 6-12 months
Approximate number of visits required in total: 10 - 14
Requires evaluation at this facility? Yes
Requires local lodging? Yes; Only in the first 2-3
months
Typical cost: More than $20,000
3rd party payers typically cover: All costs; except for
the stimulator when discharged
Type of equipment: Home use stimulator; FDA
approved stimulator; Implanted electrode(s)
Availability of equipment: Purchase

154

FES RESOURCE GUIDE

'

ITALY

85.02

FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Controlling spasticity
Controlling tremor
Description: The primary purposes (indivisible) of
therapeutic electrical stimulation (TES) are
Neuromuscular and Circulatory. We use 4 channel
electrical stimulators on each muscle group of the trunk
and limbs in physiological sequences.
History: Dr. Alferi started using TES in 1973 at
S.Gerardo Hospital in Monza for persons with
hemiplegia. In 1989 started using TES and FES for
persons with SCI again in Monza and from 1993 in the
Rehab. Center in Lonato-Brescia in collaboration with
Dr. Ruggero Prati and Dr. Stefano Visconti. There have
been a total of 18 persons treated.
Status: Experimental research
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-7
Thoracic: Motor: T1-12
ASIA Intemationallmpairment Scale: A B

85.03
FES Application:
Circulatory/Skin treatments
Improving circulation in limbs
Description: The primary purposes (indivisible) of
therapeutic electrical stimulation (TES) are
Neuromuscular and Circulatory. We use 4 channel
electrical stimulators on each muscle group of the trunk
and limbs in physiological sequences.
History: Dr. Alferi started using TES in 1973 at
S.Gerardo Hospital in Monza for persons with
hemiplegia. In 1989 started using TES and FES for
persons with SCI again in Monza and from 1993 in the
Rehab. Center in Lonato-Brescia in collaboration with
Dr. Ruggero Prati and Dr. Stefano Visconti. There have
been a total of 18 persons treated.
Status: Experimental research
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-7
Thoracic: Motor: T1-12
ASIA Intemationallmpairment Scale: A B
Paraplegia

Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: from 4 weeks -12
months
Restrictions/ Contraindications: Compromised
general conditions, pace-maker (cardiac and
respiratory), some types of uncontrollable spasticity.
Treatment course:
Evaluation! assessment - once a week for 6 weeks
Training - twice a day, 5 days a week for 6 weeks
Post-implementation therapy/treatment - once a day, 5
days a week for 2-6 weeks
Maintenance / check-ups - check-ups bimonthly for
6-12 months
Approximate number of visits required in total: 10 - 14
Requires evaluation at this faCility? Yes
Requires local lodging? Yes; Only in the first 2 - 3
months
Typical cost: More than $20,000
3rd party payers typically cover: All costs; except for
the stimulator when discharged
Type of equipment: Home use stimulator FDA
approved stimulator; Implanted electrode(~)
Availability of equipment: Purchase

--

Tetraplegia/ Quadriplegia
Time elapsed post-injury/onset: from 4 weeks -12
months
Restrictions/ Contraindications: Compromised
general conditions, pace-maker (cardiac and
respiratory), some types of uncontrollable spasticity.
Treatment course:
Evaluationl assessment - once a week for 6 weeks
Training - twice a day, 5 days a week for 6 weeks
Post-implementation therapyltreatment - once a day, 5
days a week for 2-6 weeks
Maintenance I check-ups - check-ups bimonthly for
6-12 months
Approximate number of visits required in total: 10- 14
Requires evaluation at this facility? Yes
Requires local lodging? Yes; Only in the first 2-3
months
Typical cost: More than $20,000
3rd party payers typically cover: All costs; except for
the stimulator when discharged
Type of equipment: Home use stimulator; FDA
approved stimulator; Implanted electrode(s)
Availability of equipment: Purchase

WHERE TO GET FES

155
ITALY / JAPAN

!~r.rmation av~ilabte:~Noinformatien pro\tl~eck '

Roul'IJ:",pjI)J()rm~tionp

',:~,

loc~~~~~~~s: ,"',.,

,.

atio~~providei~h"

Ac:;ce~1iJIbiIity: V'\It1eeICha!r'a~ible;sfncL' b~tblrf.l!,)Ji\'!ls;


HalldiC:ijPJ~.nl:Ori(inn

available..... .

. , . .,

No restrictioAls:;.

86.01

FES Application:
Upper limb movement
Grasping
Description: We aim at controlling force, and slip of
the object from the hand. Sensors of force and slip are
located on the hand and/or on the object.
History: Has been in use at this facility for 1 year. We
are in the phase of FES system (electronics and
computer control)
implementation. Preliminary trials on healthy subjects
and 1 person with tetraplegia are in development.
Status: Experimental research
Candidate Description:
Spinal cord injury

Cervical
Tetraplegia! Quadriplegia
Restrictions/ Contraindications: No info. provided
Treatment course:
No information provided
Requires evaluation at this faCility? No information
provided
Requires local lodging? No information provided
Typical cost: No information provided
3rd party payers typically cover: No costs
Type of equipment: Research prototype stimulator;
Transcutaneous/surface electrode( s)
Availability of equipment: No information provided

JAPAN

87.00

P:M; & Rehabilitation


Osaka RosafHospital
1179-3, Nagasone - CHO
Sakai Osaka 591
JAPAN
Tel:.0722-52-3561
JolIfree:
FAX:0722-55~3369t
E-Mail:

Director: JiroKawamura

Contact Pel'Son:Jiro~aWamura
Prog~mDe$Criptfo.n.:li6IihicalappUcation of
augmenting cough by FES.
Information available: No information provided

Hours: 8:30 AMto5:00PM,Mon(j~y - Saturday:

Location of services: No infQrmation provicleEf'< .',

Accessibility: Whe~tcliaip'acCessjb;le.incl.bf.itflrooms; .

Handicapped parking available


..

Populations .served: Adult (age 16 tOl55)

Areas served: Jii!lpan

Rete.rral 'required?' Yes, FfOfl'tiPhysician

Blllln,,,iir1f4tNo InfOrmation provided

Payment m~ods: No information provijed

Type of facjlity: PU9liclysupported;Nc)n'1!J:l[ofit;

Inpatient facility; O~tpatientfacifity;H~pitE!f

Accreditation: NO:.ii1formationprovi:lea '

Lice"sing/~ertification:N~tappUcable

156

FES RESOURCE GUIDE

JAPAN

87.01

FES Application:
Respiratory treatments
Cough assistance
Description: No information provided
History: No information provided
Status: Experimental research
Candidate Description:
Spinal cord injury
Cervical: Motor: C5 I Sensory: C5
Tetraplegia! Quadriplegia

@ .... ~_~G(J

~.nailf&S Project
TOhokul,l:Jniversily
2-1 Selry&machi,Aoba-ku
Sendai980,,77
JAPAN
Tel~~g1,;,()~!;';273-9014
TolI;,;free:
FAX: 81;1.022-274-0608E;;'Mail:
Direetor:yasuflpbu. Handa; N6z0muHoshimiya
Contact Pert
Yoshiora Kiyoshfge
Programl! . . . <on;We.havethe limited population
programth~as'JlPparteabtl&teMlnlsVy of welfare
at Tohoku t..Jnivef'Sly. Thererore, we opened the
speciaIFES:elj~iGdor convenience (Hokuryo FE9t:linic
since 1991).
Information available: languages otherthanngflsh

88.01

FES Application:
Bladder control
lower limb movement
Upper limb movement
Neuromuscular treatments
Orthopaedic treatments
Respiratory treatments
Sensory aids
Description: The first step is electrode implantation.
Neuromuscular treatments are then carried out at
home to strengthen and decrease spasticity. After this
FES programmed movement will start. Specific
~ppli~tions include: bladder emptying, controlling
Incon~mence, preventing I treating pressure sores,
steppmg and walking, standing / transfer assistance,
grasping, reaching, treating weak, atrophied muscles,
controlli.ng spasticity, regaining voluntary function,
enhanCing neural regeneration, preventing / treating
osteoporoSiS, preventing / treating contractu res
breathing assistance, and sensation I feedback:
History: We started clinical FES applications 12 years
ago. In 1991 the present FES equipment (30 ch
portable stimulator and implanted electrodes) were

Restrictionsl Contraindications: No info. provided


Treatment course:
No information provided
Requires evaluation at this facility? Yes
Requires local lodging? No information provided
Typical cost: No information provided
3rd party payers typically cover: No costs
Type of equipment: Home use stimulator; Research
prototype stimulator; Transcutaneous/surface
electrode(s)
Availability of eqUipment: No charge

--

Japanese
Houl'S~/9:00 AMfo12:00,.2daysaiweek; 9:00 AM to
4:00. PM; weekdays
locati()n ofl$erviC8$~Serviceprovfders locatior1\l
Acc8S$ibility~Wheel~hairaccessiblei j~I~batfjro()ms;

Bandleapped parkiog:availabte;:Neat~ccessiblepublic
transport
Populations ser\lSd:~No restrictions
Areas served: Japan; Korea
Referral:requi~~?Yes From: Physician
Billing info: Fixed rates
Payment tnethCJds! Cash
TypeOffacility:Pederal{agenC.~:e()flege rUniversity .
program; Hospital
Accreditation: NoinfOlmation pr.ovided
Licensing/Certification:Not appl~ble

produced. From 1992, our program was supported by


the Ministry of Welfare.
Status: No information provided
Candidate Description:
Spinal cord injury
Cervical: Motor: C4
Thoracic

Lumbar

Hemiplegia

Paraplegia

Tetraplegia! Quadriplegia

Restrictionsl Contraindications: Severe

complications (ex. cardiopulmonary...).

Treatment course:

No information provided

Requires evaluation at this facility? Yes

Requires local lodging? Yes

Typical cost: $1,000-$5,000

3rd party payers typically cover: No costs

Type of equipment: Home use stimulator; Not FDA

approved stimulator; Research prototype stimulator;

Implanted electrode(s)

Availability of equipment: Purchase

I~

WHERE TO GET FES

157
NETHERLANDS

1'
'-"

:.~~~of,*rvic
~~~i. .

......

"''-"

<Popt.tli(tfons ..,

'rV~ providers location


< ~iblepublic transport
:Male'"~fl:Iy; Adult (age 16 to 65)

.. .

;:~rea:si$erved?ntethenands

RQ,"erra

"-

"'"
\.,..

Yes Frbm:Physician
Dotch law
bilUnsurance
u~~rted; F~eralcy;

'

.... . . . . . .
. . . acility;Gbllege J Unl
tion,{~ro.vl(f~di
..
. .ehabilitationprogram; Research &
()ffilijl};)tl'liatl anglish"A"~' ..elopm~f}tcenter
AccreditatiQI1~X~ information provided
Licensing/certff(Cation: Not applicable

89.01
FES Application:
Sexual function
Electroejacu lation
Description: The fertility program is offered to men
with a spinal cord dysfunction, and ejaculation
impairment, with a partner who carries the child. When
vibration fails, the man is treated with electrostimulation
in collaboration with in-vitro fertilization labs.
History: Has been available for 5 years.
Status: Clinical service
Candidate Description:
Spinal cord injury

@
90.00
Electrical Bladder Stimulation inSpillal.Cotd
Injury
University Hospital St. Radboud
Departmentof Urology
P.O. Box 9101
Nijmegen NL,.s500 HB
NETHERLANDS
Tel: 32-80-613920
Toll-free:
FAX: 31-80-541032
E-Mail:
Director: Philip EV. Kerrebroeck, M.D., Ph.D.
ContactPerson: Philip e.v. Kerrebroeck, M:D~, Ph.D.
Program Description: No informatiofl:provided
Information available: PrintedforrY"\StjVideOtape
format; Languages otherlhan English - Dutch

Restrictionsl Contra indications: No info. provided


Treatment course:
No information provided
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: No information provided
3rd party payers typically cover: No information
provided
Type of eqUipment: Clinic use stimulator; Not FDA
approved stimulator; Research prototype stimulator
Availability of equipment: No information provided

Hours: 7:30 AM to 7:3'0 PM, 7 days a<we'ek


Location ofservices: Service'providers location
Accessibility: Wheelchair accessible;incl. bathrooms;
Handicapped parking available; Mearaccessible public
transport; Facilities for persOns with spinal cord injuries
on Urology Unit
Populations served: Adult (age 16 to 65)
Areas served: Unlimited
Referral required? Yes From: PhYSician
Billing info: No charge; Fixed rates
Paymentmethods: No information provided
Type of facility: Hospital
Accreditati.omNoinformation provided
Licensing/Certification:. Not applicable

158

FES RESOURCE GUIDE

NETHERLANDS/POLAND

90.01
FES Application:
Bladder control
Bladder emptying
Bladder incontinence
Description: Intra- or extra-dural sacral rhizotomies
and implantation of a Finetech-Brindley bladder
controller. EEC approved clinical service.
History: Available since Jan., 1989,52 persons have
been treated, capacity for 10 - 15 implants per year.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: complete I Sensory: complete
Thoracic: Motor: complete / Sensory: complete
Lumbar: Motor: complete / Sensory: complete
ASIA International Impairment Scale: ABC D
Paraplegia
Tetraplegia! Quadriplegia

Time elapsed post-injury/onset: 1 year


Restrictions! Contraindications: No info. provided
Treatment course:
Evaluationl assessment - 6 weeks
Pre-implementation therapy/treatment - 2 days
Inpatient surgical procedure(s) - 1 day
Inpatient fitting/implementation - +/- 10 days
Maintenance / check-ups - 1st year - every 3 months;
2nd year - every 6 months; all later years - 1 x / year
Approx. number of visits required: 6 in the first year
Requires evaluation at this facility? No
Requires local lodging? No; Outpatient fitting
possible after +/- 5 days
Typical cost: $5,000-$10,000
3rd party payers typically cover: All costs
Type of equipment: Home use stimulator; Not FDA
approved stimUlator; Implanted electrode(s)
Availability of equipment: No charge; however extra
external stimUlator is charged

POLAND

@91:~OO

EIeett!CaI:Stimulation in Tretatmtl'tpfSJlinal
Cord~lhjuriesMetropolitarfiRenatiilitiftid'rt

center
Wiet2ajewskiego 12
Konstancin05.;.511
POLAND
Tel: 48-22~56-40.;.G1
TOII..ftee:
FAX: 48..22.;.58-46-80
E-Mail:
Director:.Prof.Jerry Kiwerski, M.D., Sc.D.
ContactPerson: Ass. Prof. Roman Pasniczek, Eng.D.
Program Description: The control of paralyzed hand
function by electrical stimulation of peripheral nerves
(no radialis and n. medianus). Electrostimulation ofthe
damaged spinal cord (after trauma).

91.01

FES Application:
Upper limb movement
Grasping
Description: Control of paralyzed .hand function
through stimulation via implanted electrodes of median
and radial nerves.
History: FES of peripheral nerves and spinal cord
stimulation - about 20 years
Status: No information provided
Candidate Description:
Spinal cord injury
Cervical: Motor: C6, C71 Sensory: C6
Tetraplegial Quadriplegia
. Time elapsed post-injury/onset: 2 - 3 months
Restrictions! Contraindications: No info. provided

Irlfonnation availabl@=Nofnrormationprovided
Hours:1:00tb2:00, .5faays.awee~
Locationmservicest:Noinfotmation prnvided
j%ceessibility: Wtieelchairaccessible, inCl. bathrooms;
Randicappedparking available; Neaf accessible public
transport
Populationsserved:.No restrictions
Areas served: Poland, .central region
Referral required? Y~s From: Physician
Billing info: Varies wltttability)topay
Payment methods: Cash; Will bill Insurance
Type offacllity: Non"profit
Accreditation! No information provided
licensing/Certification: Notapplicable

Treatment course:
Evaluation! assessment
Pre-implementation therapy/treatment
Inpatient surgical procedure(s)
Inpatient fitting/implementation
Training
Post-implementation therapy/treatment
Approximate number of visits required in total: one
hospital stay for about 3 months
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $10,000..$20,000
3rd party payers typically cover: No info. provided
Type of equipment: Clinic use stimulator; Home use
stimulator; Research prototype stimUlator; Implanted
electrode(s)
Availability of equipment: No information provided

-'

--

....",

WHERE TO GET FES

159
POLAND

91.02

FES Application:
Neuromuscular treatments
Enhancing neural regeneration
Description: Spinal cord directly stimulated with
implantation of stimulating electrodes in contact with
th~ spinal cord. Operation on the first day after trauma.
History: FES of peripheral nerves and spinal cord
stimulation - about 20 years
Status: No information provided
Candidate Description:
Spinal cord injury
Time elapsed post-injury/onset: to 20 hours
Restrictions/ Contraindications: No info. provided

fRl92.00

'tJ,nlf~itet of;

28ci~1
Poznarrc61-545\" '

POLANo.

Tel: O.;a1-310;;217
16"',,'6%:\

FAX:
E-Mail:

Director: PrC>f:dthah. Kazimiera Milanowst<a.

c;:ontact Pen;on: dr Przem


Lisir\s~l\

. Program,~~crlpti

andbladdar~ntrol;l8r

Treatment course:
Evaluation/ assessment
Pre-implementation therapy/treatment
Inpatient surgical procedure(s)
Inpatient fitting/implementation
Training
Post-implementation therapy/treatment
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typlcalcost: $10,000-$20,000
3rd party payers typically cover: No info provided
Type of equipment: Clinic use stimulator; Home use
stimulator; Research prototype stimulator; Implanted
electrode(s)
Availability of equipment: No information provided

tion Ofs
ersloCa
Atcessibility:
i'Handicapped pa
t~nsport

,'.....
Populations~ed!;NS~stJietions

Area$1Served: Poland

Refe~,.requia:8d7:~,eS.'F'rom~:#hY~iclan
B.illin~Nmo: t"lpl:!l1'arge'

Paymel'1t,methodS: No information

eo

. j~~
q~nopedi~atmening With~1e after
Outpati~nt facility; Hospital; Rehabilitat!Ghcenter;
spi.nalcord.i9itJries, hes(Hrauma; MS, and~

RehabilitatiofffPragram
.
o~hopediediSeases...

InformafiOttavaUablaf-FNoinformation provided

Hours:~tOOAMto12:00'PM

92.01

FES Application:
Bladder control
Bladder emptying
Description: Three electrodes with different impulses
used. Sometimes we modulate impulses if it is
necessary.
History: Treatment in use for 20 years. This program
is available to all who need it. Instructions were made
by Polish Academy of Sciences.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Cervical: Motor. C4-7 / Sensory: C4-7
Thoracic: Motor / Sensory
Lumbar: Motor: L4-5 / Sensory: L4-5
Sacral: Motor: S1-2/ Sensory: S1-2
Hemiplegia
Paraplegia
Tetraplegia! Quadriplegia

type Offacility: Norl.;;profit Inpatle

Accredlta,oo~tPolishAcademyofcScience

UcensinglCertification: NotappOcable

Time elapsed post-injury/onset: 2 months


Restrictions/ Contraindications: Neoplasma, cardiac
disease, angiopathia III and IV grades, psychiatric
disorders, pregnancy
Treatment course:
Evaluationl assessment - 2 times per week
Training - each day during hospitalization, 3 seriesl10
treatments
Approximate number of visits required in total: 30
Requires evaluation at this facility? Yes; According
with Polish Academy of Sciences instructions
Requires local lodging? No; We have outpatients
and inpatients
Typical cost: No information provided
3rd party payers typically cover: No costs;
government funding
Type of eqUipment: Clinic use stimulator; FDA
approved stimulator; Transcutan/surface electrode(s)
Availability of eqUipment: No charge; Paid by the
government

160

FES RESOURCE GUIDE

POLAND / PORTUGAL
~

92.02

FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Description: We are using what is typically used in our
country, Stymat 120, Stymat 200, Interdyn.These use
low frequency and low intensity currents and
transcutaneous electrodes.
History: We have used this treatment for 20 years.
This program is available for all who need it.
Instructions were made by Polish Academy of
Sciences.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-7
Lumbar: Motor: L1-5
Hemiplegia
Paraplegia

Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 1 month
Restrictions/ Contraindications: Neoplasma, cardiac
disease, angiopathia III and IV grades, psychiatric
disorders, metal implants.
Treatment course:
Evaluationl assessment - 2 times per week
Training - each day during hospitalization, 5 series of 4
times per week
Approximate number of visits required in total: 15
Requires evaluation at this facility1 Yes
Requires locallodging1 No
Typical cost: No information provided
3rd party payers typically cover: No costs;
government funding
Type of equipment: Clinic use stimUlator; FDA
approved stimUlator; Transcutan/surface electrode(s)
Availability of equpmt.: No charge; in-house use only

PORTUGAL
~

,93.00

F.E;;S~

floqitaIGe,,~11StAntonio

Servico.DelFisima

LarggJ?rof. Able Salazar

Pdrt04000

PORTUGAL

Tel: 351-2-5483191
Toll-free:

FAX:351-2-3203'1SE;'Mail:

Oil'8ctor: Mana JoaoAndrade, M.D.

Cdntact Petson:Maria.Joao Andrade.

pro.grarn Description: TheFES programsta(ted.in

Jan., 1993. It. is targeted to SCI, complete and

incOmPlete, FESis/used for muscle strengthening in

incom tetein'uries as well as standin andwalkln .

IMormatlon availabl.Siilnfcirmation:igivenv~rbally.

HbUrs:8:30AMto 4,OO'PM,.Monday ~ Friaay

Location ofs~nvlces: No information provided,

A;ecessibiliW,:".Wheelchair accessible,.i~GL bathrooms;

Handi~Rped
g available

...d:. NorestrlQtions

Populati6ns
Areaaserved:vPotitttsii' .
,.

Refefritlfequi.11:'~Nc) .

Billip9'info: Fi~;;r;itM<

PaY'mentmetI101fS='No'inm~Qrrprovided

FeGferafcsgerreyt

nt facility; Hospital

Typeof:facil
Non;;;proflf, In

Accreditation:

Lieensin Certificatibn:'Notil':i

93.01

FES Application:
Lower limb movement
Stepping and walking
Standing I transfer assistance
Description: The device we use has 2 channels and
works with surface electrodes, channels are operated
sequentially by manual control. The first allows knee
joint locking by quadriceps stimulation, the second
stimulates the peroneal nerve leads into a withdrawal
reflex resulting in flexion in all 3 pOints of the lower limb.
History: The FES program was inifiated in Jan. 1993
with inpatients for muscle strengthening, standing and
walking. Since August 1993 it has been used in
outpatients too. Capacity to treat 7 persons, 8 have
achieved standing and walking.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Cervical
Thoracic
Lumbar: Motor: L2

ASIA International Impairment Scale: ABC


Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: a few days up to years
Restrictions/ Contraindications: mental diseases,
uncontrollable spasticity, associated peripheral lesions,
range of motion limitations, lack of participation
Treatment course:
Evaluation/ assessment - ongoing
Pre-implementation therapy/treatment - spasticity
treatment and if necessary recovery of range of motion
Inpatient fitting/implementation - 1 hour per day
Outpatient fitting/implementation - 1 hour per day
Training - daily
Approximate number of visits required in total: variable
Requires evaluation at this facility? Yes
Requires locallodging1 Yes
Typical cost: $5,000-$10,000
3rd party payers typically cover: All costs; if
receiving welfare or private insurance
Type of equipment: Home use stimulator; FDA
approved stimUlator; Transcutan/surface electrode(s)
Availability of equipment: No charQe

WHERE TO GET FES

161
PORTUGAL / SLOVENIA

93.02
FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Description: The FES device we use allows a muscle
to work during 4 seconds with a 4 second pause. Using
two surface electrodes in each channel it is possible to
choose the muscles to be worked. Technical data:
frequency 20 Hz, pulse range 0.25 ms; amplitude
0-180 rnA (alkaline battery).
History: We have treated 42 persons for muscle
strengthening so far.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Cervical
Thoracic
Lumbar
ASIA International Impairment Scale: C D
Paraplegia
Tetraplegia/ Quadriplegia
Other spinal disorder: strumfel disease
I

Time elapsed post-injury/onset: few days up to years


Restrictions/ Contraindications: mental diseases,
uncontrollable spasticity, associated peripheral lesions,
lack of partiCipation
Treatment course:
Evaluation/ assessment - ongoing
Pre-implementation therapy/treatment - spasticity
treatment and if necessary recovery of range of motion
Inpatient fitting - daily as long as there is improvement
Outpatient fitting/implementation - daily as long as
there is i'mprovement
Training - 1 hour per day
Maintenance / check-ups - every 3,6,9,12 months
Approximate number of visits required in total: 10
Requires evaluation at this facility? Yes
Requires local lodging? No; can be done at home
Typical cost: $1,000-$5,000
3rd party payers typically cover: All costs; if
receiving welfare or private insurance
Type of equipment: Home use stimulator; FDA
approved stimulator; Transcutan/surface electrode(s)
Availability of equipment: No charge

SLOVENIA

W
94.00
Centre for tmplantableTechnology and
Sensors
ITIS d.o~o. Ljubijana'
U~pipot 11
Ljubljana 61000
SLOVENIA
Tel: 386..a1-1251-161
TO!l"ft'ee:
F~X:,386..a1,;2t3S..s06
E~1Utait:'
Qi,.ctor: Dr.Janez~;Rozman
Person. Dr. Janez Rozman
Program Description: Gentepfor implantable
teehnology and sensors'is dealing with 'the modeling,
design and fabrication of systems for surface and
implantable stimUlation of neuro-muscular'systems as
well as electrode: systems for recording of muscle and
nerve activity. We: organize an evaluation of different

Comet

implantable: systemsandanimal'experimerits..
.
Information available: Printed and Videotape.formal ,
Hours: No information provided
.. '.
location of services: No information provkfed
Accessibility: No information provided
Populations served: No restrictions
Areas served: Unlimited
Referral required? Yes From: Physician
Billing info: Fixedrates;Varte~ with ability to pay
Payment metllods~Casll;(,)l1arg~/CreditCard; Will bill
Insurance; WiIl~l:jllll\1ledicaid;WiIi bill. Medioare;.WlII bill
Other third-party payment
Type oUacility: Privately supported; Federal agencw
For profit; Non-profit; Research & development center
Accreditation: No information provided
Licensing/Certification: Not applicable

94.01
FES Application:
Lower limb movement
Stepping and walking
Description: FNS is applied during the swing phase of
the affected leg, dorsiflexing the foot and correcting its
equinovarus position. As the leg rises, the person
releases the heel switch that turns on the external unit,
thus transmitting information and energy to the
implanted assembly via the antenna.
HiStory: Available for 2 years; have treated 3
individuals; with a capacity to treat 10 per year.
Status: Experimental research
Candidate Description:
Hemiplegia
Restrictions/ Contraindications: Spasms of the
affected foot

Treatment course:

Evaluationl assessment - 1 time a wk. for 3 wks.

Pre-implementation treatment - 1 time a wk. for 2 wks.

Inpatient surgical procedure(s) - 1 time a wk. for 1 wk.

Outpatient surg. procedure(s) -1 time a wk. for 1 wk.

Inpatient fitting/implementation - 1 time a wk. for 1 wk.

Outpatient implementation. - 1 time a wk. for 2 wks.

Maintenance / check-ups - 1 time a wk. for 1 wk.

Approximate number of visits required in total: twolyr

Requires evaluation at this facility? No

Requires local lodging? No

Typical cost: $1,000-$5,000

3rd party payers typically cover: Some costs; for

Slovenia citizens

Type of eqUipment: Home use stimulator; Research

prototype stimUlator; Transcutan.lsurface electrode(s)

Availabili of e ui ment: Purchase

162

FES RESOURCE GUIDE

95.01

FES Application:
Lower limb movement
Stepping and walking
Description: 2 channel FES system for walking; 4
channel FES system for walking (in our Institute rarely
are more channels used); surface stimulation. Has
been approved by domestic authorities.
History: For persons with SCI, our Institute has used
FES for more than 15 years.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C8
Thoracic: Motor: T1-12
Hemiplegia
Paraplegia

95.02

FES Application:
Circulatory/Skin treatments
Treating pressure sores
Description: Usually one channel transcutaneous
electrical stimulation with electrodes on intact skin
around the wound (approximately 2 hours of
stimulation a day). Has been approved by domestic
authorities.
History: This has been used for more than 10 years
for research purposes, about 5 years in routine use.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Hemiplegia
Paraplegia
Tetraplegia! Quadriplegia

--

Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: after approx. 1 month
Restrictionsl Contraindications: General
contraindications for low frequency electrical stim.
Treatment course:
Evaluation/ assessment - approximately 1 wk.
Inpatient fitting/implementation - approx. 1-2 mos.
Outpatient fitting/implementation - approx. 1 - 2 mos.
Training - approximately 1 - 2 months
Requires evaluation at this facility? Yes
Requires local lodging? Yes; Mostly
Typical cost: $1,000-$5,000;$5,000-$10,000
3rd party payers typically cover: No info. provided
Type of equipment: Home use stimulator; FDA
approved stimulator; Transcutan.lsurface electrode(s)
Availability of equipment: Purchase; Rental

Restrictionsl Contraindications: General


contraindications for low frequency electrical
stimulation.
Treatment course:
Evaluation/ assessment - approximately 1 wk.
Inpatient fitting/implementation - approximately 1 - 3
months
Outpatient fitting/implementation - approx. 1 - 3 months
Requires evaluation at this facility? Yes
Requires local lodging? Yes; Mostly
Typical cost: $1,000-$5,000;$5,000-$10,000
3rd party payers typically cover: No information
provided
Type of equipment: FDA approved stimulator;
Transcutaneous/surface electrode(s)
Availability of eqUipment: Purchase; Rental

--

WHERE TO GET FES

163
SLOVENIA

~
95.03
FES Application:
Bladder control
Bladder incontinence
Description: Rectal and vaginal applications. Has
been approved by domestic authorities.
History: This has been used for more than 15 years.
Status: Clinical service
Candidate Description:
Multiple sclerosis
Spinal cord injury
Hemiplegia
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: - after about 1 month

Restrictions! Contraindications: General


contraindications for low frequency electrical stim.
Treatment course:
Evaluation/ assessment - approximately 1 wk.
Inpatient fitting/implementation - approximately 1 month
Outpatient fitting/implementation - approx. 1 month
Training - approximately 1 month
Requires evaluation at this facility? Yes
Requires locallo~ging? Yes
Typical cost: $1,000-$5,000;$5,000-$10,000
3rd party payers typically cover: No info. provided
Type of equipment: FDA approved stimulator;
Transcutaneous/surface electrode(s)
Availability of equipment: Purchase; Rental

~
95.04
FES Application:
Respiratory treatments
Cough assistance
Description: This FES application is still in a research
phase.
History: This has been used for about 2 years.
Status: Experimental research
Candidate Description:
Spinal cord injury
Cervical
TetraRlegia/ Quadriplegia

Restrictions! Contraindications: General


contraindications for low frequency electrical stim.
Treatment course:
Evaluation/ assessment - approximately 1 wk.
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $1,000-$5,000;$5,000-$10,000
3rd party payers typically cover: No info. provided
Type of equipment: FDA approved stimUlator;
Transcutaneous/surface electrode(s)
Availability of equipment: No information provided

~
95.05
FES Application:
Sexual function
Electroejaculation
Description: This FES application is still in a research
phase.
History: Positive effects have been observed for at
least about 10 years.
Status: Experimental research
Candidate Description:
Spinal cord injury
Thoracic

Restrictions! Contraindications: General


contraindications for low frequency electrical stim.
Treatment course:
No information provided
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $1,000-$5,000
3rd party payers typically cover: No info. provided
Type of equipment: FDA approved stimUlator;
Transcutaneous/surface electrode(s)
Availability of equipment: No information provided

~
96.00
FESfor Lower Extremities after SCI

Facialty of Electrical and Computer Engineering


Republic Slovenia Rehabilitation Institute
Trzaska 25
Ljubljana 61111
SLOVENIA
TolIftee:
Tel: 386-61-1768"-411
FAX: 386-61-264--990
E-Mail: kralj@roboJer.unilj:si
Director:, Professor AlojzKralj
Contact Person: ,professorAlojz Kralj
Program Description: OUt aim:is:restorati6mof
walking in cdmplefely and incompletely paralysed SCI
persons using multichannel surfaceelectricar
stimulation' rehabilitative systems.
'

Information available: ,No. informatioT1'provided.


Hours: No information provided
Location of.services: No information provide~ ,
Accessibility: Wheelchair accessible, incl. bathrooms;
Handicapped parking available
Populations served: Adult (age 16 to 65) ..
Areas served: Unlimited
Referral rsquired? No
Billing Info: No information provided
Payment methods:' No information provided
Type of facility: CollegeIUniversity progtcil11
Accreditation: NOinlormation'provided '
LicensiriglCertification:Not:;applicable

164

FES RESOURCE GUIDE

SLOVENIA / SPAIN

96.01

Restrictionsl Contraindicatlons: Candidates are


persons with spastic complete paraplegia and
Incomplete para- and tetraplegia. Contraindications
are strong contractu res and eventually other general
health problems.
Treatment course:
Evaluation! assessment - 1 day
Pre-implementation therapy/treatment - 0-2 months
Training - 1-2 months
Maintenance / check-ups - every 6 months
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: No information provided
3rd party payers typically cover: All costs
Type of equipment: Home use stimulator, Not FDA
approved stimUlator; Transcutan/surface electrode{s)
Availability of equipment: Purchase

FES Application:
Lower limb movement
Stepping and walking
Description: Four-channel (two two-channel units)
FES is delivered to knee extensors and peroneal
nerve. Walking is voluntarily controlled by the
participant through two push buttons built into the
handles of the walker or crutches.
History: The FES gait restoration is available for 15
years, over 100 individuals have been treated.
Status: Experimental research
Candidate Description:
Spinal cord injury
Thoracic
Paraplegia
Tetraplegia! Quadriplegia

The~~cf(efi.I'9Y
23,f'ratr,4a

..... .

'. '.
FAX:'~~12-0543i!;:
DlteQt8rt;ttarry;,l;.a"l1om;

G~tiP ..

O.T..

...................

LawhomiO~~~:~
Fttoj"m.
.
n:Smali
- 4 TTl
ERG~S.'bycle efgometers, TIF!fi~ter-1I for
8io~back; AlT - n- walking system ror"ersons with
paraplegia;'Micro FES - portable stimulator tot persons
with-hemiplegia.
Information'8Y8I1able: Printed format; .languages

97.01

FES Application:
Lower limb movement
Stepping and walking
Description: Portable 4 channel stimulator (ALT - 2)
from Ljubljana. Bilateral stimulation of quadriceps and
peroneal nerve for persons with par:aplegia for standing
and walking.
History: Has been available for 2 years, maximum
capacity of 6 persons per day.
Status: Clinical service
Candidate Description:
Spinal cord injury
Thoracic: Motor: T6-12
Paraplegia
Time elapsed post-injury/onset: 3 months
Restrictions/ Contraindications: No: cardiac
pacemaker, severe autonomic dysreflexia, severe

'. . 1 . batttroomS;

. Handicap~
transport

iI$l)~;~~~a,ccessible public
,. ...................... " . .

.P"Ulationsse~~~~~s
:-~1'eas'Served: Untimibii ......' .....

Referralrequired?'Y$~. From:pny,$iofan
i3i1ling info: FixedrateB; Va!iesw~.ability to pt!lY
Payment methods: Gash; Charge/CreditCard
Type of!facility: Privately supported; . Outpafientfacility
Accreditation: Not.a~r5ljcat)le"
Licensing/Certification: No information provided

osteoporosis, heterotropic ossification, presence of


plates/pins/screws in femur, hip/knee/ankle
subluxation. No deep vein thrombosis. No unhealed
bone fractures.
Treatment course:
Evaluation! assessment -1-2 hours {initial evaluation}
Pre-implementation therapy - 6-8 wks; 3 timeslwk
Outpatient implementation - 3 times a week (training)
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $1,000-$5,000
3rd party payers typically cover: No costs
Type of equipment: Clinic use stimUlator; Home use
stimulator, Not FDA approved stimulator;
Transcutaneous/surface electrode( s)
Availability of equipment: Purchase

WHERE TO GET FES

165
SPAIN

97.02

FES Application:
Cardiovascular exercise
Bicycle ergometry
Description: TTl ERGYS cycle ergometry - computer
controlled stim. of quadriceps, hamstrings, and gluteal
muscles via 18 surface electrodes, for persons with
paraplegia & tetraplegia, 30 min. of exercise 3 x / week.
History: Available for 2 years, capacity of 6 per day.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C3-8
Thoracic: Motor: T1-12
Lumbar: Motor. L1
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 3 months

97.03

FES Application:
Neuromuscular treatments
Treating weak, atrophied muscles
Description: TTl SpectraStim 2000 p 2 channel
computer controlled stimulator. Used to strengthen
atrophied muscles, usually in preparation for cycle
ergometry or walking.
History: Has been available for 2 years, maximum
capacity of 6 persons per day.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C3-8
Thoracic: Motor: T1-12
Lumbar: Motor: L 1
Hemiplegia
Paraplegia
Tetraplegia! Quadriplegia

97.04

FES Application:
Neuromuscular treatments
Regaining voluntary function
Description: TTl NeuroEducator II 4 channel
biofeedback computer controlled system for regaining
voluntary function of impaired muscles.
History: Available for 2 yrs, capacity of 6/ day.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C3-8
Thoracic: Motor: T1-12
Lumbar: Motor: L1-5
Sacral: Motor: S1-3
Hemiplegia

Restrictions/ Contraindications: No cardiac


pa~ma~er, severe osteoporOSiS, heterotropic
o~slficabon, severe autonomic dysrefJexia,

hlp/knee/ankle subluxation, presence of


plates/pins/screws in femur, no unhealed bone
fractures.
Treatment course:
Evaluation/ assessment - 1-2 hours (initial evaluation)
Pre-implementation treatment - 3 timeslwk for 6-8 wks
Outpatient implementation - 3 times a week (training)
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: More than $20,000
3rd party payers typically cover: No costs
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;
Transcutaneous/surface electrode( s)
Availability of equipment: Purchase; Rental

Time elapsed post-injury/onset: 3 months


Restrictions/ Contraindications: No cardiac
pacemaker, severe osteoporosis, heterotropic
ossification, severe autonomic dysreflexia,
hip/knee/ankle subluxation, presence of
plates/pins/screws in femur, no unhealed bone
fractures.
Treatment course:
Evaluation/ assessment -1-2 hours (initial evaluation)
Pre-implementation therapy/treatment - 3 times a week
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $1,000-$5,000
3rd party payers typically cover: No costs
Type of equipment: Clinic use stimulator; Home use
stimulator; FDA approved stimulator;
Transcutaneous/surface electrode(s)
Availability of equipment: Purchase; Rental

Paraplegia
Tetraplegia/ Quadriplegia
Time elapsed post-injury/onset: 1 month
Restrictions/ Contraindications: No unhealed bone
fractures.
Treatment course:
Evaluationl assessment -1-2 hours (initial evaluation)
Pre-implementation therapyltreatment - 3 times a week
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: Less than $1,000
3rd party payers typically cover: No costs
Type of equipment: Clinic use stimulator; FDA
approved stimulator; Transcutan/surface electrode(s)
Availability of equipment: No information provided

166

FES RESOURCE GUIDE

languages

98.01

FES Application:
Bladder control
Bladder emptying
Bladder incontinence

Description: SARS (Sacral Anterior Root Stimulator)

for bladder control, Brindley system.

History: 20 cases in five years.

Status: Clinical service

Candidate Description:

Spinal cord injury

Cervical: Motor: C7-8/ Sensory: C7-8

Thoracic: Motor: All levels / Sensory: All levels

Lumbar: Motor: L1 / Sensory: L1

ASIA Intemationallmpairment Scale: A B

Paraplegia

Tetraplegia! Quadriplegia

Time elapsed post-injury/onset: 1 year

98.02

FES Application:
Bowel control
Bowel emptying
Bowel incontinence
Description: SARS (Sacral Anterior Root Stimulator)
for bladder control, Brindley system.
History: 20 cases in five years.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C7-8 / Sensory: C7-8
Thoracic: Motor: All levels / Sensory: All levels
Lumbar: Motor: L 1 / Sensory: L1
ASIA International Impairment Scale: A, B
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 1 year

Restrictionsl Contraindications: Restrictions: sacral


sores, implanted prosthetic materials. Contraindications:
younger than 18 years, psychiatric disorders.
Treatment course:
Evaluation/ assessment - 1 month
Inpatient surgical procedure(s) - 1 month
Outpatient surgical procedure(s) - 3 weeks
Training - 2 weeks
Maintenance / check-ups - 3 months
Approximate number of visits required in total: 10
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $5,000-$10,000
3rd party payers typically cover: No costs
Type of equipment: Home use stimUlator; Not FDA
approved stimUlator; Implanted electrode(s)
Availability of equipment: No charge

Restrictionsl Contraindications: Restrictions: sacral


sores, implanted prosthetic materials. Contraindications:
younger than 18 years, psychiatric disorders.
Treatment course:
Evaluationl assessment - 1 month
Inpatient surgical procedure(s) - 1 month
Outpatient surgical procedure(s) - 3 weeks
Training - 2 weeks
Maintenance / check-ups - 3 months
Approximate number of visits required in total: 10
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $5.000-$10,000
3rd party payers typically cover: No costs
Type of equipment: Home use stimUlator; Not FDA
approved stimu lator
Availability of equipment: No charge

--

--

WHERE TO GET FES

167
SPAIN

98.03

FES Application:
Sexual function
Erection / electroejaculation
Description: SARS (Sacral Anterior Root Stimulator)
for erection control, Brindley system.
History: 20 cases in five years.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical: Motor: C7-8/ Sensory: C7-8
Thoracic: Motor: All levels I Sensory: All levels
Lumbar: Motor: L1 / Sensory: L1
ASIA International Impairment Scale: A. B
Paraplegia
Tetraplegia! Quadriplegia
Time elapsed post-injury/onset: 1 year

98.04
FES Application:
Lower limb movement
Stepping and walking
Standing / transfer assistance
Description: Joseph Stefan Institute - ALT-2 is a dual
channel stimulator for cyclical training of muscles for
standing and gait for persons with spinal cord injuries.
Each participant needs two devices.
History: We started in 1991; 33 have been treated.
Status: Experimental research
Candidate Description:
Spinal cord injury
Thoracic: Motor: T4-11 / Sensory: T4-11
ASIA International Impairment Scale: A, B
Paraplegia

'99.00

Restrictions/ Contraindications: Restrictions: sacral


sores, implanted prosthetic materials (rachis).
~ontraindications: younger than 18 years, psychiatric
disorders.
Treatment course:
Evaluation/ assessment - 1 month
Inpatient surgical procedure(s) - 1 month
Outpatient surgical procedure(s) - 3 weeks
Training - 2 weeks
Maintenance / check-ups - 3 months
Approximate number of visits required in total: 10
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $5,000-$10,000
3rd party payers typically cover: No costs
Type of equipment: Home use stimulator; Not FDA
approved stimulator
Availability of equipment: No charge

Time elapsed post-injury/onset: 3 months


Restrictions/ Contraindications: Age over 55;
obesity.
Treatment course:
Evaluation! assessment - 2 weeks
Training - 2 months
Maintenance / check-ups - 1 month
Approximate number of visits required in total: 10
Requires evaluation at this faCility? Yes
Requires local lodging? No
Typical cost: $1,000-$5,000
3rd party payers typically cover: No costs
Type of equipment: Home use stimulator; Not FDA
approved stimulator; Transcutan/surface electrode(s)
Availability of eqUipment: Purchase

Locatio.... of services:; Serviceptoviders;iocatidn.


Accessibllity:WheeIChairaccessible,incf:~athrooms;
Handicappectparking available; Near accessibte~,public
t1()spitaIJuanCanatejo
transport; Accessible hotelneaFby ..
". .
.
i.2as Jubias, 84
PopulatJonei1Jerved: Adult (age 16 to 65) ......
lJl~oruna15006
Areas served%~acia! NorthwestotzSpairiifL
SPAIN
Referral requiredlYesfrpm: Ph
..
'Te.l: 034=81=171817
TolIfree:
BilUngii!'fo: No charge.ic:Spa
FA)(!034-81-178001
E.;Mail:}
Paynteijt method&;Wilfbill
Director: .,Dr. FranCisco J. Juan, Chief of Spinal Cord
- H~alth:~alacia~rvice. ..;.... ...
Injuryl)nit
1Y~of"faCillty:Pl.lbliG1y;'StJPp~rtedl,StEf':ag_ey.; .
CorttactfPersort:Dr. Salvador de la Baltera. SCIUhit.
Inpattentfacility;. Outpatie~tfSGility;8o~health .... '
Prog".rn!DescriPtion:weu~e FES.fG~'resttJre
a9enc~hRenab,center; Reflab'!;'program; Researth&
inde~nden(J6.andfUncti(:)n; f$tipersonswith SEt
'developmel'it;cer1ter
Informatioll""lab~:'PrinteO format; Languages
Accreditation:SpanishAccredifed
iother than English -Spanls!:r .
Licensing/Sanification: Not applicable
I'lOQrs: 4hoursa day, MOl'lday Friday

Electrical Stimulation fQr Spinal Cord InJured:


lJnidad de Lesionados'Medulares ..

168

FES RESOURCE GUIDE

SPAIN / UNITED KINGDOM

99.01

FES Application:
Lower limb movement
Stepping and walking
Description: We use the Parastep (R) System to
restore independence and function of selected Spinal
Cord Injured individuals in order to improve
independently and take steps.
History: Available for 2 years, more than 12 persons
have been treated, we have 30 beds for spinal cord
injured and we use inpatient and outpatient resources.
Status: Clinical service
Candidate Description:
Spinal cord injury
ASIA International Impairment Scale: A
Paraplegia

--

Restrictionsl Contraindications: No info. provided


Treatment course:
Evaluation/ assessment - one time
Pre-implementation therapy - 3 times/wk for 2 weeks
Training - 3 times a week for 12 - 14 weeks
Maintenance / check-ups - every week
Approximate number of visits required in total: - 32/34
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: $10,000-$20,000
3rd party payers typically cover: All costs; Spanish
Social Security Health Care System
Type of equipment: Clinic use stimulator; FDA
approved stimulator; Transcutaneous/surface
electrode(s)
Availability of equipment: No charge

UNITED KINGDOM

~ 100.00
UniYersityofBristol
Bristol Royal Infirmary
Clinic 8 level 5
Bristol Royallnfirinary
MarlbOrough'Street .
Bristof.BS281TW
UNITEDKINGDOM
Tel: 44.117-928-3022. Toll-free:
FAX: 44-117-928-2470. E-Mail:
Director: Dr. Rosie Jones
Contact Person: Dr. Rosie Jones
Program Description: Exercise stimulation and
footdrop FES for persons with multiple sclerosis and
peripheral nerve injury. Stimulation of facial
musculature for function restoration, myoplastic
stimulation for incontinence.

100.01

FES Application:
Lower limb movement
Stepping and walking
Description: Exercise stimulation for improvement of
footdrop. Use of heel switched footdrop devices for
selected users.
History: Available for 5 years, evaluation of
neuromuscular performance and outcomes of
stimulation strategies.
Status: No information provided
Candidate Description:
Multiple sclerosis
Restrictionsl Contraindications: Not ataxic

Infonnation available: Printed format


Hours: 9:00 AM to 5:00 PM, 4 days a week
Location of services: Service providers location
Accessibility: Wheelchair accessible, inct bathrooms;
Handicapped parking available; Near accessible public.
transport
Populations served: No restrictions
Areas served: United Kingdom
Referral required? No
Billing info: No charge
Payment methods: No information provided '.
Type of facility: Publicly. supported; Non-profit;
Outpatient facility; Hospital; Rehabilitation program;
Research & development center
Accreditation: No information provided
Licensing/Certification: Not applicable

Treatment course:
Evaluation/ assessment - on admission
Pre-implementation treatment - exercise programme
Outpatient implementation - 1 mo. after exercise started
Post-implementation therapy/treatment - review of
whole programme is 12 weeks
Maintenance / check-ups - monthly for 12 weeks, then
every 6 months
Requires evaluation at this facility? Yes
Requires local lodging? No; Live all over the United
Kingdom
Typical cost: No information provided
3rd party payers typically cover: No costs
Type of equipment: FDA approved stimulator
Availability of equipment: No charge

hra

WHERE TO GET FES

169
UNITED KINGDOM

100.02

FES Application:
Bowel control
Bowel incontinence
Description: Feedback and stimulation in persons with
fecal incontinence from neurologic damage and
ideopathic nerve degeneration. Myoplastic stimulation
for anal repair.
History: New project.
Status: No information provided
Candidate Description:
Other spinal disorder: Peripheral nerve injury
Lumbar
Sacral
Restrictions/ Contraindications: Ideopathic nerve

Dr.

injury.
Treatment course:
Evaluation/ assessment - on admission
Pre-implementation therapy - exercise programme
Inpatient surgical procedure(s) - varies if repair required
Outpatient implementation - 1 mo after exercise started
Training - 1 session
Post-implementation therapy/treatment - monthly
Requires evaluation at this facility? Yes
Requires local lodging? No; Live all over the U.K.
Typical cost: No information provided
3rd party payers typically cover: No costs
Type of equipment: FDA approved stimulator
Availability of equipment: No charge

Nick Donaldson

pf(Klr,llm.iHlnnj~iftn: Evaluation of potential value of

101.01

FES Application:
Lower limb movement
Standing / transfer assistance
Description: 12-channellumbar anterior root
stimulator, using intradural tripolar electrodes and RF
linked multiplexor implant stimulator. External
equipment software controlled.
History: Current programme 1992-1997.
Investigational use of up to 8 devices. One device so
far has been implanted under this programme (as of
3/95).
Status: Experimental research
Candidate Description:
Spinal cord injury
Thoracic: Motor: T 4-12 / Sensory: T6-12
Paraplegia
Restrictions/ Contraindications: Excess spasticity,
lower motor neuron paraplegia. hip or knee
contractu res. heterotropic ossification, significant
concurrent medical illness. autonomic dysreflexia, no

lumbar spinal instrumentation, no known


post-traumatic syringomyelia.
Treatment course:
Evaluation/ assessment - 2 weeks
Pre-implementation therapy/treatment - 12 weeks
Inpatient surgical procedure(s) -1 week inpatient, 8
hour surgery
Outpatient fitting/implementation - weekly visits
Training - daily
Post-implementation therapy/treatment - as required
Maintenance / check-ups - as required
Requires evaluation at this facility? Yes; Strict
evaluation protocol
Requires local lodging? Yes; Strict evaluation
protocol
Typical cost: No information provided
3rd party payers typically cover: All costs; for U.K.
citizens
Type of equipment: Research prototype stimulator;
Implanted electrode(s)
Availability of equipment: No charge

170

FES RESOURCE GUIDE

UNITED KINGDOM
~

101.02

FES Application:
Lower limb movement
Stepping and walking
Description: Train and stand using the external closed
loop control standing system, the implant is intended to
enable standing and basic stepping.
History: Started 2 years ago, first implant 3 months
ago (as of 2/95). Development work still to come.
Status: Experimental research
Candidate Description:
Spinal cord injury
Thoracic: Motor: T3-12
Paraplegia
Time elapsed post-injury/onset: 1 year
~
102.00
Evaluation'of a Hybrid Walking Orthosis
Combini~g Functional Electrical Stimulation
with theJiReciprocating Gait Orthosis

North Western Orthotic Unit - Clinical Sciences Building


Hope Hospital - Eccles Old Road
Salford M68HD
UNITED KINGDOM
Tel: 44"'(}161-7874242 Toll-free:
FAX: 44:.0161-7874241 E-Mail:
epowtee@fsi.ho.man.ac.uk
Director: Mr. Ers Ross
CoritactPerson: Mrs. L. Sykes
Program Description: Our aim is to evaluate the
hybrid FESand RGO system with a goal ofintroducing
it as a clinical treatment. We aim to assess the impact
of addingFES to the RGO in terms of energy
expenditure during ambulation, spasticity, bone density
~

---

Restrictionsl Contraindications: Good health, no


joint contractu res, no rodding in the spine at the implant
site, no severe spasticity. Must be complete.
Treatment course: Training for the closed loop control
standing system as above. System can be implanted
after 3 months use. One weeks hospitalization needed.
Requires eval. at this facility? No; Salisbury or RNOM
Requires local lodging? No
Typical cost: More than $20,000
3rd party payers typically cover: All costs; MRC funded
Type of equipment: Clinic use stim.; Home use stirn.;
Research prototype stirn.; Implanted electrode(s)
Availability of equipment: No charge

and RGO home use.


Information available: Please contact the Unit
Hours: variable/flexible, Monday - Friday
Location of services: Service providers location
Accessibility: Wheelchair accessible, incl. bathrooms;
Handicapped parking available
Populations served: Adult (age 16 to 65)
Areas served: Great Britain; Salford area
Referral required? Yes From: Physician
Billing info: No charge - to British National;
Participants Regional Health Authority will be charged
as appropriate.
Payment methods: Will bill Other third-party payment
Type offacility: Publicly supported; British National
Health Service; Non-profit; Outpatient facility; Hospital
Accreditation: No information provided
licenSing/CertifICation: Not applicable

102.01

FES Application:
Lower limb movement
Stepping and walking
Description: FES is applied using surface electrodes
to stirn. quadriceps with the contralateral hamstrings.
Knee lock produces reciprocal flexion/extension at the
hip. An initial conditioning programme strengthens the
muscles and improves fatigue resistance. Afterwards
stimulated walking with the RGO is introduced. The
participant is taught to coordinate muscle stirn. of the
legs with the appropriate phase of the gait cycle. In this
way propulsion during ambulation can be assisted.
History: The programme runs from Feb, 1993 to Feb.
1996 and allows for 10 participants, 7 are currently
involved or being assessed (as of March '95).
Status: Experimental research
Candidate Description:
Spinal cord injury
Paraplegia
Tetraplegia/ Quadriplegia - incomplete
Other spinal disorder: spina bifida
Restrictionsl Contraindications: Participant must be:
adult; suitable candidates for an RGO or already an
RGO user; no lower motor neuron lesion of nerves
supplying quadriceps or hamstrings; non progressive

illness; no pacemaker; no significant cardiovascular/


respiratory illness; no history of recent bone fractures;
able to make time/travel commitments; well motivated.
Treatment course:
Evaluation/ assessment - 5 visits approx. 1 hr. each
Pre-implementation therapy/treatment - depends on
participants physical condition
Outpatient fitting - 2 visits approx. 1 hour each (RGO)
Training - 2 - 3 times a week for 6 weeks (RGO)
Training - 2 - 3 times a week for 12 weeks (FES)
Maintenance / check-ups - regular review every 6 mos
Maintenance / check-ups - maintenance as needed
Approximate number of visits required in total: 75 plus
Requires evaluation at this facility? Yes; Evaluation
by a multi-disciplinary team speCialised in orthotics
Requires local lodging? No; Must be close enough to
travel on outpatient basis
Typical cost: No information provided
3rd party payers typically cover: All costs; for British
Nationals only when the National Health Service
(Public Health Service) will fund treatment.
Type of equipment: Clinic use stim.; Home use stirn.;
Research prototype stirn.; Transcutaneous electrode(s)
Availability of equipment: No charge; loaned

WHERE TO GET FES

171
UNITED KINGDOM

Dlil_Clfa;' TQnyTi'orrmh$
COliilaJctFten~on: ToilY,tJ".romaI1S"

tion!l'heBrindl~:(};itl~techJ
blt;ldder sti
.......<implanted for imProVement of.
blatJder function ~O(terection.

103.01

FES Application:
Bladder control
Bladder emptying
Description: Brindley (Finetech) bladder implant.
History: Available for 3 years in Salisbury.
Status: Clinical service
Candidate Description:
Spinal cord injury
Cervical
Thoracic
Paraplegia
Tetraplegia! Quadriplegia
...
Restrictions/ Contraindications: No significant spinal
sensation. Must have adequate hand control.

@
104.00
Dukeof'CotnwallSpinal TreatmenH::entre.
Depa
ntof Medical'.Physics:anttr;;
Bio
alEngineering

i.icensing/Cettlftcation: Ndt'applicable

Treatment course:
Evaluation/ assessment - video-urodynamics and anal
stimulation
Inpatient fitting/implementation - 1-2 wks hospitalization
Maintenance I check-ups - 6 monthly follow-up
Requires evaluation at this facility? No; One of
several centers
Requires local lodging? No
Typical cost: $10,000-$20,000
3rd party payers typically cover: No info. provided
Type of equipment: Not FDA approved stimulator;
Implanted electrode(s)
Availability of equipment: No information provided

Location of servi.: No information provided '.'


Accessibility: Wheelchair accessible, inct ba'throoms;
0

Handicappedparking~'ilable

PopulationsserV!d:Adult(age 16 t06S)

Salisbury District Hospital


Areas served: Unlimited

SalisburyWiltshire'SP28BJ
Referral required? Yes From: Physician

UNITED KINGDOM
Billing, info: No charge

Tel: . f 722-336363 ext 4065


Ton-free~
Payment methods: No infotmationprovided .

FAX: 1722-325904
E~MaiU
Type of fac,lity: DepartmentofH~lthiNon-ptofft;
.Director: Ian SWian for standing and gait; John Hobby ... Outpatient facility; Hospita~ Rehabmtation center;
for hand grasp
RehabiUtatiooprogram; Researchoi&development
ConuctPerson:.Paul Taylor .. ~1
center
Program Description:.:No.inform'atlorl:provided
AccreditatiomNoinformation provided
InforrnationavailabkcPrinted format ..
licenSing/Certification: Not applicable
Hours: 1:00 PM t05:30.PM,Tues., Wed. and Thurs.
'00

172

FES RESOURCE GUIDE

UNITED KINGDOM
l

104 :01

FES Application:
Lower limb movement
Standing / transfer assistance
Description: Quads and glutes stimulated for knee
and hip extension. Knee angle monitored and
feedback to control quad stimulation, surface
stimulation. Participants stand for typically 15 minutes,
1 hour maximum, system used for standing anywhere.
History: Developed over the last ten years, here,
University of 8ath, and at Rnom Stanmore. Used by
about 30 persons, capacity of 10 a year.
Status: No information provided
Candidate Description:
Spinal cord injury
Paraplegia
Thoracic: Motor: T3-12 / Sensory: T3-12
Restrictionsl Contraindications: Joint contractu res,
poor health, bad spasticity
Treatment course:
Evaluation/ assessment - one session

Pre-implementation therapy/treatment - passive


standing and strengthening 0 - 1 month
Outpatient fitting/implementation - 3 mos ES training - 2
mos (1 session a week) standing practice, 0 - 2 mos
setting up close loop control.
Maintenance / check-ups - monitored at 1 wk, 1 mo, 3
mos and then every 6 mos after home use
Approximate number of visits required in total: 15
Requires evaluation at this facility? No; Used at
Rnom Stanmore, Marie Theties House, St Michaels
Hosp, Hayle, Cornwall
Requires local lodging? No
Typical cost: $5,000-$10,000
3rd party payers typically cover: All costs;
Department on Health / MRC funded
Type of equipment: Home use stimulator; Not FDA
approved stimulator; Transcutan/surface electrode(s)
Availability of equipment: No charge; Not outside the
prOQramme

104.02

FES Application:
Lower limb movement
Stepping and walking
Description: A single channel dropped foot stimulator
and a two channel stimulator that can be adapted for
several different functions are available. The devices
are controlled using foot switches or hand switches.
History: Developed over 6 years in Salisbury, over 120
partiCipants but this includes 70 or so persons with
stroke.
Status: No info provided; Experimental research
Candidate Description:
Multiple sclerosis
Hemiplegia
Cervical
Thoracic

Sacral
Time elapsed post-injury/onset: 1 year
Restrictions/ Contraindications: Good health, no
joint contractures, no severe spasticity.
Treatment course:
Evaluation/ assessment - varies case to case
Requires evaluation at this facility? No; Here or at
Marie Theties House, St Michaels Hospital Hayle,
Cornwall
Requires local lodging? No
Typical cost: Less than $1,000
3rd party payers typically cover: All costs
Type of equipment: Clinic use stirn.; Home use stirn.;
Not FDA approved stimltr.; FDA approved stirn.;
Transcutaneous/surface electrode(s)
Availability of equiDment: Purchase; No charge

l
104 .03
FES Application:
Upper limb movement
Grasping
Description: The Cleveland implant is a totally
implanted 8 channel stimUlator designed to provide key
and palmar grip. It is controlled by movements of the
contralateral shoulder.
History: PartiCipant selection started last year. First
implant planned for April, 1995.
Status: Experimental research; Feasibility study; Multi
center clinical trial
Candidate Description:
Spinal cord injury
Cervical: Motor: C5-6/ Sensory: C5-6
Tetraplegia/ Quadriplegia
Time elapsed post-injury/onset: 2 years
Restrictionsl Contraindications: Must be in good
health, no contractu res, no severe spasms

Treatment course:
Evaluation/ assessment - 3 sessions
Pre-implementation therapyltreatment - 5 wks as
outpatient
Inpatient surgical procedure(s) - 1 week as an inpatient
Inpatient fitting/implementation - daily 3 weeks training,
one month after implant
Training - continues
Maintenance / check-ups - continues
Approximate number of visits required in total: 8 - 10
Requires evaluation at this facility? Yes
Requires local lodging? No
Typical cost: More than $20,000
3rd party payers typically cover: All costs; Funded
by charity and the Department of Health
Type of equipment: Home use stimulator; Not FDA
approved stimUlator; Implanted electrode(s)
Availability of equipment: No charge

--

WHERETO

FES

173
UNITED KINGDOM

.. 'ers location
incl. bathrooms;
pssible public
S:$lemed~

''rolL:.fre.Zt;.

114'i~11~~i403 ~,:;"

b.heller@sheffi~ld:ac.uk
Director: DrJBen Heller

Contact P:etson: Dr. BerrHelier

Program ~crlptlon:Res.earch. intothe<J~~~ment

of FESproquCed standingj\A.'~lkingandconti~

Information available;, i'4o'infOrmationpmvltled .

105.01

FES Application:
Lower limb movement
Stepping and walking
Description: Investigating the detection of anticipatory
movements to improve balance control in FES
standing.
History: Available for 1 year, is a research
programme.
Status: Experimental research
Candidate Description:
Spinal cord injury
Thoracic: Motor: T6 / Sensory: T6
Paraplegia
Time elapsed post-injury/onset: 2 years

105.02
FES Application:
Bladder control
Bladder emptying
Description: We support the Sheffield Spinal Injuries
Unit in the set-up and follow-up of the Finetech
Brindley Sacral Anterior Root Stimulator.
History: Available for 10 years, approximately 50
people have partiCipated.
Status: Clinical service
Candidate Description:
Spinal cord injury
Thoracic: Motor: T1
Lumbar: Motor: L1
Paraplegia
Restrictionsl Contraindications: No info. provided

No restricti~~, . ..........
Kingdom, N~m
Yes From: Physician
charge
No infol'iTlBonprovided
Publicly suppolted; BtitishNational
Non-profit; ReS~~& development

O';>",UII.1:I\.1

Restrictions! Contraindications: No info. provided


Treatment course:
Evaluation/ assessment - 1 time
Training - 3 times a week for 10 weeks
Post-implementation therapyltreatment - 1/wk for 6 wks
Approximate number of visits required in total: 10
Requires evaluation at this facility? Yes
Requires local lodging? Yes
Typical cost: $1,000-$5,000
3rd party payers typically cover: No info. provided
Type of equipment: Clinic use stimUlator; Research
prototype stimUlator; Transcutaneous/surface
electrode(s)
Availability of equipment: No charge; loaned to
participants

Treatment course:
Evaluation! assessment
Inpatient surgical procedure(s)
Inpatient fitting/implementation
Training
Maintenance / check-ups
Approximate number of visits required in total: 6
Requires evaluation at this facility? Yes; Need
urodynamic equipment
Requires local lodging? No
Typical cost: $5,000-$10,000
3rd party payers typically cover: All costs; NHS
Type of equipment: Home use stimulator; Not FDA
approved stimulator; Implanted electrode(s)
Availability of equipment: No charge; provided by NHS

174

FES RESOURCE GUIDE

--

--

--

--

--

L
PART 3. MORE RESOURCES ON FES

This part has been compiled to assist readers who like to do as much research as they
can before making a big decision. You may want more information than this book alone
can provide. The resources in this part can assist you in gathering the additional FES
information you need. Because there are many general resources available on spinal
cord injury or multiple sclerosis, there is no attempt to duplicate that material here. If you
need more information on non-electrical stimulation topics, such as details on traditional
treatments, contact the entries in this section marked with an asterisk (*) for assistance.
The following additional resources are contained in this part:

Suggested Reading on Functional Electrical Stimulation


A selected, topical bibliography with both popular and technical references on
functional electrical stimulation

Information and Referral Centers


Libraries, information centers, publishers and consumer organizations that can
help consumers and professionals find information on electrical stimulation

Professional Organizations
An alphabetical listing of professional organizations that sponsor special interest
activities in functional electrical stimulation

Stimulation Equipment Manufacturers


An alphabetical listing of selected manufacturers of FES products such as
stimulators and electrodes. The manufacturers included here were identified by the
FES providers listed in Part 2. Where to get FES.

175

Part 3. More Resources on FES


Suggested Reading on Functional Electrical Stimulation
These selections are intended to provide additional reference material for the reader interested in
learning more details about functional electrical stimulation and its specific applications. These listings are
meant to be a comprehensive bibliography on the topic of FES. These references were chosen to be
representative of current work in the field of FES. Each reference can lead the interested person to many
additional references on related topics.
Both popular literature and technical references are provided. The readings are listed by topic, using
the same terms and ordering as those that described the FES applications in Patt1. Learning about FES.
Most of the readings deal with FES in spinal cord injury because there is less literature available on FES in
multiple sclerosis.

.om

I. Popular Literature
For someone who does not have a technical background in functional electrical stimulation, finding
good reference materials is difficult. Most of the articles that appear in the popular press tell one person's
story, and do not review all of the options, FES or otherwise. Some of the materials listed below are reviews,
others are not, but each was selected because they do describe current FES techniques. A layperson should
be able to understand the information in these materials with minimal technical assistance. Most of these
references should be available from a public library. Ask your librarian if you need help locating them, or
contact the FES I nformation Center.
GENERAL
FES Information Center. Introduction to Functional Electrical Stimulation. FES Information Center:
Cleveland OH, 1992.
FES Information Center. Layperson's Glossary on Functional Electrical Stimulation. FES Information
Center: Cleveland OH, 1992.
Functional Electrical Stimulation. In: Spinal Network, Spinal Network: Boulder CO, 1993, P 147.
Himrich BL and Thornley S. ElectrifYing Medicine. How Electricity Sparked a Medical RevolLition. Lerner
Publications: Minneapolis, 1995.
Kantor, C. Implantable Motor Prostheses. Medical Device Research Repott. Vol 2, No 2, pp. 8-10, 1995.
Maddox S. The promise of electricity: function, nerve growth, cure? In: Spinal Network. 1st Edition, Spinal
Network: Boulder CO, 1987, pp 95-98.
CARDIOVASCULAR EXERCISE
FES Bikes. In: Spinal Network. Spinal Network: Boulder CO, 1993, pp 158-160.
RX for Fitness Part 3: Start Doin' It! Paraplegia News, June, 1995, pp 42-49.
BREATHING ASSISTANCE
Underhill W. Assisted Breathing. In: Spinal Network, Spinal Network: Boulder CO, 1993, pp 107-112.
COUGH ASSISTANCE
Coughing device patented. SCI Life, Spring, 1995, p 10.

Medical News: Hit the cough button. New Mobility, Fall, 1992, p 21.

176

FES RESOURCE GUIDE

GRASPING AND REACHING

---

Kilgore KL and Bryden A. Heart in Hand - Regaining Hand Function. Team Rehab Report, July, 1995, pp.
26-29/40.
New device may restore use of hand. SCI Life, Spring, 1995, p 10.

BLADDER CONTROL
King T. Taking control- Proper diagnosis and treatment are the keys to controlling, not just managing,

urinary incontinence. Team Rehab Report, September, 1995, pp 23-25.

Maddox S. Bladder news. Spinal Network Extra, Spring, 1991, pp 14-15/17.

Perkash I. The paralyzed bladder: Currenttreatments. Paraplegia News, Vol 45, No 9, pp 20-21, 1991.

TRANSFERS AND STANDING


Bak OJ. Standing up to spinal injury. Design News, May 7, 1990, pp 119-121.

STEPPING AND WALKING


Intensive therapy and walking. In: Spinal Network. Spinal Network: Boulder CO, 1993, pp 148-157.

Jaeger RJ. Stimulating steps. TeamRehab Report, July, 1994, pp 19-24.

Kobetic R. Advancing step by step. IEEE SPECTRUM, Vol 31, No 10, pp. 27-31,1994.

Olofson C. Computer-aided walking: Restoring natural gait to paraplegics. Technology Review, Vol 96, No

1, pp 11-12, 1993.

ELECTROEJACULATION
Fertility for men. In: Spinal Network, Spinal Network: Boulder CO, 1993, pp 332-338.

Fertility Update. New Mobility, July/August, 1995, pp.18-21.

PAIN MANAGEMENT
Kahn, J. Pain management using electrotherapeutic modalities. Rehab Management, Feb/Mar 1994,
p.133.

PREVENTINGITREATING OSTEOPOROSIS
Gerhart KA. Osteoporosis: a fact of life. Paraplegia News. August, 1995, pp 32-36.
Mysiw WJ. The role of weight bearing and functional electrical stimulation -induced exercises on bone loss
after an acute spinal cord injury. Paraplegia News, December, 1990, pp 38-39.

REGAINING VOLUNTARY FUNCTION/ IMPROVING MOVEMENT CONTROL


Goldsmith MF. Medical News- Computerized biofeedback training aids in spinal injury rehabilitation.
JAMA, February 22,1995, pp 1097-1099.
Woodworth B. Defying the odds: therapeutic electrical stimulation can be useful in treating various forms
of neuromuscular disorders. Independent Living, Sept-Oct 1993, b8 n4 p32(4).

MORE RESOURCES ON FES

177

II. Technical References


Most technical references are "peer-reviewed" which means that experts have checked them for technical
accuracy before they are published. Therefore, they are generally more accurate than the information that
appears in the popular literature, but also more difficult to understand. The references listed below really
require some background in medicine or engineering to fully understand the material. Consider asking your
doctor or other health care professional for assistance to help interpret these materials. It may also be helpful
to have a medical and/or technical dictionary handy. These references should be available from a college or
hospital library. Contact the FES Information Center if you are unable to locate a library in your region.
GENERAL
Anthology on Electrical Stimulation. Physical Therapy. American Physical Therapy Association: Alexandria
VA Volumes 1-4, 1993. (Covers muscle function, pain management, wound healing, and paralysis
management. )
Baker LL et al. NeuroMuscular Electrical Stimulation - A Practical Guide. Los Amigos Research and
Education Institute: Downey, CA, 1993.
Brindley GS and Rushton ON, Eds. Neural Prostheses. Balliere's Clinical Neurology Series. Balliere
Tindall: London. Vol 4, No 1,1995.
Kahn J. principles and practice of Electrotherapy. Churchill Livingstone: New York, 1994.
Peckham PH and Creasey G. Neural prostheses: clinical applications of functional electrical stimulation in
spinal cord injury. Paraplegia, Vol 30, pp 96-101, 1992.
Scott, TRD and Peckham PH. Functional electrical stimulation and its application in the management of
spinal cord injury. In: Diagnosis and Management of Disorders of the Spjne, R Young and RM Woolsey,
Eds. WB Saunders: Philadelphia, pp 377-396,1995.
Special Issue on Functional Electrical Stimulation. Assistive Technology, Vol 4.1 , 1992.
Special Issue on Functional Electrical Stimulation. Basic and Applied Myography, Vol 4, No 2,1994.
Special Issue on Functional Electrical Stimulation. Joumal of Rehabilitation Research and Development,
Vol 33, No 2, 1996.
Stein RB, Peckham PH, Popovic, DB. Neural prostheses: Replacing motor function after disease or
disability, Oxford University Press: New York, 1992.
Yarkony G et al. Neuromuscular stimulation in spinal cord injury I: Restoration of functional movement of
the extremities. Archives of Physical Medicine and Rehabilitation, Vol 73, pp 78-86, 1992.
Yarkony GM. et al. Neuromuscular stimulation in spinal cord injury: II: Prevention of secondary

complications. Archives of Physical Medicine and Rehabilitation, Vol 73, pp 195-199, 1992.

CARDIOVASCULAR EXERCISE
Glaser RM. Functional neuromuscular stimulation. Exercise conditioning of spinal cord injured patients.
Intemational Joumal Of Sports Medicine Vol 15, No 3, pp 142-148, 1994.
Sipski ML, Alexander CJ, Harris M. Long-term use of computerized bicycle ergometry for spinal cord injured
subjects. Archives Of Physical Medicine And Rehabilitation Vol 74, pp 238-241, 1993.
Ragnarsson K. Lower limb endurance exercise after spinal cord injury: Implications for health and

functional ambulation. Joumal of Neurological Rehabilitation v5, p37-48, 1991.

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FES RESOURCE GUIDE

BREATHING ASSISTANCE

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Elefteriades JA. Pacing of the diaphragm. In: Schields JW, Ed. Surgery of the Chest. Lea & Febiger:
Philadelphia, 1994.
Peterson DK et al. Electrical activation of respiratory muscles by methods other than phrenic nerve cuff

electrodes. Pace, Pacing And Clinical Electrophysiology, Vol 12, pp 854-860, 1989.

COUGH ASSISTANCE
Jaeger RJ et al. Cough in spinal cord injured patients: Comparison of three methods to produce cough.

Archives Of Physical Medicine And Rehabilitation, Vol 74, pp. 1358-1361, 1993.

GRASPING AND REACHING


Gorman PH and Peckham, PH. Upper extremity functional neuromuscular stimulation. Journal Of
Neurological Rehabilitation. Vol 5: 1/2 pp 3-11, 1991.
Nathan RH. Control strategies in FNS systems for the upper extremities. Critical Reviews in Biomedical

Engineering, Vol 21, No 6, pp 485-568, 1993.

Wieler M et al. Electronic glove augments tenodesis-grip and hand-opening in people with quadriplegia.
Physiotherapy Canada Vol 46, No 2, Suppl, p 94, 1994.

BLADDER AND BOWEL CONTROL


Creasey, G and Bodner, DR. Review of sacral electrical stimulation in the management of the neurogenic

bladder. NeuroRehabilitation, Vol 4, No 4, pp 266-274, 1994.

Tanagho EA, Schmidt RA, Orvis BR. Neural stimulation for control of voiding dysfunction: a preliminary

report in 22 patients with serious neuropathic voiding disorders. Journal of Urology, Vol 2 Pt 1, pp 340
345,1989.

TRANSFERS AND STANDING


Marsolais EB et al. Augmentation of transfers for a quadriplegic patient using an implanted FNS system. A

case study. Paraplegia, Vol 32, pp 573-579,1994.

Yarkony Get al. Functional neuromuscular stimulation for standing after spinal cord injury. Archives of

Physical Medicine and Rehabilitation, Vol 71, No 3, pp 201-206, 1990.

STEPPING AND WALKING


Bajd T et al. Use of functional electrical stimulation in the rehabilitation of patients with incomplete spinal
cord injuries. Journal Of Biomedical Engineering, Vol 11, No 2, pp. 96 - 102, 1989.
Granat MH et al. The role of functional electrical stimulation in the rehabilitation of patients with incomplete

spinal cord injury - observed benefits during gait studies. Paraplegia, Vol 31, No 4, pp 207-215,1993.

Graupe D and Kohn KH. Functional Electrical Stimulation for Ambulation by Paraplegics: Twelve Years of

Clinical Observations and System Studies. Kreiger Publishing Company: Malabar, FL, 1994.

Kantor C et al. Report on a conference on motor prostheses for workplace mobility of paraplegic patients in
North America. Paraplegia, Vol 31, pp 439-456,1993.
Pedotti A and Ferrarin M. Restoration of Walking for Paraplegics. Recent Advancements and Trends. lOS
Press: Burke, VA, 1992.

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179

Phillips CA. Functional electrical rehabilitation technological restoration after spinal cord injury. Springer
Verlag: New York, 1991.
Stein RB, Belanger M, Wheeler G. Electrical systems for improving locomotion after incomplete spinal
cord injury: an assessment. Archives Of Physical Medicine and Rehabilitation, Vol 74, pp 954-959, 1993.

ELECTROEJACULA TION
Bennett CJ et al. Sexual dysfunction and electroejaculation in men with spinal cord injury: review. Journal
Of Urology, Vol 139, pp453-457, 1988.
Ohl D. Electroejaculation. Urologic Clinics of North America, Vol 20, No 1, pp. 181-188, 1993.

PREVENTINGffREATING PRESSURE SORES


Levine SP et al. Blood flow in the gluteus maximus of seated individuals during electrical muscle
stimulation. Archives Of Physical Medicine And Rehabilitation, Vol 71, pp 682-686, 1990.
Levine SP et al. Electric muscle stimulation for pressure sore prevention: tissue shape variation. Archives
Of Physical Medicine And Rehabilitation, Vol 71, pp 210-215, 1990.
Yarkony GM. Pressure ulcers: a review. Archives of Physical Medicine and Rehabilitation, Vol 75, No 8,
pp 908-917,1994.

CONTROLLING TREMORS
Javidan M, Elek J, Prochazka A. Attenuation of pathological tremors by functional electrical stimulation. II:
Clinical evaluation. Annals of Biomedical Engineering, Vol 20, No 2, pp 225-236, 1992.

MULTIPLE SCLEROSIS
Davis R. Is spinal cord stimulation for incomplete spinal cord injury and multiple sclerosis a useful
rehabilitation prosthesis? Proc. of 12th World Congress, International Federation of Physical Medicine and
Rehabilitation. Sydney, AUSTRALIA. March 1995.
Jones RJS et al. The influence of neuromuscular stimulation on physiological activity and functional ability
in multiple sclerosis. Clinical Rehabilitation, Vol 6, Suppl., p 36,1992.
Livesley E. Effects of electrical neuromuscular stimulation on functional performance in patients with
multiple sclerosis. Physiotherapy, Vol 78, pp 914-917, 1992.

PEDIA TRIC APPLICA TIONS


Flett PJ. The rehabilitation of children with spinal cord injury. Journal of Paediatrics and Child Health, Vol
28, No 2, pp 141-146, 1992.
Smith BT and Gardner ER. Functional electrical stimulation. In: The child with a spinal cord injury, Betz RR
and Mulcahey MJ, Eds. American Academy of Orthopaedic Surgeons: Rosemont, IL, In Press, 1995.
Triolo RJ et al. Application of functional neuromuscular stimulation to children with spinal cord injuries:
candidate selection for upper and lower extremity research. Paraplegia, Vol 32, pp 824-843, 1994.
Weese-Mayer DE et al. Diaphragm pacing in infants and children. Journal of Pediatrics, Vol 120, No 1, pp
1-8, 1992.

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IInformation and Referral Centers (FES Related)


This is an alphabetical listing of libraries, information centers and consumer organizations that can
help consumers and professionals find information on electrical stimulation through the services and
resources they offer.

ABLEOATA
8455 Colesville Road, Suite 935
Silver Spring, MD 20910-3319
(301 )588-9284 or (800)227-0216
E-Mail: naric@cap.gwu.edu
ABLE INFORM BBS: (301)589-3563
ABLEDATA, funded by the National Institute on Disability and Rehabilitation Research, provides information
and referral assistance on a wide range of assistive technology products. The center maintains a database of
information about products for people with disabilities that includes some FES products. The database is
available via the Internet or on CD-ROM. Services are available for a nominal fee.

Consortium of Multiple Sclerosis Centers'


Gimbel MS Comprehensive Care Center, Holy Name Hospital
718 Teaneck Road
Teaneck,NJ 07666
(201 )837-07727; (201 )837 -8504 FAX
The consortium was established in 1986 to enhance collaboration by the foremost MS centers in North
America. It serves as an international clearinghouse for research results, the latest treatments, clinical trials,
and patient education programs, offering newsletters and other publications for health care professionals and
MS consumers. In addition, the consortium should be able to offer some assistance in identifying member
centers that use and/or evaluate FES techniques.

ECRI
5200 Butler Pike
Plymouth Meeting PA 19462
(215)825-6000
ECRI is widely recognized as the world's leading independent organization committed to the improvement of
health care technology. The organization produces the annual Health Devices Sourcebook, based on the
world's largest medical product database, which lists electrical stimUlation products. Services such as
publications, information systems, consulting, and laboratory services are provided for a fee.

FES Information Center

Cleveland FES Center


11000 Cedar Avenue
Cleveland OH 44106-3052
(216)231-3257 or (800)666-2353
E-Mail: fes_info@po.cwru.edu
HTTP:// feswww.fes.cwru.edu
The FES Information Center is an international resource center on functional electrical stimulation, offering
publications, directories, a special library and other educational materials. The center publishes a regular
newsletter, FES Update, that covers developments in the field. The Center is also the publisher of this book.
Services are available free of charge or for a nominal fee. Some services are available via the Internet.

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181

Food and Drug Administration


Center for Devices and Radiologic Health (MS HFZ 133)
Office of Orphan Products Development (MS HF35)
5600 Fishers Lane
Rockville MD 208571
The Food and Drug Administration is the federal program that monitors the safety and effectiveness of medical
products in the US. The Center for Devices and Radiologic Health is responsible for monitoring the
introduction of new products, including electrical stimulation products, and the safe use of the products.
Consumers are encouraged to partiCipate in the consumer panels that review applications for new medical
devices. The Office of Orphan Products Development monitors drugs and medical devices that support the
treatment of diseases and conditions that affect a US population of less than 200,000. Both offices can
provide some information on the status of electrical stimulation devices for people with paralysis.

Medical Economics Data, Inc.


5 Paragon Drive
Montvale NJ 07645-1742
(201 )358-7500
This organization annually publishes the Medical Device Registerwhich is a comprehensive listing of medical
products, including electrical stimulation equipment. The book is available for purchase although it can be
found at most medical libraries.

National Database of Educational Resources on Spinal Cord Injury'


Division of Education
The Institute for Rehabilitation Research
1333 Moursund
Houston, TX 77030
(713)797-5945
This comprehensive database is a central resource and retrieval center for disseminating information on spinal
cord injury. Some electrical stimulation topics are covered. This project was sponsored by the Paralyzed
Veterans of America Education and Training Foundation.

National Library of Medicine'


Office of Public Information
8600 Rockville Pike
Bethesda MD 20894
(301 )496-6308
E-Mail: publicinfo@occshost.nlm.nih.gov
The National Library of Medicine, part of the National Institutes of Health, is the world's largest research library
in a single scientific and professional field. The NLM serves as a national resource for all US health science
libraries, providing lending services through a National Network of Libraries of Medicine consisting of more
than 4,000 libraries. The library holds most of the books and journals that cover electrical stimulation topics
and its database, MEDLlNE, provides electronic access to the documents. Most materials are available via
interlibrary loan. Contact the NLM Regional Medical Library Referral (1-800-338-7657) to locate the
participating library nearest you.

National Multiple Sclerosis Society'


733 Third Avenue
New York NY 10017-3288
(212)986-3240 or (800)532-7667
The Information Resource Center and Library at the National Multiple Sclerosis Society provides a wide range
of information on multiple sclerosis, including information on innovative treatment methods. The Society and
its chapters also provide education, counseling and advocacy services. Inside MS, a magazine for the
membership, is published three times a year.

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FES RESOURCE GUIDE

National Rehabilitation Information Center (NARIC) ,


8455 Colesville Road, Suite 935
Silver Spring, MD 20910-3319
(301 )588-9284 or (800)346-2742
E-Mail: naric@cap.gwu.edu
ABLE INFORM BBS: (301 )589-3563

--

NARIC, funded by the National Institute on Disability and Rehabilitation Research, provides information and
referral assistance on all topics related to disability and rehabilitation. The center maintains a copy of FES
Information Center databases and can provide information on FES topics. Other services include publications
such as bibliographies, directories, and a newsletter. Services are provided for a nominal fee. Some services
can be accessed via the Internet.
National Spinal Cord Injury Association (NSCIAf
545 Concord Avenue, Suite 29
Cambridge MA 02138
(617)441-8500 or (800)962-9629
E-Mail: NSCIA1@eworld.com
NSCIA is the largest civilian-based organization serving the needs of the US spinal injury community. It was
started by the Paralyzed Veterans of America after World War II. The mission of the association and its
chapters is to improve the quality of life for persons with spinal cord injury and diseases and their families.
The NSCIA supports a resource center/information clearinghouse on SCI, and publishes a quarterly
magazine, SCI Life. They offer a Fact Sheet on Functional Electrical Stimulation.
Paralyzed Veterans of America (PVA)"
801 Eighteenth Street, NW
Washington DC 20006
(202)872-1300 or (800)424-8200
The PVA was founded following World War II to assist paralyzed veterans who had recently returned from the
war in re-entering mainstream society. There are member chapters around the country. The Spinal Cord
Research Foundation (SCRF) is one of the nation's largest private funding sources for spinal cord research,
supporting grants ranging from basic neuroscience to applied clinical research. The Spinal Cord Injury
Education and Training Foundation (ETF) supports innovative educational and training programs designed to
improve the knowledge and abilities of health care professionals, people with spinal cord injury or disease and
their families. Each foundation has supported electrical stimulation projects. This book was sponsored in part
by ETF. PVA also provides resources on services for disabled veterans, SCI and MS demographics, the
economic consequences of spinal cord disease, wheelchair standards, ADA accommodations, and many
other topics.
Spinal Cord Injury Hotline'
2201 Argonne Drive
Baltimore MD 21218
(800)526-3456
This hotline, run by and for persons with spinal cord injury, is available 24 hours a day and can provide much
information about spinal cord injury and treatment options, including electrical stimulation. The service is
recently affiliated with the Paralyzed Veterans of America.

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.These organizations can provide general resource information on spinal cord injury or multiple sclerosis.

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183

rofessional Organizations (FES Related)


This is an alphabetic listing of professional organizations that sponsor special interest activities in
functional electrical stimulation. Most services offered by these organizations are fee-based, although some
information may be obtained free of charge.
American Physical Therapy Association (APTA)
1111 North Fairfax Street
Alexandria VA 22314-1488
(703)684-2782
APTA is a professional organization for physical therapists. It provides many services, including publications,
educational programs, and conferences. APTA sponsors special interest groups in electrotherapy, neurology
and spinal cord injury. They also maintain a roster of therapists around the country who are certified in clinical
specialty areas, including electrotherapy.
American Spinal Injury Association (ASIA)
250 E. Superior St., Room 619
Chicago IL 60611
(312)908-3425
ASIA is an interdisciplinary professional association for health care professionals working in the field of spinal
cord injury. The annual scientific meetings regularly address advances in treatment and rehabilitation for
persons with spinal injury. On occasion, their annual meeting and educational publications cover electrical
stimulation topics.
Association for the Advancement of Medical Instrumentation (AAMI)
3330 Washington Boulevard, Suite 400
Arlington VA 22201-4598
(703)525-4890
AAMI is a unique alliance of the health care professions, providing information on the development and use of
medical technology. The association plays a major role in developing standards for medical eqUipment,
including electrical stimulation eqUipment. AAMI's services include conferences and publications.
Biomedical Engineering Society (BES)
PO Box 2399
Culver City CA 90231
(310)618-9322
The society encourages the development, dissemination, integration, and utilization of knowledge in
biomedical engineering. The society publishes a quarterly bulletin. Their annual conference usually covers
electrical stimulation topiCS.
IEEE Engineering in Medicine and Biology Society (EMBS)
345 East 47th Street
New York, NY 10017
(212)705-7900
The IEEE-EMBS is a society of the Institute of Electrical and Electronic Engineers dedicated to engineering
applications in medicine and biology. Their publications and conferences regularly cover topics in electrical
stimulation. They provide a fee-based document delivery service.
International FES Society (IFESS)
c/o Paul Meadows, Secretary
5030 N. Hill Street
La Canada, CA 91011 USA

184

FES RESOURCE GUIDE

The purpose of this new society, formalized in 1995, is to promote the understanding of the application of
electrical stimulation in the field of medicine through meetings, tutorials and publications. The society
communicates primarily through an electronic mail LlSTSERVat the University of Alberta. IFESS plans to
sponsor an annual technical meeting. English is the official language of the society.

...,

International Neuromodulation Societyl American Neuromodulation Society


1015 Chestnut Street, Suite 1400
Philadelphia, PA 19107
USA
(215)955-2364; (215)923-4939 FAX
The international society was founded in 1989; the American society was founded in 1994. The goal of
neuromodulation is not to cure a disease, but to enhance normal function or to reduce dysfunction by
modulating the chemical and electrical properties of the nervous system. The societies aim to improve the
application of neuromodulation, to provide a forum for scientific research and education, and to foster the
development of practice guidelines.

National Institutes of Health


The National Institutes of Health are the major federal institutes in the US supporting basic research in the
health sciences field. Two major programs that support FES research are:
1) Neural Prosthesis Program, Division of Fundamental Neurosciences
National Institute of Neurological Disorders and Stroke

Room 916 Federal Building

Bethesda MD 20892

(301)496-5746

This program supports investigators studying the rehabilitation of individuals with spinal cord injury and
other types of paralysis. Research focus areas are neuroprosthesis development, detection and
processing of nervous system signals, and selective activation of the nervous system for restoration of
function. The program provides quarterly progress reports and sponsors an annual technical workshop.
2) National Center for Medical Rehabilitation Research
National Institute on Child Health and Human Development

Building 61 E- Rm. 2A03

9000 Rockville Pike

Bethesda MD 20892

(301 )402-2242

Established in 1990, the mission of the center is to improve medical rehabilitation efforts to restore or
improve function in persons with disability through research on: mobility, behavioral adaptation to
functional loss, whole body response to lost function, assistive devices, outcome measures, epidemiology,
demography, and treatment intervention effectiveness. The center has funded FES projects for bowel and
bladder control, coughing, and restoration of sensation.
National Science Foundation
Biomedical Engineering and Research to Aid Persons with Disabilities
4201 Wilson Boulevard
Arlington VA 22230
(703)306-1319
The National Science Foundation is a federal government agency whose aim is to promote and advance
scientific and engineering progress in the US. The objective of the Biomedical Engineering programs is to
foster the development of biomedical engineering through the support of research and training. The program
funds various research related to FES, as well as special design projects that allow engineering students to
construct custom prototypes for persons with disabilities.

...,

MORE RESOURCES ON FES

183

IProfessional Organizations (FES Related)


This is an alphabetic listing of professional organizations that sponsor special interest activities in
functional electrical stimulation. Most services offered by these organizations are fee-based, although some
information may be obtained free of charge.
American Physical Therapy Association (APTA)
1111 North Fairfax Street
Alexandria VA 22314-1488
(703)684-2782

APTA is a professional organization for physical therapists. It provides many services, including publications,
educational programs, and conferences. APTA sponsors special interest groups in electrotherapy, neurology
and spinal cord injury. They also maintain a roster of therapists around the country who are certified in clinical
specialty areas, including electrotherapy.
American Spinal Injury Association (ASIA)
250 E. Superior St., Room 619
Chicago IL 60611
(312)908-3425

ASIA is an interdisciplinary professional association for health care professionals working in the field of spinal
cord injury. The annual scientific meetings regularly address advances in treatment and rehabilitation for
persons with spinal injury. On occasion, their annual meeting and educational publications cover electrical
stimulation topics.
Association for the Advancement of Medical Instrumentation (AAMI)
3330 Washington Boulevard, Suite 400
Arlington VA 22201-4598
(703)525-4890

AAMI is a unique alliance of the health care professions, providing information on the development and use of
medical technology. The association plays a major role in developing standards for medical equipment,
including electrical stimulation equipment. AAMl's services include conferences and publications.
Biomedical Engineering Society (BES)
PO Box 2399
Culver City CA 90231
(310)618-9322

The society encourages the development, dissemination, integration, and utilization of knowledge in
biomedical engineering. The society publishes a quarterly bulletin. Their annual conference usually covers
electrical stimulation topics.
IEEE Engineering in Medicine and Biology Society (EMBS)
345 East 47th Street
New York, NY 10017
(212)705-7900

The IEEE-EMBS is a society of the Institute of Electrical and Electronic Engineers dedicated to engineering
applications in medicine and biology. Their publications and conferences regularly cover topics in electrical
stimulation. They provide a fee-based document delivery service.
International FES Society (IFESS)
c/o Paul Meadows, Secretary
5030 N. Hill Street
La Canada, CA 91011 USA

184

FES RESOURCE GUIDE

The purpose of this new society, formalized in 1995, is to promote the understanding of the application of
electrical stimulation in the field of medicine through meetings, tutorials and publications. The society
communicates primarily through an electronic mail LlSTSERV at the University of Alberta. IFESS plans to
sponsor an annual technical meeting. English is the official language of the society.

International Neuromodulation Societyl American Neuromodulation Society


1015 Chestnut Street, Suite 1400
Philadelphia, PA 19107
USA
(215)955-2364; (215)923-4939 FAX
The international society was founded in 1989; the American society was founded in 1994. The goal of
neuromodulation is not to cure a disease, but to enhance normal function or to reduce dysfunction by
modulating the chemical and electrical properties of the nervous system. The societies aim to improve the
application of neuromodulation, to provide a forum for scientific research and education, and to foster the
development of practice guidelines.

National Institutes of Health


The National Institutes of Health are the major federal institutes in the US supporting basic research in the
health sciences field. Two major programs that support FES research are:
1) Neural Prosthesis Program, Division of Fundamental Neurosciences
National Institute of Neurological Disorders and Stroke
Room 916 Federal Building
Bethesda MD 20892
(301)496-5746
This program supports investigators studying the rehabilitation of individuals with spinal cord injury and
other types of paralysis. Research focus areas are neuroprosthesis development, detection and
processing of nervous system signals, and selective activation of the nervous system for restoration of
function. The program provides quarterly progress reports and sponsors an annual technical workshop.
2) National Center for Medical Rehabilitation Research
National Institute on Child Health and Human Development
Building 61 E- Rm. 2A03
9000 Rockville Pike
Bethesda MD 20892
(301 )402-2242
Established in 1990, the mission of the center is to improve medical rehabilitation efforts to restore or
improve function in persons with disability through research on: mobility, behavioral adaptation to
functional loss, whole body response to lost function, assistive devices, outcome measures, epidemiology,
demography, and treatment intervention effectiveness. The center has funded FES projects for bowel and
bladder control, coughing, and restoration of sensation.

National Science Foundation


Biomedical Engineering and Research to Aid Persons with Disabilities
4201 Wilson Boulevard
Arlington VA 22230
(703)306-1319
The National Science Foundation is a federal government agency whose aim is to promote and advance
scientific and engineering progress in the US. The objective of the Biomedical Engineering programs is to
foster the development of biomedical engineering through the support of research and training. The program
funds various research related to FES, as well as special design projects that allow engineering students to
construct custom prototypes for persons with disabilities.

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185

Rehabilitation Research and Development Service

US Department of Veterans Affairs

103 South Gay Street

Baltimore MD 21202-4051

(410)962-1800

The mission of the RR&D Service is to improve the quality of life of impaired and disabled veterans through
support of an intramural research and development program. The program is designed for rapid transfer of
RR&D technology and dissemination of information into the VA medical care system. The Service publishes a
quarterly journal and annual progress reports that are available free of charge. In addition to merit review
research projects on functional electrical stimulation at individual VA Medical Centers, RR&D also supports a
Center of Excellence in FES.

RESNA (Rehabilitation Engineering and Assistive Technology Society of North America)


1700 North Moore Street, Suite 1540

Arlington VA 22209-1903

(703)524-6686

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'

RESNA is an interdisciplinary association for the advancement of rehabilitation and assistive technology. It

sponsors an annual conference and publishes a newsletter and a journal, Assistive Technology. The society

supports a special interest group on Electrical Stimulation (SIG-10) that meets annually and coordinates FES

activities at the annual conference. The association has a special mission to include consumers with

disabilities in its membership.

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Society for Physical Regulation in Biology and Medicine


(formerly Bioelectrical Repair and Growth Society)
PO Box 64
Dresher PA 19025
(215)659-5180
The purpose of the society is to further international and interdisciplinary research, communication,

cooperation, and education in the study and clinical applications of the effects of electricity and magnetism in

growth, repair, and regeneration of human cells and tissues. Electrical stimulation applications such as

pressure ulcer treatment, promoting bone growth, and regeneration of neural tissues are of particular interest

to this society. The society hosts an annual conference.

Whitaker Foundation
901 15th Street, NW, Suite 1000

Washington, DC 20005

(202) 408-1505
The Whitaker Foundation is the major private source of funding for biomedical engineering in the US. It has
provided funding for various FES projects in recent years. The foundation recently announced its plans to
liquidate its assets by the year 2006 in order to concentrate its efforts and funds over a brief time span to best
serve the biomedical engineering community.

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IManufacturers of Electrical Stimulation Equipment


This is an alphabetical listing of selected manufacturers of FES products such as stimulators and
electrodes. The manufacturers included here were identified by the FES providers included in Part 2. Where
to get FES. Each entry includes an address, phone number and brief information about the type of FES
products that are available. Each entry also includes a description of the kinds of FES applications that the
particular manufacturer's products have been used for as reported by the FES providers listed in Part 2. This
does not necessarily imply any endorsement of the use of these products for this purpose by the manufacturer
or the FES Information Center and its affiliates.

L
186

FES RESOURCE GUIDE

3M Health Care
3M Center Building, 275-4E-01
st. Paul, MN 55144-1000
800- 228-3957
Products- Electrode: Transcutaneous/surface

Treatment Applications
Cardiovascular Exercise
Lower Limb Movement
Neuromuscular Treatments

Asah Medico A/S


Physical Med
Valseholmen 11-13
Hvidovre DK-2650
DENMARK
Tel: 45-31-784466
Products- Electrode: Transcutaneous/surface

Treatment Applications
Upper Limb Movement

Atrotech Co.
Treatment Applications
P.O. Box 28
Respiratory Treatments
FIN - 33721
Tampere, FINLAND
Products- StimUlator

Description- Atrostim , JUKKA - Phrenic nerve stimulator. See also Medlink Technical Corporation.

Avery Laboratories Inc. I The Dobelle Institute


Treatment Applications
61 Mall Drive
Bladder Control
Commack,
Bowel Control
Respiratory Treatments
Long Island, NY 11725-5703
516-864-1600
Products- Stimulator; Electrode: Implanted

Description- Breathing Pacemakers, Diaphragm Pacer - uni-Iateral or bi-Iateral implanted diaphragm

pacers; Micturition Stimulator - activation of bladder contractions by direct spinal cord stimulation;

Percutaneous Electrical Nerve Stimulator, Implantable Peripheral Nerve Stimulator - for severe,

intractable pain.

Axelgaard Manufacturing Co., Ltd.


329 West Aviation Road
Fallbrook, CA 92028-3227
619-723-7554

Treatment Applications
Cardiovascular Exercise
Lower Limb Movement
Upper Limb Movement
Neuromuscular Treatments
Respiratory Treatments

Products- Electrode: Transcutaneous/surface


Description- PALS, PALS Plus, PALS Flex - Electrodes that conform to the body for TENS, FES.
Some are reusable.

Treatment Applications
Bioflex, Inc.
736 Kenwick Road
Bowel Control
Cardiovascular Exercise
Columbus, OH 43209
614-236-8079; 800-552-3539
Neuromuscular Treatments
Products- Electrode: Transcutaneous/surface
Description- Custom garments incorporating electrodes. Bioflex's services are for a wide variety of
persons with central nervous system disabilities, and include neuromuscular stimulation systems for
the lower extremities, upper extremities and trunk. Garments are compatible with any commercial
FDA stimulator and are designed for home use.
Biomech Designs Ltd.
Treatment Applications
7955 - 98 Avenue
Lower Limb Movement
Edmonton, Alberta T6A OB5
CANADA
403-469-3484
Products- Stimulator
Description- Quadstim (4 channel), Unistim (1 channel) - Multi-use stimulator for therapeutic or
rehabilitation purposes.

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187

Chattanooga Group, Inc.


Treatment Applications
4717 Adams Road
Lower Limb Movement
P.O. Box 489
Neuromuscular Treatments
Hixson, TN 37343-0489
800-592-7329
Products- Stimulator; Electrode: Transcutaneous/surface

Description- Electrotherapy products including various use stimulators and electrodes.

Dalzell USA Medical Systems


Treatment Applications
3567 Whitewood Road
Sexual Function
The Plains, VA 22171
703-253-7734
(Dr. S.W.J. Seager: 202-877-7535)
Products- Stimulator

Description- Seager 14, Seager Electroejaculator.

The Dobelle Institute See Avery Laboratories Inc.


Dynatronics
470 W. Lawndale Dr. Bldg. D.
Salt Lake City, UT 84115
801-485-4739; 800-874-6251
Description- Dynatron ES 180

Treatment Applications
Neuromuscular Treatments
Products- Stimulator

Treatment Applications
DynaWave Corporation
2520 Kaneville Court
Neuromuscular Treatments
Circulatory / Skin Treatments
Geneva, IL 60134
708-232-4945
Products- Stimulator

Description- DynaStim 50, Dynawave Model 12 Unit - Stimulators for TENS, EMS, and NMES.

ElectroLogic Of America, Inc.


Treatment Applications
Cardiovascular Exercise
3035 Dryden Road
Dayton, OH 45439
513-299-7589
Products- Stimulator
Description- StimMaster Home Bike Ergometer - Home ergometer, adaptive closed-loop control of
resistance which increases local blood circulation while countering muscle atrophy. ELA 4000, ELA
2500 - clinic use ergometers.
Electrostim USA
Promatek Industries Ltd
1851 Black Road
Joliet, IL 60435
800-231-9621
Products- Stimulator
Descri ption- Electrostim 180-210

Treatment Applications
Neuromuscular Treatments

EMPI, Inc.
1275 Grey Fox Road
S1. Paul, MN 55112
612-636-6600; 800-328-2536

Treatment Applications
Cardiovascular Exercise
Lower Limb Movement
Upper Limb Movement
Neuromuscular Treatments

Products- Stimulator
Description- Focus, Respond II - Dual channel stimulator for NMS; Respond Select - NMS stimulator
allowing preset or programmable protocols.

188

FES RESOURCE GUIDE

Finetech Limited
Treatment Applications
13 Tewin Court, Welwyn Garden City
Bladder Control
Hertfordshire AL7 1AU, England
Bowel Control
Tel: 0707 330942
Products- Stimulator; Electrode: Implanted

Description- Sacral anterior root stimulator for enhancing bladder, bowel, and sexual function

Grass Instrument Company


101 Old Colony Avenue
P.O. Box 516
Quincy, MA 02169
617-773-0002
Products- Stimulator

Description- Grass Stimulator

Treatment Applications
Respiratory Treatments

Henley International Inc.; Neuromedics


Treatment Applications
Division
Neuromuscular Treatments
104 Industrial Blvd.
Sugar Land, TX 77478-3128
800-237 -87 49
Products- Stimulator; Electrode: Transcutaneous/surface
LecTec Corporation
10701 Red Circle Drive
Minnetonka, MN 55343
612-933-2291; 800-777-2291
Products- Electrode: Transcutaneous/surface

Treatment Applications
Lower Limb Movement

Life-Tech, Inc.
Treatment Applications
10515 Harwin
Bladder Control
P.O. Box 36221
Houston, TX 77036
718-988-6060
Products- Stimulator; Electrode: Implanted

Description- Continuous Use Stimulator; Acute care.

Maximum Performance Technologies


Petrofsky Center for Rehabilitation and Research
13765 Alton Parkway, Suite E
Irvine, CA 92718
714-855-4837
800-497-6787

Treatment Applications
Bladder Control
Bowel Control
Cardiovascular Exercise
Lower Limb Movement
Neuromuscular Treatments
Circulatory / Skin Treatments

Products- Stimulator
Description- Challenge 4010 Stimulator - Use of stimulator can increase muscle bulk and circulation
in individuals with lower motor neuron injury or peripheral nerve injury.
MEDimplant, Inc.
Treatment Applications
Respiratory Treatments
Laudongasse 10
A-1080 Vienna AUSTRIA
Tel: 4311-408-68-48
Products- Stimulator
Description- Respiratory Pacemaker - Functional electrostimulation of phrenic nerves in central or
peripheral disorders of respiration. Battery-powered control device supplies the implanted 8 channel
pacemaker via an external transmission aerial with stimUlation pulses and power.
Treatment Applications
Medlink Technical Corporation
Respiratory Treatments
730 N. Pueblo Drive, #108
Taos, NM 87571
505-751-0133
Products- Stimulator

Description- U.S. distributor of Atrostim, JUKKA - Phrenic nerve stimulator. See also Atrotech.

-'

--

MORE RESOURCES ON FES

189

Medtronic
Treatment Applications
Bladder Control
Medtronic Nortech Division
Bowel Control
5255 East River Drive
Cardiovascular Exercise
Minneapolis, MN 55421
Lower Limb Movement
800-669-8355
Upper
Limb Movement
Medtronic Neurological Division
Circulatory / Skin Treatments
7000 Central Avenue, NE
Sensory Aids
Minneapolis, MN 55432-4000
Sexual Function
612-574-4879
Products- Stimulator; Electrode: Transcutaneous/surface; Implanted
Description- Interstim - Implantable bladder stimulation product. ITRELII - Implantable spinal cord
stimulator for pain.
Mettler Electronics Corporation
Treatment Applications
1333 South Claudina Street
Neuromuscular Treatments
Anaheim, CA 92805
714-533-2221; 800-654-9305
Products- Stimulator; Electrode: Transcutaneous/surface
Description- EZ-trode, SYS*Stim 207A.
NEC Corporation
NEC San-ei Instruments, Ltd.
NKD Building, 42-6
Hongo 3-Chome
Bunkyo-ku, Tokyo 113 JAPAN
Tel: 03-5684-1417

Treatment Applications
Bladder Control
Lower Limb Movement
Upper Limb Movement
Neuromuscular Treatments
Orthopaedic Treatments
Respiratory Treatments
Sensory Aids

Products- Stimulator; Electrode: Implanted


Description- FES Mate 1000 - Restoration of movement in paralysis; prevention of muscular atrophy
after bone or joint surgery; training and improvement of paresis. Thirty channel functional electrical
stimulation system with percutaneously implantable electrode method.
NeuroControl Corporation
Treatment Applications
11001 Cedar Avenue
Upper Limb Movement
Cleveland, OH 44106
216-844-6955; 800-378-6955
Products- Stimulator; Electrode: Implanted
Description- Freehand System - Implanted medical device which allows persons with quadriplegic
injury at the C5/C6 level to regain use of a paralyzed hand and improve their quality of life.
Neuromotion, Inc.
Treatment Applications
Upper Limb Movement
University of Alberta, Division of Neuroscience
507 Heritage Medical Research Centre
Edmonton Alberta T6G 2S2
CANADA
403-492-3763
Products- Stimulator; Electrode: Transcutaneous/surface
Description- Bionic Glove - an FES device designed to re-educate hand muscles in C5-6 spinal cord
injured people.
Treatment Applications
Neuromuscular Electrical Stimulation Systems,
Ltd. (NESS)
Upper Limb Movement
P.O. Box 2500
19 Ha-Haroshet Street
Raanana 43465 ISRAEL
Tel: 972-9-985738
Products- Stimulator
Description- Handmaster A portable battery-powered non-invasive upper limb FES system. It
comprises a splint worn on the forearm and hand, connected to an electronic control unit by a light
cable.

190

FES RESOURCE GUIDE

Sigmedics Inc.
Treatment Applications
One Northfield Plaza, Suite 410
Lower Limb Movement
Northfield, IL 60093
708-501-3500; 800-582-9255
Products- Stimulator; Electrode: Transcutaneous/surface
Description- Parastep TM I System - Enables skeletally mature spinal cord injured persons (levels
C6-t12) to stand and attain limited ambulation and/or take steps, with assistance if required.

---

Sinties SCientific, Inc.


Treatment Applications
1216 N. Lansing Avenue, Suite B
Cardiovascular Exercise
Tulsa, OK 74106
919-599-7828; 800-852-6869
Products-Stimulator
Description- Muscle-Stim Power Trainer - Leg cycle ergometer provides lower limb neuromuscular
stimulation, lower limb stimulator and upper limb exerciser, or lower and upper limb exerciser.
Staodyn, Inc.
Treatment Applications
P.O. Box 1379
Neuromuscular Treatments
Longmount, CO 80501-1379
303-772-3631; 800-525-2114
Products- Stimulator

Description- EMS+1, EMS +2 - Neuromuscular stimulators.

Stimtech Products Inc.


One Brigham Street
Marlborough, MA 01752
800-451-7915
Products-Stimulator
Description- One 2 One

Treatment Applications
Neuromuscular Treatments

Treatment Applications
Stimwear, Inc.
476 Arroyo Chico
Cardiovascular Exercise
Lower Limb Movement
Laguna Beach, CA 92651
Neuromuscular Treatments
714-494-9423
Products- Electrode: Transcutaneous/surface

Description- Electrode-enhanced garments meant to simplify muscle stimulation for routine exercise.

These garments use no tape or other irritants. Stated benefits include reduced spasticity, increased

circulation, building muscle bulk, increase in range of motion, etc.

Treatment Applications
Stratec Electronic
Lower Limb Movement
Gewerbestr.10 7534 Birkenfeld -2
Neuromuscular Treatments
Grafenhausen GERMANY
Tel: 07082/50081
Products- Stimulator
Description- BIOCY-8 - Training of paralyzed or immobilized muscles, stimulation of functions for
standing, walking, and gripping. Four independent stimulation channels, battery monitoring.

Therapeutic Alliances, Inc.


Treatment Applications
Cardiovascular Exercise
333 North Broad Street
Neuromuscular Treatments
Fairborn, OH 45324
513-879-0734
Products- Stimulator
Description- ERGYS, REGYS - FES leg-cycle ergometer for prevention/retardation of muscle
atrophy; maintain/improve range of motion; increase circulation to stimulated muscles; and relaxation
of spastic muscles. NeuroEducator 11- biofeedback device for use with computerized ergometers.
Therapeutic Technologies, Inc.- See Therapeutic Alliances, Inc.
Unipatch, Inc.
1313 West Grant Boulevard
Wabasha, MN 55981
612-565-2601; 800-328-0454

Treatment Applications
Bladder Control
Bowel Control
Upper Limb Movement
Neuromuscular Treatments

Products- Electrode: Transcutaneous/surface


Description- Multi-Day, Re-Ply, Re-Flex, Unipatch #806, Encase Plus - Re-usable, self-adhering
electrodes.

--

--

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PART 4. GLOSSARY ON FES

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This part contains a glossary with more than 200 entries to assist you in learning
more about functional electrical stimulation. Each entry is a bolded word,
acronym, or phrase, followed by its definition. They are listed alphabetically.
Some entries are cross-referenced to others.
The entries were chosen because they appear elsewhere in this book, or
because you are likely to come in contact with them in your conversations with
FES professionals or consumers, or if you do further reading on the topic.
A glossary is meant to provide assistance with understanding the meaning of a
word or phrase in a given context. It should never take the place of medical
advice from a licensed professional. Also keep in mind that the usage of certain
words may differ from person to person. A medical dictionary can provide
additional clarification if necessary.

191

Part 4. Glossary on Functional Electrical Stimulation (FES)

Accepted practice. Characterized by widely


available commercial systems, regular
prescription by health care providers, and
coverage for the treatment and devices by
medical insurance companies.
Activation. See Stimulation.
Activities of daily living (ADL). Day-to-day tasks
that must be performed by an individual or a
personal assistant; e.g., bathing, dressing, and
eating.
Afferent. Conveying nerve impulses toward the
brain or spinal column. See also Efferent.
AFO. See Ankle foot orthosis.
Agonist. A contracting muscle whose contraction
is opposed by another muscle. See also
Antagonist.
ALS. See Amyotrophic lateral sclerosis.
Ambulation. See Gait.
Amyotrophic lateral sclerosis (ALS). A disease
of the upper and lower motor neurons; its cause
is unknown. The disease arises from gradual
degeneration of cells in the brain and spinal
cord which leads to muscle paralysis. Also
known as Lou Gehrig's Disease.
Anal stimulation. Delivery of electrical pulses
through an electrode inserted into the anus to
activate the surrounding nerve tissue, typically
to provide continence. See also Bowel
evacuation; Electroejaculation.
Animal models. The use of animals to evaluate
FES techniques prior to implementation of
clinical evaluations. Useful for enhancing,
fine-tuning, and determining the safety and
efficacy of electrical stimulation techniques.
Ankle foot orthosis (AFO). A brace worn on the
foot to stabilize movement or limit rotation of the
foot about the ankle.
Anode. The electrically positive electrode
required in a stimulation system to form a
complete path for current to travel through the
body part of interest. Anodes may be shared
between stimulus channels. See also Cathode.
Antagonist. The muscle which exerts an opposite
action to that of another muscle. See also
Agonist.
Applied neural control. The body of knowledge
associated with the development of technology
and devices based on the electrical excitability
of nerves.
ASIA impairment scale. As defined by the
American Spinal Injury Association, a method
for describing the deficit that results from a
spinal injury. A= Complete: No motor or

sensory function is preserved in sacral


segments 54-55. B= Incomplete: Sensory but
not motor function is preserved below the
neurological level and extends through S5-S5.
C= Incomplete: Motor function is preserved
below the neurological level. and the majority of
key muscles below the neurological level have a
muscle grade less than 3. D= Incomplete: Motor
function is preserved below the neurological
level, and the majority of key muscles below the
neurological level have a muscle grade greater
than or equal to 3. E= Normal: Motor and
sensory function are normal.
Assistive technology. See Rehabilitation
technology.
Atrophy. Reduction in size of a muscle or muscle
group because of disease or disuse. See also
Hypertrophy.
Autonomic dysreflexia. Sudden onset of high
blood pressure, slow heartbeat. sweating and
severe headache.
Axon. The central core of a nerve fiber. See also
Nerve.
Basic research. A stage of development of FES
that investigates neurophysiological phenomena
using computer and animal models.
Bed sore. See Decubitus ulcer.
Bicycle ergometry. The use of electrical
stimulation to cause movement of the leg
muscles against loaded bicycle pedals.
Commercial FES cycling systems are available.
Biofeedback. The technique of making
unconscious or involuntary bodily processes
perceptible to the conscious mind in order to
manipulate them by conscious mental control.
Typically, EMG (electromyogram) biofeedback
is used with FES to facilitate muscle contraction.
Biomedical engineering. The application of
engineering principles to biology and medicine.
Bladder evacuation. The process of emptying
the bladder or urination. May be enhanced by
using electrical stimUlation to contract the
bladder and force the contents out, thereby
reducing the risk of residual urine which may
lead to serious infection. See also Penile
erection.
Bladder function. The role of the bladder in
evacuating urine (micturition) and the role of the
urinary sphincters in preventing the evacuation
of urine. Lack of sphincter control is known as
incontinence. See also Incontinence; Micturition.

192
Bone stress. A condition caused by external
force applied to the bone; excess force could
cause bone fracture.
Bowel evacuation. The process of emptying the
bowels. May be enhanced by applying electrical
stimulation to specific skin areas of the low back
(lumbar and sacral dermatomes) if voluntary
control of the bowel has been lost. See also
Penile erection.
Candidate referral. The process by which an
individual is referred to an electrical stimulation
program on the basis of program type, medical
condition, geographic location, etc.
Cardiovascular exercise. A stage of exercise
during which the heart rate is raised to a level
sufficient to improve fitness. May be induced
using electrical stimulation to contract muscles,
as in bicycle ergometry.
CARF. Commission on the Accreditation of
Rehabilitation Facilities.
Cathode. An electrically negative electrode. One
cathode is required in a stimulation system for
each muscle or nerve group to be activated.
See also Anode.
Central nervous system (CNS). The part of the
nervous system comprising the brain and spinal
cord. Diseases of the CNS include cerebral
palsy, multiple sclerosis, spinal cord injury,
stroke, and head injury.
Cerebrovascular accident (CVA). See Stroke.
CFES. See Computerized Functional Electrical
Stimulation.
Channel. A speCification of electrical stimulators,
referring to the number of separate
nerve/muscle groups which can be activated by
the stimulator. Each channel requires an
anode-cathode electrical pair.
Circulatory pooling. Collection of the blood due
to inadequate circulation. May be reduced by
the use of electrical stimulation to muscles in
the vicinity of the pooling to produce a pumping
action.
Clinical research. The stage of development of
FES at which techniques are being evaluated in
small numbers of human subjects, as opposed
to animal or computer models. 'Also called
clinical feasibility studies. Preceded by basic
research.
Clinical service. In theory, any use of FES
offered as a service, typically for a fee, that is
not in any way considered experimental. In
practice, certain aspects of the treatment may in
fact be experimental.
Closed-loop control. See Control.
CNS. See Central nervous system.
Command. The Signal whose value determines
the onset, duration, & level of stimulus applied.

FES RESOURCE GUIDE

Complete spinal lesion. An injury to the spinal


cord that prohibits transmission of all Signals
between the brain and the peripheral nerves.

Results in total loss of muscle power and

sensation below the level of injury. See also

Incomplete spinal lesion.

Computerized Functional Electrical Stimulation


(CFES). The control of stimulation parameters
by a computer. Often used to describe FES
cycling systems.
Computerized muscle stimulation. Use of a
computer or microprocessor to generate
complex stimulation patterns applied to a
muscle or muscles.
Contraction. The shortening of muscle fibers due
to activation of a muscle by voluntary or external
means.
Contracture. See Joint contracture.
Control. Mechanisms that vary stimulus
parameters to a muscle to regulate function.
Open-loop control mechanisms use a pre-set
relationship between the command input and
the stimulus output. Closed-loop control
mechanisms can vary the relationship between
command input and stimulus output according
to feedback signals. Such signals contain
information about quantities such as force or
position.
Cuff electrode. An electrode that wraps partly or
entirely around a nerve. Usually made of a soft
material with embedded metal contacts.
Decubitus ulcer. An inflammation or sore in the
skin over a prominent bone. Results from lack
of circulation to the area due to prolonged
pressure or restricted blood supply (ischemia).
Also known as bed sores, pressure sores, or
ischemic sores.
.
Deep venous thrombosis. Blood clotting in the
deep veins in the legs.
Denervation. A condition in which the activation
path between a nerve and muscle is no longer
working due to peripheral nerve trauma or
central nervous system disease, causing lower
motor neuron damage. The condition results in
muscle atrophy and often causes muscle
contractu res. As a short term therapeutic
treatment, denervated muscle can be activated
by direct stimulation of the muscle tissue,
requiring a relatively high amplitude electrical
stimulus.
Department of Veterans Affairs (VA). The
department of the federal government
responsible for overseeing veteran services,
including health care. The VA's Rehabilitation

Research and Development service sponsors a

large portion of Functional Electrical Stimulation


research.

--

GLOSSARY ON FES

Dermatomal stimulation. Stimulation of a


dermatome, an area of the skin in which all the
sensory nerve receptors belong to the same
spinal cord level, to control spasticity.
Diaphragm. A dome-shaped muscle that
separates the chest and abdominal cavities.
Aids breathing by its upward and downward
movements.
Diaphragm pacing. Electrical stimulation of the
diaphragm to produce respiration. Stimulation
may be applied at the phrenic nerve or at the
diaphragm muscle.
Disability. A medically determined physical,
mental, sensory or emotional impairment that
interferes with major tasks of daily living.
Doffing. Taking an article off, as in removing a leg
brace or wrist splmt.
Donning. Putting an article on, as in putting on a
surface electrode system.
Dorsal column stimulation. See Spinal cord
stimulation.
Dynamic graciloplasty. An FES system that
keeps the rectum closed. The system requires
a surgical procedure that transfers a leg muscle
(gracilis) to be a loop around the rectum. An
electrode to that muscle and a stimulator are
implanted.
Efferent. Conveying nerve impulses toward a
muscle or other organ. See a/so Afferent.
Electrical muscle stimulation (EMS). Use of
electriCity to activate muscles.
Electrical stimulation. A broad term which refers
to the therapeutic or functional use of electrical
current in the human body to produce a
particular outcome.
Electrocutaneous stimulation. See Electrotactile
stimulation.
Electrode. The conduction medium used to apply
an electrical current to the body or to record an
electrical signal coming from the body. A
minimal electrode system consists of one anode
and one cathode. Electrodes are manufactured
from a variety of materials and in various styles.
See a/so Cuff electrode, Epimysial electrode;
Intramuscular electrode; Needle electrode;
Nerve electrode; Surface electrode.
Electrode array. A type of electrode that has
multiple electrical contacts in one compact unit
for recording from or stimulating at multiple
sites.
Electrode burn. A burn on the skin or in the body
that results when current is applied to an
electrode at an intensity that is higher than a
safe level.
Electrode lead. The wire that attaches the
electrode to the stimulator.

193

Electroejaculation. The technique used to induce


ejaculation of sperm in the male by electrical
excitation of the sensory organs, typically by
stimulation inside the rectum.
Electromagnetic stimulation. See MagnetiC
stimulation.
Electromyogram (EMG). The electrical activity
recorded from a muscle. Can be used to study
muscle contractions. Often used in biofeedback
techniques.
Electrophysiology. The study of the physiologic
effects of electrical activation of the nervous
system.
Electrotactile stimulation. The use of electrical
stimulation to activate the sensory nerves
responsible for the sense of touch. May be used
in sensory feedback or visual prosthesis
applications. Also known as electrocutaneous
stimulation.
Electrotherapy. The clinical practice of applying
electricity to the body to achieve a therapeutic
result. This would include FES applications
such as muscle strengthening, wound healing,
contracture prevention, and improving
circulation.
EMG. See Electromyogram.
EMS. See Electrical muscle stimulation.
Energy. The capacity to do work or to perform
vigorous activities.
Epimysial electrode. An electrode that is
surgically fixed to the surface of the muscle.
Erection. See Penile erection.
Ergometry. The study of, the work performed by
muscles. See a/so Bicycle ergometry.
Ergotherapy. The use of physical activity and
exercise in the treatment of disease.
Excitability. A measure of the ease with which a
cell, nerve, or muscle can be excited.
Excitation. See Stimulation.
Exercise. See Muscle strengthening.
Experimental research. Any use of FES that is
considered to be investigational by the FDA or
other foreign authority.
Extension. A movement that increases the angle
between two adjoining bones of the skeletal
system. See a/so Flexion.
Facilitation. Supplementation of a patient's
voluntary muscle response with various motor
and sensory stimuli. See a/so Biofeedback.
Fatigue. The loss of the ability of muscle tissues
to respond to stimuli that normally would cause
a muscular contraction. Occurs following
strenuous physical activity.
FDA. See Food & Drug Administration.
Feasibility. Typically refers to a research study at
a single institution involving 10 or fewer
subjects.

I"
I
194
Feedback. Information about what is taking place
in response to a stimulus that is returned to the
stimulus controller; e.g., force and position
information. See also Control; Sensors.
FES. See Functional Electrical Stimulation.
Flexion. A movement which decreases the angle
between two adjoining bones of the skeletal
system. See also Extension.
Floor reaction orthosis. A rigid ankle foot
orthosis developed in the 1960s which uses the
ground reaction vector to provide stability for
standing. See also Hybrid orthosis.
FNS. See Functional neuromuscular stimulation.
Food and Drug Administration. The federal
agency responsible for regulating the safety and
efficacy of medical devices sold in the U.S.
Foot-drop. An abnormal neuromuscular condition
which is characterized by the inability to
dorsi-flex or invert the foot due to peroneal
nerve interruption, often resulting from stroke.
May be corrected by orthoses or electrical
stimulation of the peroneal nerve.
Force. Energy or "pressure" applied in such a way
that it initiates motion or alters the size or shape
of an object.
Frequency. The rate of occurrence of stimulus
pulses.
Functional Electrical Stimulation (FES). As
defined by the FES Information Center: a
rehabilitation technique where low-level
electrical current is applied to an individual with
a disability to enhance that person's ability to
function and live independently. Usually refers
to applications which provide long term
assistance or replacement of a miSSing or
impaired body function. The term often has
different meanings in different communities; if
the definition is not clear, ask for clarification.
See also Therapeutic electrical stimulation.
Functional evaluation. A clinical evaluation of a
person based on the completion of tasks, often
including the activities of daily living.
Functional neuromuscular stimulation (FNS).
The application of electrical stimulation to the
neuromuscular system for the purpose of
completing functional tasks. Sometimes used
interchangeably with FES. Typically refers to the
use of electrical stimulation to provide long term
assistance or replacement of an impaired
neuromuscular function.
Funding. Financial support for a research project;
e.g., grants from the government or private
foundations.
Gait. The act of walking or ambulation. Can be
assisted by electrical stimulation and/or
orthoses. See also Hybrid orthosis.

FES RESOURCE GUIDE

Ground reaction orthosis. See Floor reaction


orthosis.
Guillain-Barre syndrome. A disease of the
peripheral nervous system which may cause
pain and weakness in the extremities as well as
paralysis. Also known as an idiopathic
polyneuritis. In general, FES is not a treatment
option.
Hand grasp stimulation. Stimulation of upper
extremity musculature to induce functional
movement of the hand.
Handicap. The disadvantage which occurs when
the design of the environment poses obstacles
or barriers to people with disabilities.
Head injury. A traumatic injury to the head that
can lead to brain cell damage resulting in brain
dysfu nction.
Hemiplegia. Paralysis on one side of the body,
often as a result of stroke or cerebrovascular
accident (eVA).
HGO. See Hip guidance orthosis.
High voltage electrical stimulation (HVES). A
type of electrical stimulation which uses
electrical stimuli with very short, high voltage
pulses. Sometimes known as high voltage
pulsed current (HVPC).
High voltage pulsed current (HVPC). See High
voltage electrical stimulation.
Hip guidance orthosis (HGO). A system that
incorporates a rigid body brace, a hip joint with
limited movement, stable knees and ankles, and
a shoe plate. Can be used with crutches to
provide reciprocal walking. Also known as
Para Walker. See also Hybrid orthosis.
HKAFO. Used to describe a hip-knee-ankle-foot
orthosis which can provide gait assistance in
total paraplegia. Sometimes used in
conjunction with electrical stimulation. See also
Hybrid orthosis.
HVES. See High voltage electrical stimulation.
HVPC. See High voltage pulsed current.
Hybrid orthosis. An FES system which uses an
orthosis (brace) in conjunction with electrical
stimulation to provide function.
Hypertrophy. Increase in the size of a muscle.
See also Atrophy.
Implant. A medical device which is surgically
wholly implanted in the body.
Implantable stimulator. Miniaturized stimulation
system surgically placed into the body. If the
stimulation system requires a transmitter and
receiver, the receiver will be implanted as well.
Impulse. A single electrical signal of short
duration. See also Pulse.
Incomplete spinal lesion. An injury to the spinal
cord which leaves some pathways for
transmission of nerve signals intact. Some

--

--

--

GLOSSARY ON FES

muscle control and sensation may remain. See


also Complete spinal lesion.
Incontinence. The inability to control urination or
defecation due to lack of sphincter control.
Electrical stimulation of the sphincter muscle
may return some degree of control.
Independent living. Controlling and directing
your own life by making decisions and taking
responsibility for your actions.
Informed consent. Prior to partiCipating in an
investigational FES program, the subject is
presented with information about potential risks
and benefits. To acknowledge that the subject
understands the information, he or she signs an
informed consent document.
Innervation. The distribution or supply of nerve
fibers or nerve impulses to a part of the body.
An innervated muscle can be readily activated
with low amplitude electrical stimulation. See
also Denervation.
Intramuscular electrode. An indwelling electrode
placed into a muscle using a hypodermic
needle, either through closed skin or an open
incision.
Ischemia. A local decrease in oxygen flow to a
tissue due to obstruction of blood flow.
Ischemic sore. See Decubitus ulcer.
JCAHO. Joint Commission on the Accreditation of
Healthcare Organizations.
Joint contracture. An abnormal condition of a
joint characterized by flexion and fixation.
These are caused by atrophy and shortening of
muscle fibers or by the loss of normal elastiCity
of the skin due to scarring. Electrical stimulation
can be used to overcome the restrictions of
contractu res by cyclically stretching the muscle
group antagonistic to the contracture.
KAFO. Refers to a knee-ankle-foot orthosis used
to stabilize and control the movement of the
lower extremity joints.
Laboratory-based equipment. Equipment that is
located and used exclusively in a laboratory
setting.
Lead. See Electrode lead.
Lesion. A discontinuity in the central nervous
system. See also Complete spinal lesion;
Incomplete spinal lesion; Lower motor neuron;
Upper motor neuron.
Long leg brace. An orthotic device that allows
paraplegics to walk on level surfaces by locking
the ankles and knees.
Lower extremity. The hip, leg and foot.
Lower motor neuron. Cells located in the spinal
cord that have extending nerve fibers which
leave the spinal cord and then innervate skeletal
muscles. If the lower motor neurons for a
particular muscle are not intact due to injury or

195
disease, electrical stimulation of the nerve and
muscle will be impOSSible. Lower motor neuron
damage may be present in spinal cord injury,
spina bifida, and ALS. See also Denervation;
Peripheral nervous system; Upper motor
neuron.
Lymph. Clear liquid that flows in lymphatic
vessels throughout the body. Contains protein,
some white blood cells, and few red blood cells.
Micturition. Elimination of urine from the bladder;
urination.
Motor training. See Facilitation.
MS. See Multiple sclerosis.
Multicenter clinical trials. A stage of FES
development characterized by well-controlled
studies in two or more clinics involving large
numbers of human subjects.
Multiple sclerosis (MS). A progressive CNS
disease characterized by destruction of the
myelin sheath that insulates nerve cell axons,
causing interruption of neural signals. There is
some indication that FES may be used to
improve function in individuals with MS.
Muscle conditioning. The process of converting
a muscle fiber type from fast-twitch fibers to
slow- twitch fibers by electrical stimulation to
decrease the likelihood of muscle fatigue.
Muscle contraction. See Contraction.
Muscle exercise. See Muscle strengthening.
Muscle reeducation. See Facilitation.
Muscle strengthening. The use of electrical
stimulation to cause repeated contractions of
muscles which have become weak and
atrophied. Causes a change in muscle fiber type
which results in a muscle less likely to fatigue.
May increase muscle bulk, thereby changing the
appearance of the extremities. Portable
stimulators with surface electrodes are typically
used in physical therapy clinics for this purpose.
See also Muscle conditioning; Atrophy;
Hypertrophy.
Musculoskeletal. Related to the function of the
bones, muscles, and their interactions.
National Center for Medical Rehabilitation
Research (NCMRR). A center of the National
Institutes of Health devoted to improving the
quality of life of individuals with medical
disabilities.
National Institute of Neurological Disorders
and Stroke (NINDS). One of the National
Institutes of Health devoted to the study of
neurological diseases and disorders.
National Institute on I;>isability and
Rehabilitation Research (NIDRR). A federal
agency of the Department of Education, Office
of Special Education and Rehabilitative
Services to support the development of devices

196
and programs which improve the ability of
individuals with disabilities to live independently.
National Institutes of Health (NIH). A group of
agencies commissioned by the Department of
Health and Human Services to oversee
research into health-related problems. Includes
the NINDS and NCMRR which sponsor a large
portion of FES research.
NCMRR. See National Center for Medical
Rehabilitation Research.
Needle electrode. A surgical-grade needle used
to record or deliver electrical impulses.
Nerve. One or more bundles of fibers which carry
electrical impulses. The fibers connect the brain
and spinal cord with other parts of the body.
See a/so Axon; Neuron.
Nerve electrode. An electrode surgically placed
in, near or around the nerve. Also known as
nerve cuff, intraneural, or epineural electrodes.
See a/so cuff electrode.
Neural prosthesis. A device which acts to
replace or improve the function of an impaired
nervous system.
Neural regeneration. The use of electrical
stimulation to enhance the regeneration of
nerve fibers that have been severed due to
accident or disease.
Neurological level. In spinal injury, refers to the
most caudal segment of the spinal cord with
normal sensory and motor function on both
sides of the body.
Neuromodulation. A method of reducing
spasticity and improving motor control by
stimulating sensory nerves.
Neuromuscular. Related to the function of nerves
and muscles.
Neuromuscular electrical stimulation (NMES).
Electrical stimulation of nerves to produce
muscle contraction.
Neuron. The basic nerve cell of the nervous
system. See a/so Axon; Nerve.
Neurophysiology. The study of the processes
and functions of the nervous system.
Neuroprosthesis. See Neural prosthesis.
NIDRR. See National Institute on Disability and
Rehabilitation Research.
NIH. See National Institutes of Health.
NINDS. See National Institute of Neurological
Disorders and Stroke.
NMES. See Neuromuscular electrical stimulation.
Open-loop control. See Control.
Orthosis. A device used to support or brace a
weak or disabled joint or muscle.
Osteoarthritis. Chronic disease involving the
jOints. Involves degeneration of cartilage,
overgrowth of bone, and impaired function.
Almost alwa~s occurs with aging.

FES RESOURCE GUIDE


Osteoporosis. A disorder characterized by
increased fragility of the bones, often occurring
in immobilized individuals.
Parameters. In FES, a set of properties whose
values determine the characteristics of the
stimulation. Usually includes level of current or
voltage, duration of a stimulus pulse, and
frequency of stimulation.
Paraplegia. Paralysis of the legs and lower parts
of the body due to an injury to the spine at the
thoracic, or chest, level.
Patient selection. The criteria applied to assess
the appropriateness of a candidate for a
particular electrical stimulation program.
Criteria usually include medical, physiological,
rehabilitative psychological, and social factors.
Pelvic floor stimulation. Electrical stimulation
applied to the pelvic muscles that support the
bladder, bowel, and reproductive organs.
Penile erection. Sometimes results from sacral
nerve stimulation for bowel or bladder emptying.
In one study, the resulting erection was strong
enough for intercourse in half of the population
studied.
Percutaneous. Through the skin.
Percutaneous electrode. An electrode inserted
through the skin, usually using a hypodermic
needle.
Peripheral nervous system. The motor and
sensory nerves outside the brain and spinal
cord. Diseases of the peripheral nervous
system include polio, muscular dystrophy,
Guillain-Barre Syndrome, and hereditary nerve
diseases such as Charcot Marie Tooth
Syndrome. In general, FES is not a treatment
option when the peripheral nervous system is
damaged. See a/so Denervation.
Peripheral neuropathy. A disorder of nerves that
lie outside the brain and spinal cord. Can be
caused by a variety of afflictions including
diabetes, alcoholism, kidney failure, and
exposure to environmental substances. In
general, FES is not a treatment option. See
a/so Denervation.
Portable stimulator. A stimulator that is compact,
lightweight and powered in such a way that it
can easily travel with an individual.
Postural stabilization. Electrical stimulation of
the spinal and other muscles to assist with
balance.
Power supply. The method for powering a
stimulator. Examples are AC (line) powered,
battery (rechargeable or replaceable) powered,
and radio frequency (RF) powered (typically
used with implants).
Pressure sore. See Decubitus ulcer.

---

GLOSSARY ON FES
Pressure sore relief. The periodic use of surface
electrical stimulation to increase circulation and
shift the load on weight-bearing tissues in an
area prone to pressure sores.
Proprioception. Awareness of posture,
movement, changes in balance, and knowledge
of position, weight and resistance of objects in
relation to the body.
Prosthesis. A device used as a substitute for a
missing or dysfunctional part of the body.
Pulse. A brief injection of electrical current,
typically lasting only microseconds. Most
stimulation systems produce many pulses in a
sequence to cause nerve activation. See a/so
Impulse.
Quadriplegia. Paralysis of the arms, legs and
trunk that occurs with an injury to the spine in
the cervical (neck) area. Also known as
tetraplegia.
Range of motion. The extent to which a jOint can
move in all possible directions. A type of
exercise, active or passive, used to assess the
condition of the muscles and joints by body
movement. Electrical stimulation can be used
to move limbs through their range of motion.
Reciprocal walking. A gait pattern where one leg
is sequentially placed in front of the other.
Reciprocating gait orthosis (RGO). A
hip-knee-ankle-foot orthosis with coupling such
that hip extension in one leg causes hip flexion
in the other, causing reciprocal walking.
Recruitment. The relationship between the
electrical charge injected into a stimulating
electrode and the resulting force generated by
the activated muscle. In general, force
increases as the charge, or intensity, increases.
See also Threshold.
Rectum. Lower part of the bowel, just inside the
anus.
Reflex. An action that occurs subconsciously
when certain signals that start in a nerve ending
travel to the spinal cord or brain. An example is
the automatic kicking of the lower leg when the
knee is tapped with a rubber hammer.
Regulatory approval. Treatment and any
associated medical devices that have received
approval from the Food and Drug Administration
(FDA) in the United States, or a comparable
regulatory agency in other countries.
Rehabilitation engineering. The systematic
application of technologies or scientific
principles to meet the needs of, and address
barriers confronted by, individuals with
disabilities. This includes areas such as
education, rehabilitation, employment,
transportation, communication, independent
living and recreation.

197
Rehabilitation technology. Any technology used
to restore or improve function in an individual
after a disabling disease or injury. Also known
as assistive technology.
Respiratory assist. A system that enhances the
act of breathing. Examples are an iron lung or a
phrenic nerve pacer.
Restoration. The return of function by direct or
indirect means after the loss of function.
RGO. See Reciprocating gait orthosis.
Rhizotomy. Cutting of a spinal nerve root.
SCI. See Spinal cord injury.
SCS. See Spinal cord stimulation.
Sensation. A feeling, impression, or awareness of
a bodily state or condition that results from
stimulation of a sensory nerve fiber.
Sensor. A device that provides electronic
information about a situation, such as force or
position information. Also known as transducer.
Sensory electrode. An electrode or electrode
array with the purpose of providing substitute
sensory information or system information to the
user.
Sensory feedback. Providing sensory information
to help describe what is happening (usually to
the FES system) during a certain situation; e.g.,
tactile stimulation to represent grasp force.
Sensory substitution. The use of one human
sense to receive information normally received
by another sense. In FES, typically
electrotactile information is substituted for an
impaired sense.
Sexual function. See Electroejaculation; Penile
erection.
Skeletal muscle. Muscle tissue conSisting of
bundles of parallel fibers. Normally contraction
is under voluntary control, as in the muscles that
control upper and lower extremity movement.
Also known as striated muscle. See also
Smooth muscle.
Smooth muscle. Muscle tissue composed of
elongated, spindle-shaped cells not under
voluntary control, as in the muscles of the
stomach and intestines. See a/so Skeletal
muscle.
Spasm. Involuntary, sudden movement or muscle
contraction. May be sustained (toniC) or
alternately contracting and relaxing (clonic).
When strong and painful, spasms are called
cramps.
Spasticity. A condition caused by involuntary
contraction of muscles due to a spinal cord
lesion or other central nervous system disorder.
Electrical stimulation may, in some cases, be
used to counteract the involuntary contractions,
thereby reducing spasticity.

bn

198
Spinal cord injury (SCI). Injury to the neural
structures of the spinal column, often due to
traumatic accident, resulting in upper and lower
motor neuron lesions. Typically leads to
paralysis and loss of sensation in parts of the
body controlled through the spinal cord below
the level where the injury occurred. Some
central nervous system diseases have similar
effects.
Spinal cord stimulation (SCS). Stimulation of the
spinal neural axis to treat pain and various
disorders of the motor system. Typically
involves insertion of electrodes into the epidural
space with subcutaneous placement of a
stimulator/receiver. Also known as dorsal
column stimulation. See also Implantable
stimulator.
Stimulation. Application of stimuli to activate
sensory and/or motor nerves.
Stimulator. A device used to apply an electrical
or magnetic stimulus through an electrode to a
nerve or muscle. May have single or multiple
channels. See also Channel; Implantable
stimulator; laboratory-based equipment;
Portable stimulator.
Stimulus. A current or voltage pulse or pulse
train, characterized by amplitude, shape,
duration, and frequency, that excites nerves and
muscles when applied to the body. See also
Parameters.
Stimulus intensity. The amount of stimulation
applied to the body, usually a combination of
frequency, pulse duration, and amplitude. See
also Parameters.
Strengthening. See Muscle conditioning.
Stroke. Sudden paralysis caused by interruption
(transient ischemic attack - TIA) or blocking
(cerebral infarction) of circulation to a part of the
brain or by sudden bleeding into the substance
of the brain (intracerebral hemorrhage). Also
known as CVA.
Subcutaneous. Under the skin.
Surface electrode. An electrode placed on the
surface of the skin over a muscle, peripheral
nerve, or skin afferents (sensory receptors that
carry impulses towards the CNS) to be
stimulated. The electrode is held to the skin by
adhesive, tape, bandaging or tight-fitting
garments. Surface electrodes are used with
electrode gel or paste to enhance electrical
conductivity between the skin and the electrode.
Swing-through walking. A gait pattern which
results when the trunk and legs follow an initial
forward movement by the arms using a walker,
crutches, or other stabilizing device. See also
Reciprocal walking.
Tactile. See Electrotactile.

FES RESOURCE GUIDE


Technology transfer. The process whereby a
research technology is transformed into a
commercially available product.
Tendon. A fibrous band of tissue which attaches
muscle to bone.
Tendon transfer. Surgical removal and
subsequent replacement of the insertion point of
a tendon to provide improved function during
movement. Typically used in the hand for
rehabilitation of people with quadriplegia.
Tendonitis. Inflammation of a tendon.
TENS. See Transcutaneous electrical nerve
stimulation.
Tetraplegia. See Quadriplegia.
Therapeutic. Any treatment of a disorder which is
deemed beneficial, but not necessary to sustain
life. May have short- or long-term effects.
Therapeutic electrical stimulation. A general
term which usually refers to electrical
stimulation applied to the body to provide
healing or natural restoration of a missing or
impaired body function.
Threshold. The level at which any further
increases in stimulus intenSity will cause
activation of a nerve or muscle.
TIA. Transient ischemic attack. See Stroke.
Training. See Muscle conditioning.
Transcutaneous electrode. See Surface
electrode.
Transcutaneous electrical nerve stimulation
(TENS). Method of electrically activating nerves
by the use of surface stimulation, typically for
the purpose of relieving pain.
Transducer. See Sensor.
Tremor. Shaking that occurs continuously or
whenever a voluntary movement is made.
Unlabelled use. Use of a device or drug that is
approved for one purpose for a different
purpose. Doctors may do this for particular
patients, but very often the unlabelled use will
not be covered by insurance. An example is use
of a spinal cord stimulator (approved for treating
pain) for improving bladder control.
Upper extremity. The shoulder, arm and hand.
Upper motor neuron. Cells which extend from
the brain to the spinal column. Diseases of the
upper motor neuron are characterized by
increased muscle tone and spasticity,
diminished superficial reflexes, and no local
twitching of muscle groups. See Lower motor
neuron.
VA. See Department of Veterans Affairs.
Walking. See Gait.
Wound healing. A stimulation technique that may
increase the speed at which a wound heals by
inducing an electrical field across the surface of
a wound.

--

--

PART 5. INDEX

This part contains index entries to help you locate a topic of interest in this book. The index
is divided into two sections -- a Topical Index and an Organizational Index. The Topical
Index contains pOinters to information in the book that covers a certain subject. For
example, if you are interested in bicycle ergometry, you can look for that entry under the
B's in the Topical Index. The Organizational Index contains pointers to information in the
book about a certain organization. For example, if you are interested in information about
the Food and Drug Administration, you can look for that entry under the F's in the
Organizational Index.
Entries in each index appear in alphabetical order. Each entry may point to either a page
number or a Program/Application Identification number from Part 2. Page numbers appear
in a regular type face. Program/Application Identification numbers appear in a balded type
face, have the format n.nn and always refer to identification numbers (not pages !) in Part

2.
For example, if the entry looked like the following:
Spinal cord injury, 15,27-30,6.00,6.01,8.00,8.03
you could turn to either page 15 or pages 27 through 30, or, in Part 2, to
Programs/Applications 6.00, 6.01, 8.00, or 8.03 to find information about spinal cord injury.
You can also use the Table of Contents at the beginning of the book to help you locate the
pages that cover your topic of interest.

INDEX

201

Improving circulation
See Circulation
Improving voluntary control of movement
See Movement control
In-vitro fertilization, 32
See also Electroejaculation
Incomplete injury, 1, 11, 17, 19,21,22,23,24,25,
28,29,30,31,37,44
Information centers, 181-82
Informed consent, 8, 66
Insurance,8,13,32,53,64,65
See also Cost
Intercostal muscles, 14
See also Diaphragm
Investigational device exemption (IDE), 8
Investigational, status, 7, 8, 9, 22, 23, 49
-L
Leads, electrode 5, 6, 22, 48
Lower limb movement, 186, 187, 188, 189, 190,1.03,
2.04,3.01,10.01,12.01,13.01,16.01,21.01,
24.01,27.01,29.02,29.04,32.01,32.02,35.03,
40.01,41.01,42.02,43.01,43.02,43.03,49.01,
51.04, 52.01, 55.02, 56.01, 57.02, 58.01, 60.01,
60.02,61.03,63.03,66.01,68.01,70.01,70.02,
71.03,74.01,76.01,77.01,78.01,79.01,80.01,
80.02,83.01,85.01,88.01,93.01,94.01,95.01,
96.01,97.01,98.04,99.01,100.01,101.01,101.02,
102.01,104.01,104.02,105.01
See also Standing, Stepping, Transfers, Walking
Lower motor neuron, 2, 15, 42
Lumbar, 26
Lung, 11, 16, 17, 19,25,29,47

- MManufacturers, 187-90
Medicare, 8
Medication, 36, 55
Motor nerve, 1,2, 12, 15,21,36,37,42,48,56
Movement control, 47, 48, 50, 51, 63-64
Multicenter clinical trial, 8, 9, 20, 31,62, 10.01, 10.02,
10.03,17.01,19.01,20.01,21.01,21.02,26.01,
27.01,28.01,30.01,35.05,37.01,38.01,39.02,
42.02, 43.02, 45.02, 45.03, 50.01, 51.03, 53.01,
55.02,62.01,67.01,71.01,71.02,73.02,74.01,
81.01, 84.01, 104.03
Multiple sclerosis, 46-64,175,179,180,181,2.01,
2.02,2.03,2.04,4.01,6.01,9.01,13.01,15.03,
19.01,20.01,23.01,28.01,31.02,34.01,34.04,
35.02,35.04,35.05,36.01,37.01,38.01,42.01,
42.02, 42.03, 42.04, 48.01, 49.01, 49.02, 49.03,
53.01, 55.01, 55.02, 58.01, 59.03, 60.02, 60.04,
65.01, 69.01, 71.02, 73.01, 73.02, 73.03, 76.01,
82.01,92.01,93.01,93.02,95.02,95.03,100.01,
104.02
- NNervous system, 1, 2, 3

Neuromodulation, 21, 37,48, 56


Neuromuscular treatments, 186, 187, 188, 189,190,
1.01,1.04,2.03,6.01,11.01,13.01,21.03,24.02,
25.01, 31.02, 33.02, 34.01, 34.02, 34.04, 35.04,
42.01,42.03,42.04,47.04,48.01,49.02,49.03,
59.01, 59.03, 60.03, 60.04, 61.01, 63.02, 68.02,
69.01,71.02,72.01,74.02,75.01,78.01,82.01,
85.02, 88.01, 91.02, 92.02, 93.02, 97.03, 97.04
See also Atrophied muscles, Regaining voluntary
function, Regeneration, Spasticity, Tremor, Weak
muscles

- 0
Organizations, professional, 183-85
OrthopaediC treatments, 189,47.03,69.01,88.01
See also Contractu res, Osteoporosis
Orthoses, 18,24,26,27,29,30
See also Braces
Osteoporosis, 3,13,14,26,28,29,39,40,41,51,
59-60, 176, 47.03
See also Orthopaedic treatments
-p
Pacemakers, 1,3,6,17,19,37,56
Pain, 1,3,5, 14, 19,21,22,24,25,28,29,37,46,
47,48,49,50,51,56,63,176,42.04
Paralysis, 2
Paraplegia, 11, 26, 30, 40, 1.01, 1.02, 1.03, 1.04,
2.01, 2.02, 2.03, 2.04, 3.01, 4.01, 5.01, 6.01, 8.01,
9.01,10.01,10.03,12.01,14.01,15.02,15.03,
15.04,16.01,18.01,21.01,23.01,24.01,25.01,
26.01, 28.01, 29.02, 29.04, 31.01, 31.02, 32.01,
32.02, 33.01, 33.02, 33.03, 34.01, 34.02, 34.03,
34.04, 35.01, 35.02, 35.03, 35.04, 35.05, 36.01,
39.02,40.01,41.01,43.01,43.02,43.03,45.03,
47.01,47.02,47.03,47.04,48.01,48.02,49.01,
49.02, 49.03, 51.04, 52.01, 53.01, 55.01, 56.01,
58.01, 59.01, 59.03, 60.01, 60.03, 61.01, 61.02,
61.03,63.01,63.02,63.03,66.01,67.03,68.01,
68.02, 68.03, 69.01, 70.01, 70.02, 71.03, 72.01,
73.01,73.02,73.03,74.01,75.01,77.01,77.05,
78.01, 79.01, 80.01, 80.02, 81.01, 83.01, 85.01,
85.02, 85.03, 88.01, 90.01, 92.01, 92.02, 93.01,
93.02, 95.01, 95.02, 95.03, 96.01, 97.01, 97.02,
97.03,97.04,98.01,98.02,98.03,98.04,99.01,
101.01,101.02,102.01,103.01,104.01,105.01,
105.02
Participating in programs, 64
Pediatrics, 179
See also Child
Pelvic floor stimulation, 22,49
Peripheral nerve, 2, 3, 25, 28, 51, 63
Peripheral nervous system, 1, 2, 3, 25, 28, 44, 51, 63
Phrenic pacer, 14, 16,66.02
See also Breathing assistance
Physical therapy, 13,33,35,36,37,39,42,54,55,
56,58,61
Pregnancy, 11, 47

br

202
Pressure sores, 3, 32, 34, 35, 36, 42, 53, 54, 55, 61,
179
See also Preventing pressure sores, Treating
pressure sores
Preventing pressure sores, 34-35, 53-54, 61.01
See also Treating pressure sores
Preventing! Treating contractu res
See Contractu res
Preventing! Treating osteoporosis
See Osteoporosis
Products, electrical stimulation
See Equipment
Pudendal nerve, 23

-QQuadriplegia, 11, 16, 19, 1.01, 1.02, 1.03, 1.04, 2.01,


2.02,2.03,2.04,4.01,5.01,6.01,7.01,8.01,9.01,
10.02,10.03,11.01,12.01,14.01,15.01,15.02,
15.03,17.01,18.01,21.02,21.03,22.01,23.01,
25.01,28.01,29.01,29.02,29.04,30.01,31.01,
31.02, 32.02, 33.01, 33.02, 33.03, 34.01, 34.02,
34.03, 34.04, 35.01, 35.02, 35.04, 35.05, 36.01,
39.01, 39.02, 40.01, 41.01, 43.01, 44.01, 45.01,
45.02,45.03,47.01,47.02,47.03,47.04,48.01,
48.02, 49.01, 49.02, 49.03, 50.01, 51.01, 51.02,
51.03,53.01,55.01,57.01,57.02,59.01,59.02,
59.03, 60.03, 60.05, 61.01, 62.01, 63.01, 63.02,
63.03,64.01,66.02,67.01,67.02,67.03,68.01,
68.02,68.03,68.04,69.01,70.01,70.02,71.01,
71.03,72.01,73.01,73.02,73.03,74.01,75.01,
76.01,77.01,77.02,77.03,77.05,78.01,81.01,
84.01,85.01,85.02,85.03,86.01,87.01,88.01,
90.01,91.01,92.01,92.02,93.01,93.02,95.01,
95.02,95.03,95.04,96.01,97.02,97.03,97.04,
98.01,98.02,98.03,102.01,103.01,104.03
Questions, 65
-RRange of motion, 36, 38, 55, 58
Reaching, 17-20,47,176,178,44.01
See also Upper limb movement
Readings, suggested, 175-79
References
See Readings, suggested
Regaining voluntary function, 44-45,1.04,6.01,
11.01, 33.02, 35.04, 49.02, 49.03, 59.03, 75.01,
82.01, 97.04
See also Neuromuscular treatments
Regeneration, 3, 49.02, 91.02
See also Neuromuscular treatments
Regulatory approval, 8, 9, 20, 46
See also Food and Drug Administration
Reimbursement, 8
See also Insurance
Research subject, 7, 8, 20, 25, 29, 65
Respiratory treatments, 186, 188, 189, 7.01, 14.01,
15.01,45.01,57.01,66.02,67.02,87.01,88.01,
95.04

See also Breathing Assistance

FES RESOURCE GUIDE

Rhizotomy, 21

- S
SCS
See Spinal cord stimulation
Secondary complications, 3, 11, 13
See also Neuromuscular treatments
Sensation, 12, 17, 19,21,22,31,38,43-44,45,46,
49,52,53,56,63,64,68.03
See also Sensory substitution
Sensors, 5,6, 7,19,20,28,30,44
Sensory nerve, 1,6, 19, 21, 36, 37, 43, 44, 48, 56
Sensory substitution, 43, 67.03, 68.03, 69.01, 88.01
Sexual function, 21,187,189,4.01,9.01,10.03,
19.01,20.01,23.01,28.01,35.05,37.01,38.01,
39.02,53.01,54.01,55.01,65.01,73.03,77.04,
89.01,95.05,98.03
See also Electroejaculation, Erection
Spasticity, 3,13,19,20,21,22,24,26,28,29,36
38,45,47,48,50,55-57,58,59,60,42.01,60.04,
61.01, 63.02, 82.01, 85.02
See also Neuromuscular treatments
Sperm, 30, 31,32,52, 53
Spinal cord injury, 11-45, 175, 176, 177, 178, 179,
181, 182, 183, 184, 1.01, 1.02, 1.03, 1.04, 2.01,
2.02,2.03,2.04,3.01,5.01,6.01,7.01,8.01,9.01,
10.01,10.02,10.03,11.01,12.01,13.01,14.01,
15.01,15.02,15.03,15.04,16.01,17.01,18.01,
19.01, 20.01, 21.01, 21.02, 21.03, 22.01, 23.01,
24.02,25.01,26.01,27.01,28.01,29.01,29.02,
29.03, 29.04, 30.01, 31.01, 31.02, 32.01, 32.02,
33.01, 33.02, 33.03, 34.01, 34.02, 34.03, 34.04,
35.01, 35.02, 35.03, 35.04, 35.05, 36.01, 37.01,
38.01, 39.01; 39.02, 40.01, 41.01, 43.01, 43.02,
43.03,44.01,45.02,45.03,46.01,47.01,47.02,
47.03,47.04,48.01,48.02,49.01,49.02,49.03,
50.01,51.01,51.02,51.03,51.04,52.01,53.01,
54.01,55.01,55.02,56.01,57.01,57.02,58.01,
59.01, 59.02, 59.03, 60.01, 60.03, 60.04, 60.05,
61.01,61.02,61.03,62.01,63.01,63.02,63.03,
64.01,65.01,66.01,66.02, ,67.01,67.02,67.03,
68.01, 68.02, 68.03, 68.04, 69.01, 70.01, 70.02,
71.01,71.03,72.01,73.01,73.02,73.03,74.01,
75.01, 76.01, 77.01, 77.02, 77.03, 77.04, 77.05,
78.01,79.01,80.01,80.02,81.01,83.01,84.01,
85.01, 85.02, 85.03, 86.01, 87.01, 88.01, 89.01,
90.01, 91.01, 91.02, 92.01, 92.02, 93.01, 93.02,
95.01,95.02,95.03,95.04,95.05,96.01,97.01,
97.02,97.03,97.04,98.01,98.02,98.03,98.04,
99.01,101.01,101.02,102.01,103.01,104.01,
104.03,105.01,105.02
Spinal cord stimulation (SCS), 19,22,24,28,37,45,
46,47,48,49,50,51,56,57,60,63,64
Spinal nerve, 1, 2, 21, 48
Splints, 17, 18,38,58

See also Bracing

Stair climbing, 80.02

INDEX

203

Standing I transfer assistance


See Standing, Transfers
Standing, 24,25, 29, 35,38,40,42, 39,50,51, 59,
176,178,2.04,12.01,16.01,29.04,43.01,49.01,
58.01,63.03,70.02,93.01,98.04,101.01,104.01
See also Lower limb movement, Transfers
Status, 7, 9,11,12,15,17,19,22,24,28,31,33,34,
35,37,39,40,42,43,45,49,51,52,54,55,56,
58,59,61,62,63
Stepping
See Walking
Stimulator, 5, 6,7,12,14,15,17,18,19,21,22,23,
27,31,33,34,37,38,39,40,41,42,43,44,45,
48,49,50,51,52,54,57,60,61,63,64
Suggested readings, 175-79
Surface electrodes, 5, 12, 17, 18, 19,20,22,24,25,
27,28,29,33,34,35,36,37,38,39,41,42,49,
51,54,55,56,57,58,60,61,62
Surgery, 5, 6, 7, 16, 18, 19,20,21,22,23,35,36,
37,38,49,50,54,55,57,62,64,66
Switch, 27, 51
Technology, 5
Tendon transfers, 18
TENS
See Transcutaneous electrical nerve stimulation
Tetraplegia.
See Quadriplegia
Therapeutic stimulation, 1, 3, 5
Thoracic, 17,25,26,29
Training, 9, 13, 16, 17,20,22,23,25,26,29,34,46,
51,64
Transcutaneous electrical nerve stimulation (TENS),

3
Transfers, 24, 25, 35, 38, 40, 42, 50, 56, 59, 60, 61,
176, 178,2.04, 12.01, 16.01,29.04,43.01,49.01,
58.01,63.03,70.02,93.01,98.04,101.01,104.01
See also Lower limb movement, Standing
Treating pressure sores, 19,35-36,54-55,29.03,
35.02, 61.01, 95.02
See also Preventing pressure sores
Treating weak atrophied muscles
See Atrophied muscles, Weak muscles
Treatments, 11-64
Tremor, 3, 43, 62, 179, 49.02, 71.02, 85.02
See also Neuromuscular treatments

Tumors, 11,31,47
- UUnlabelled use, 22, 28, 37, 46, 49, 51, 56, 63
Upper limb movement, 186, 187, 189, 190,10.02,
17.01,21.02,30.01,39.01,44.01,45.02,50.01,
51.01,51.02,51.03,59.02,60.05,61.01,62.01,
64.01,67.01,68.04,69.01,71.01,77.01,77.02,
77.03, 84.01, 86.01, 88.01, 91.01, 104.03
See also Grasping, Reaching
Upper motor neuron, 2, 12,42
Urinary tract infections, 11,21,23, 26, 29, 48, 51

-v
Ventilator, 14, 16
Veteran, 181, 182, 185,5.00,6.00,15.00,17.00,
21.00,27.00,31.00,37.00,43.00,44.00,45.00,
47.00, 53.00, 57.00
Voluntary movement
See Regaining voluntary function
Volunteer, 66
See also Research subject

-wWalking, 26,50-52,56,59,60,61,176,178,1.03,
2.04,3.01,10.01,12.01,21.01,24.01,27.01,
29.02,32.01,32.02,35.03,40.01,41.01,42.02,
43.02,43.03,49.01,51.04,52.01,55.02,56.01,
57.02,58.01,60.01,60.02,61.03,63.03,66.01,
68.01, 70.01, 71.03, 74.01, 76.01, 79.01, 80.01,
83.01,85.01,93.01,94.01,95.01,96.01,97.01,
98.04, ,99.01,100.01,101.02,102.01,104.02,
105.01

See also Lower limb movement

Weak muscles, 2, 3, 5, 25,42,46,41-43,60-61,


1.01, 2.03, 21.03, 24.02, 25.01, 31.02, 34.01,
34.02,34.04, 35.04,42.03,47.04,48.01, 49.02,
59.01,60.03,61.01,63.02,68.02,72.01,74.02,
75.01,77.01,85.02,92.02,93.02,97.03
See also Cardiovascular exercise, Lower limb
movement, Neuromuscular treatments, Upper limb
movement
Wheelchair, 11, 18, 19, 25, 26, 34, 40, 53, 59
Wound, 1, 35,54,55
See also Pressure sores

CONTINUED

bs

204

FES RESOURCE GUIDE

IOrganizational Index
3M Health Care, 186

DynaWave Corporation, 187

-A
ABLEDATA. 180
American Neuromodulation Society. 184
American Physical Therapy Association, 183
American Spinal Injury Association, 183
Asah MedicoNS, 186
Association for the Advancement of Medical
Instrumentation, 183
Atrotech Co., 186
Austin Hospital, 62.00
Avery Laboratories Inc., 186
Axelgaard Manufacturing Co., Ltd., 186

-E
ECRI,180
ElectroLogic Of America, Inc., 187
Electrostim USA, 187
Emory University Department of Rehabilitation
Medicine, 11.00
EMPI, Inc., 187

-8
Baltimore Veterans Affairs Medical Center. 17.00
Baylor College of Medicine, 53.00
Bioelectrical Repair and Growth Society. 185
Bioflex, Inc., 186
Biomech DeSigns Ltd., 186
Biomedical Engineering Society, 183
Boston University School of Medicine, 20.00
Brockton! West Roxbury VA Medical Center, 21.00
Burke Rehabilitation Center, 40.00

-cCAllES, 78.00
CARF,78
Case Western Reserve University, 45.00
Center for Motor Rehabilitation, 67.00
Center for Physical Rehabilitation, 30.00
Centre for Implantable Technology and Sensors,
94.00
Centre for Spinal Cord Injured, 77.00
Centre Propara, 78.00
Chattanooga Group, Inc., 187
Cleveland Clinic Foundation, 42.00
Cleveland FES Center, 43.00, 44.00, 45.00
Cleveland VA Medical Center, 43.00
Colon and Rectal Surgical Associates, Ltd., 26.00
Commission on the Accreditation of Rehabilitation
Facilities, 78
Consortium of Multiple Sclerosis Centers, 180
Cornell Medical Center, 38.00

-0
Dallas Rehabilitation Institute - HealthSouth, 52.00
Dalzell USA Medical Systems, 187
Detroit Medical Center, 24.00
Dobelle Institute, 186
Duke of Cornwall Spinal Injured Centre, 103.00
Duke of Cornwall Spinal Treatment Centre, 104.00
Dynatronics, 187

-F
FES Centre, 62.00
FES Information Center, 46
Finetech Limited, 188
Flower Hospital! Rehabilitation Center, 49.00
Food and Drug Administration, 8, 55,181
Free University Hospital, 89.00

- G
G.F. Strong Centre, 74.00
Good Samaritan Hospital, 41.00
Grand Valley State University School of Health
Sciences, 22.00
Grass Instrument Company, 188
-HHampstead Centre Spinal Injuries Clinic, 61.00
HealthSouth Rehabilitation Hospital of Greater
Pittsburgh, 50.00
Help Them Walk Again Foundation, Inc., 33.00
Henley International Inc, 188
Hines VA Hospital, Rehabilitation R&D Center,
15.00
Hope Hospital, 102.00
Hospital Das Clinicas Da Faculdade de Medicina,
69.00
Hospital Geral St Antonio, 93.00
Hospital Juan Canalejo, 99.00
Hunter Holmes McGuire VA Medical Center, 57.00

-I
IEEE Engineering in Medicine and Biology Society,
183
Illinois Institute of Technology, 14.00
Immanuel Rehabilitation Center, 32.00
Institut Guttmann, 98.00
International FES Society, 184
International Neuromodulation Society, 184
International Therapeutic Technology, 97.00
ITIS d.o.o. Ljubljana, 94.00

- JJefferson Barracks - Spinal Cord Injury Unit, 31.00

"."...-~

. - -.......

--~.--

...-

-...... -

INDEX

205

-KKessler Institute for Rehabilitation, Inc., 35.00


Klinik Berlin, 79.00
Klinikum Grosshadeum University, 80.00

-LLectec Corporation, 188


Life-Tech, Inc., 188
Long Beach Memorial Rehabilitation Hospital, 3.00
Los Angeles Doctors Medical Group, 1.00
Lowenstein Rehabilitation Center, 83.00
Lutheran Medical Center, 30.00

-MMagee Clinic, 72.00


Marcelo J. Fite Rehabilitation Institute, 60.00
Mark W. Vogel, MD, 4.00
Maximum Performance Technologies, 188
Mayatek Medical, 72.00
Medical College of Virginia, 58.00
Medical Economics Data, Inc., 181
Medical Illness Counseling Center, 18.00
Medical Research Council, 101.00
Medimplant, Inc., 188
Medlink Technical Corporation, 188
Medtronic, 189
Mellen Center, 42.00
MetroHealth Medical Center, 44.00, 45.00
Metropolitan Rehabilitation Center, 91.00
Mettler Electronics Corporation, 189
Miami Project to Cure Paralysis, 10.00
Minnesota VA Medical Center, 27.00
Moulsdale, Murphy, Sigelbaum and Lerner, PA,
19.00
Mount Sinai Medical Center, 36.00, 37.00

-NNational Center for Medical Rehabilitation Research,


184
National Database of Educational Resources on
Spinal Cord Injury, 181
National Institute of Neurological Disorders and
Stroke, 184
National Institute on Child Health and Human
Development, 184
National Institutes of Health, 184
National Library of Medicine, 181
National Multiple Sclerosis Society, 181
National Rehabilitation Hospital, 9.00
National Rehabilitation Information Center, 182
National Science Foundation, 185
National Spinal Cord Injury Association, 182
National University Hospital, 82.00
NEC Corporation, 189
Neural Engineering Clinic, 16.00
Neurocontrol Corporation, 189
Neuromedics, 188
Neuromotion, Inc., 189

Neuromuscular Electrical Stimulation Systems, Ltd,


189
Neuromuscular Retraining Clinic, 59.00
Neuroscience Centre, 77.00
New York Hospital, 38.00
Newington Childrens Hospital, 8.00
Next Step Rehabilitation and Research, 13.00

-0
Ohio State University, 46.00
Osaka Rosai Hospital, 87.00
- p
Paralyzed Veterans of America, 182
PEERS Program, 1.00
Petrofsky Center for Rehabilitation and Research,
2.00
Pritzker Institute of Medical Engineering, 14.00
Public Hospital, 85.00

-RRehabilitation and Fitness Center, 34.00


Rehabilitation and Research Center, 58.00
Rehabilitation Engineering and Assistive Technology
Society of North America, 185
Rehabilitation Institute of Michigan, 24.00
Rehabilitation Institute, 29.00, 95.00
Rehabilitation Medicine Associates, 25.00
Rehabilitation Research and Development Service,
185
Rehabilitation Services - Center for Rehabilitation
Medicine, 11.00
RESNA,185
Royal Adelaide Hospital, 61.00
Royal North Shore Hospital, 64.00

-8
S.M.1. Center for Sensory-Motor Interaction, 76.00
Sendai FES Project, 88.00
Shake-a-Leg FES Research Program, 63.00
Shepherd Center, 12.00
Shriners Hospitals Philadelphia Unit, 51.00
Sigmedics Inc., 190
Sinties Scientific, Inc., 190
Society for Physical Regulation in Biology and
Medicine, 185
Southwest Fertility Center, 54.00
Spinal Cord Injury Hotline, 182
S1. Francis Health Care Centre, 48.00
Strong Memorial Hospital, 39.00
Staodyn, Inc., 190
Stimtech Products Inc., 190
Stimwear, Inc., 190
Stratec Electronic, 190

-T
TherapeutiC Alliances, Inc., 190
Therapeutic Technologies, Inc, 190

------------------------------------------------------------------------------------------~

206

FES RESOURCE GUIDE

Tohoku University, 88.00


Toronto Hospital- Western Division, 73.00

-UUnipatch, Inc., 190


Universal Institute, Inc., 34.00
Universitet of Medicine Poznan, Poland, 92.00
University Hospital St. Radboud, 90.00
University Hospitals, 65.00
University of Alberta, 71.00, 74.00
University of Bristol, 100.00
University of Miami School of Medicine, 10.00
University of Michigan, 23.00
University of Minnesota, 26.00, 27.00
University of Missouri, 28.00
University of Rochester Medical Center, 39.00
University of Rome, 86.00
University of Sydney, 63.00
University of Utah Health Science Center, 55.00
University of Vienna, 66.00
University of Wisconsin Hospital and Clinics, 59.00
University Witten/Herdecke, 81.00

-vVA Medical Center - San Diego, 6.00

Vancouver Hospital and Health Sciences Centre,

5.00
Veterans Administration - St. Louis, 31.00
Veterans Affairs Rehabilitation Research and
Development Service, 185
Vienna Working Group FES, 66.00

-wWest Los Angeles VA Medical Center, 5.00


West Roxbury VA Medical Center, 21.00
Whitaker Foundation, 185
Woodrow Wilson Rehabilitation Center, 56.00
Wright State University, 47.00

- yYale University School of Medicine, 7.00

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