Functional Electrical Stimulation (FES)

Functional Electrical Stimulation (FES) applies low level electrical impulses to weakened, damaged or paralysed muscles to help improve your capability and mobility.

Ortho Advantage aims to use FES devices to help patients increase their mobility.

Electrical Muscle Stimulation results in

  • Walking with more speed, stability and confidence
  • Improved balance and decreased risk of trips and falls
  • Increase muscle strength and endurance
  • Reduced tightness and muscle cramping
  • Exercise at home or outside the rehabilitation centre
  • Assist hand and finger movements
  • Increase joint motion and blood flow

Conditions treated with Functional Electrical Stimulation (FES)

Ortho Advantage uses Functional Electrical Stimulation (FES) devices to help patients suffering from drop foot, lower limb muscle weakness and upper limb muscle weakness due to:

  • Stroke
  • Multiple Sclerosis
  • Acquired Brain Injury
  • Cerebral Palsy

Frequently Asked Questions about the Functional Electrical Stimulation (FES) device

The human body naturally uses small electrical impulses to cause muscles to move. If the body is unable to generate or transmit this nerve signal from the brain to the desired muscle, then the muscle will be unable to move.

Functional Electrical Stimulation (FES) devices are technology which generates muscle movement at a desired area by directly transmitting a low-level electrical impulse to the nerve, activating the
muscle.

For a person unable to move a muscle due to injury or a condition which has affected the central nervous system, FES devices can be used to compensate for this deficit

These devices are wearable, battery-powered and specifically target a muscle or muscle group at a specific time to increase function.

An example of this is an FES device for drop foot. The device will sense when the patient is lifting their foot from the ground and stimulate the common peroneal nerve to activate the muscles which generate lift (dorsiflexion) at the ankle.

Depending on position and tuning of the device we can also
adjust the amount of eversion (moving the foot away from body at the ankle joint).

The FES device will provide a low-level electrical impulse to a specific region and cause a muscle contraction.

The muscle contraction will create movement at a joint. The ‘functional’ in ‘functional electrical stimulation’ refers to this contraction being used in a real world setting and to enable activity or movement, rather than a purely therapeutic reason such as pain relief.

The aim for an FES device is to improve the function of a stroke, MS or patient suffering muscle weakness or paralysis due to a neurological condition.

Having said that, pain relief and rehabilitation are often desired and beneficial side effects of Ortho Advantage’s functional electrical stimulation treatments.

Research has shown considerable and impressive improvements in function, strength, endurance of patients when using FES. Current research is investigating the effects of FES devices on rehabilitation, especially from a neuroplasticity (changes in the brain) perspective and if external stimulation of a muscle can help the brain adapt and heal to create a lasting benefit even after the user has removed the device.

The benefits of functional electrical stimulation (FES) is that you are using your own muscles to move and not reliant on a passive device. This may assist with rehabilitation and re-training the brain in the case of a stroke or stimulating the muscles and maintaining strength in the case of MS or partial spinal cord injury.

Our patients often report the following benefits to wearing FES devices compared to wearing no device:
- Improvements in rehabilitation
- Faster walking speed
- More symmetrical movement
- Reduced spasticity in opposing and affected muscle groups
- Increase in muscle strength and endurance
- Reduced tightness and muscle cramping

Patients report the following benefits of FES when compared to a device such as an Ankle Foot Orthosis (AFO):
- Ability to wear a greater variety of footwear
- No skin rubbing from orthotic devices
- Less muscle atrophy
- Better ability to walk on angled or rough terrain
- Limbs feel more free
- Ability to walk barefoot

FES devices are suitable for people with muscular weakness, loss of co-ordination or paralysis due to upper motor neuron issues. An upper motor neuron issue is an issue which is limited to the brain or spinal cord. A patient with a lower motor neuron lesion (such as nerve injury in the extremity) is not generally suitable for FES as the pathway the electrical impulse act along is interrupted and can’t conduct the signal regardless of an internal or external generation.

Interestingly, even if the nerve is severed beyond the spinal cord but above the site of stimulation, the stimulation will generally not work. We require a complete circuit from muscle to spinal cord to complete the stimulation, and the nerve will generally cease to function due to the damage to the structures which provide the cells with the necessary resources for cellular maintenance.

At Ortho Advantage, we use functional electrical stimulation systems for patients with:
- Foot drop
- Quadriceps weakness
- Upper limb weakness

Our goals will always align with those of the patient, but most people work with us seeking to function more effectively, gain strength, rehabilitate more effectively and gain independence.

Muscle weakness resulting from the below conditions may benefit from functional electrical stimulation:
- Stroke
- Multiple Sclerosis
- Parkinsons
- Acquired Brain Injury
- Spinal Cord Injury
- Incomplete Spinal Cord Injury
- Cerebral Palsy

An FES System works very differently to a traditional ankle foot orthosis and both have unique purposes.

A Functional Electrical Stimulation (FES) stimulates your own muscles to lift your foot and enable toe clearance. An traditional ankle foot orthosis (AFO) will generally lift your foot via an externally applied force to create toe clearance.

Neither of these options are definitely better or worse. What is most important is what a patient prefers and what they will walk best in and does the tool for the job match up with their goals.

This will vary patient to patient and our experts at Ortho Advantage can provide an initial consult and assessment of any condition.

Some FES patients find that a larger variety of footwear options are available to them compared to wearing an AFO. This is due to the fact the FES system is positioned below the knee and there is no structure in the shoe (unless we choose to incorporate a foot switch).

For a patient with a more complex presentation ie associated knee weakness, contractures, spasticity and other complicating factors a custom ankle foot orthosis might be a better option.

Everyone needs to be assessed on an individual basis.

We strongly suggest booking an appointment with our orthotists to discuss your specific situation and if an FES device is a better option for you than your current device.

Contact us to book in an initial consultation and assessment. Most patients under the age of 65 will be suitable for NDIS funding which can assist with the cost.

Yes! Our Ortho Advantage electrical muscle stimulation trained clinician will guide you through the process. We can begin by testing if your condition is suitable for electrical muscle stimulation FES and if we we can generate a muscle contraction at the desired location. If a stimulation can be achieved you can try several different FES devices in our clinic under the instruction and supervision of our trained clinicians.

Once it is known what Functional Electrical Stimulation (FES) device will work with your lifestyle and goals, we can arrange for a trial FES device which you can take home with you.

This device may collect information about how much use it is getting, and other relevant data. When you come in for the follow up appointment we download this data for analysis as it can assist us with funding applications and analysis in the future.

Electrical muscle stimulation FES systems range from $4,000 to $14,000. The cost will depend on the type we use and the components required to get the best outcome for you.

The reason for the large variation in cost is due to the different technology built into the FES devices. Some are more simple devices, whereas others use complex computer algorithms, gyroscopes and accelerometers to know when to stimulate the muscle at the correct time.

Most patients under the age of 65 with a condition where an FES device is required will qualify for NDIS funding and most patients with an FES device do not have to pay anything out of pocket.

Yes. As with any assistive technology the FES device can be funded on NDIS if it is deemed necessary to your goals and it is clinically justified. We are experienced with the NDIS and will guide you through and advocate on your behalf.

We will generally test your abilities with and without the device using validated tests called ‘outcome measures’ to prove there is a benefit to you wearing the device.

We will then present this to the funding body as evidence to gain approval. These tests may include walking speed, walking safety, gait analysis.

The first step is to contact our clinic and arrange an initial consultation.

If you are over 65 or not NDIS funded we can help you decide on an option and investigate other funding for you but it is likely there will be some out of pocket costs for you.

During this process, regardless of age or condition we will:

Guide you through the system and advocate on your behalf if we believe an FES system will be beneficial for you.

We will direct you towards the best system within your budget and investigate other options with you if the cost is not achievable.

FES devices are generally used on patients for the upper and lower limbs, however there are additional devices out there which can assist with respiratory and other bodily functions which work with similar principles. These devices are outside of our scope of practice.

As with most things, there are slight trade-offs. Functional Electrical Stimulation (FES) devices are more expensive than a basic ankle foot orthotic. Most will require charging once per day (usually overnight as per you’d charge your phone), patients with certain pacemaker devices may not be suitable, patients without the hand function or assistance to put the device on may not be suitable, there is a gentle buzzing sensation at the site of stimulation and an effective stimulation may not be possible on every candidate (patients with lower motor neurone lesions).

Functional Electrical Stimulation (FES) devices are simple for patients to use once set up and your experienced Ortho Advantage expert has guided you with thorough support and training. The assessment, set up and fine tuning to elicit an effective stimulation (getting the stimulation at the correct place and the correct rate at the correct time) takes some practice and expertise which is why being fit by an Ortho Advantage expert is important.

The training effect of electrical muscle stimulation FES refers to the improvement some patients feel even after taking the device off. This training effect may be due to
- Improved muscular strength and endurance gained through use
- The patient becoming more aware of their capabilities while using the neglected muscle group
- Changes in brain function and the instigation of neuroplastic changes in the brain

There are multiple studies demonstrating changes and improvements in function of patients when the electrical muscle stimulation FES device has been removed or switched off.

No! In fact, the exact opposite will occur. As people who are suitable for Functional Electrical Stimulation (FES) have a functional muscle group but lack the ability to control that muscle, often the muscle will become weak and atrophied even if trying to rehabilitate as best as they can.

Application of a FES device will stimulate that muscle to work and function as it would pre-disease or injury.

Patients will often notice an increase in the size and endurance of the muscle group being stimulated after several weeks of use.

FES devices can be particularly useful in the early stages of stroke while a patient is recovering to maintain muscle and theoretically will help to stimulate neuroplastic changes in the brain via feedback from that muscle group to the brain.

This may help re-integrate that particular body segment into the body schema.

Some of the higher end FES devices have built in ‘training modes’ which will stimulate the particular muscle group on a pre-programmed routine. This can enable a patient to build muscle and endurance in the affected bodily segment while doing as little as sitting on the couch watching TV or any other non-weight bearing activity.

If you visit our clinic and we find that the FES device doesn’t work for you, there will be no additional costs beyond our standard $70 initial consultation fee.

Your Ortho Advantage clinician will be able to use our assessment and the consultation to decide if there are other appropriate orthotic devices for you and advise accordingly.

Be supported by your local Orthotist. Book an appointment today.