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Lower extremity applications of functional neuromuscular stimulation
1Pritzker Institute of Medical Engineering, Illinois Institute of Technology, Chicago 60616.
Assistive Technology : the Official Journal of RESNA
|December 10, 1991
Summary
Functional electrical stimulation (FES) for lower extremity movement, like standing and walking, has limited clinical use due to challenges with open-loop control, muscle fatigue, and technology. While FES can aid standing and is available in hybrid systems for walking, widespread clinical application requires further development and FDA approval.
Area of Science:
- Rehabilitation Engineering
- Neuroprosthetics
- Biomechanics
Background:
- Functional electrical stimulation (FES) is widely researched for lower extremity applications but has minimal clinical implementation.
- Current clinical FES predominantly uses open-loop control, delivering predetermined stimulus patterns without real-time feedback.
- Muscle fatigue in electrically stimulated contractions presents a significant challenge for sustained functional movement.
Purpose of the Study:
- To review the current state of clinical applications for lower extremity Functional Electrical Stimulation (FES).
- To identify challenges and limitations hindering the widespread adoption of FES in clinical practice.
- To assess the potential and current status of various FES technologies, including surface, percutaneous, and implantable systems.
Main Methods:
- Literature review summarizing current knowledge on clinical FES applications.
- Analysis of existing FES technologies, control strategies (open-loop vs. closed-loop), and challenges like muscle fatigue.
- Evaluation of the clinical availability and regulatory status of different FES systems.
Main Results:
- FES-aided standing is achievable with surface electrodes but requires research protocols and IRB approval.
- Multichannel FES systems are not yet clinically available in the US, pending FDA approval of devices like "Parastep".
- Hybrid systems, such as the Reciprocating Gait Orthosis (RGO) with FES, are the only current clinically available walking assistance incorporating FES.
Conclusions:
- Significant hurdles remain for widespread clinical FES application, including control strategies, muscle fatigue management, and technological maturity.
- Implantable and percutaneous FES systems are not yet practical for clinical use, requiring further technological advancements.
- While FES shows potential for improving mobility, further research is needed to establish long-term benefits, cost-effectiveness, and user acceptance.