Functional Electrical Stimulation "TRUST-M"

Functional electrical stimulation (FES) is a technique of stimulating the muscles in motion during their physiological activity. It is intended to restore muscle function and its automatism. In many neurological diseases, such as cerebral stroke, infantile cerebral palsy, peripheral and central paralyses and pareses of various origin, normal muscle involvement in the motor act is disrupted. Therefore, muscle spasticity is characterized by constantly high tension, which is usually accompanied by a change in the phase of muscle activity in the performed movement. The muscle may increase its activity in that phase of movement where activity must decrease. Applying various therapeutic intervention techniques on the muscle, you can increase its activity and make it stronger. However, its negative impact on the performed movement will increase and may lead to a deterioration of the function. Currently, FES is one of the specific techniques intended for the purposeful correction of pathologically altered muscle function.

This method is based on precise synchronization of stimulating pulses with the phase of motion. Stimulating pulses are applied to the muscle not once, but consistently and frequently during the entire period of active muscle action. This is why cyclic motions are used for FES. For the lower limbs, these are walking, the stepper, or the exercise bike; for the upper limbs these are various types of hand trainers: exercise bike, rowing, and others. An electrostimulation session requires 30 minutes to one hour. During this period, the patient makes several thousand cyclic movements. Recurrent excitation of the muscle in the desired phase makes it possible to reprogram it and restore normal physiological activity. Of course, only relatively intact muscles can be recovered. If, for example, there is a pathology of the central nervous system, then it is possible to achieve a compensation level, depending on the existing pathology and its combination with other disorders.

FES has significant differences from conventional electrical stimulation of muscles carried out during inactivity:

• in case of a significant defect — active development of the correct or optimal movement pattern;
• highly precise correction of abnormal movements;
• selective training of muscles using a normal physiological pattern of its function;
• independence of correction of the movement pattern of muscles from external conditions of their activity;
• fast and effective development of a long-lasting new motor skill.

The video shows the moment FES is performed on the bicep muscle of the arm with rhythmic movements. The upper curve (blue color) is the sensor data, and the rectangular pulses below are the actual time of the stimulating channel’s operation.Electrical stimulation of muscles with simulteneous movements

A record of functional electrostimulation of the bicep muscle, as it is usually recorded by the software package, is shown below. The upper (green) curve is the elbow joint’s movements. The lower curve is the start and end time of muscle stimulation.

The stimulation channel generates pulses of electric current that can be adjusted according to many parameters:

• mono- or bipolar;
• pulse duration;
• pulse amplitude;
• time between pulses of different polarity (for bipolar);
• pulse rate;
• stimulation start time (relative to the movement cycle);
• stimulation end time (relative to the movement cycle).

Such a multifunctional electrostimulation channel allows precise customization to a particular patient. In the preinstalled methods, all necessary parameters are included and only adjustment for the given patient is required.

Another advantage of Trust-M is that with this FES system it is possible to perform treatment and rehabilitation activities during lessons on any training device. The combination of FES with biological feedback significantly increases the efficacy of FES, improves patient motivation, and positively affects their mood.

The essential advantages of Trust-M are that these technical and methodical solutions make it possible to significantly increase the efficacy of FES by reducing the time for preparatory measures, improving the accuracy of synchronization of electrical stimulation with the motor action, expanding the available types of movements which can be used to conduct FES, including movements of the upper limbs and various locomotions not associated with walking.

Indications for FES:

• injuries with damage to large tubular bones, joints, spine, as well as craniocerebral trauma;
• peripheral and central paralysis and paresis;
• hemiparesis of cerebral origin as a result of vascular or traumatic lesion;
• infantile cerebral palsy;
• spinal cord injuries at various levels accompanied by flaccid or spastic paralysis;
• scoliotic disease;
• spinal osteochondrosis;
• slow healing fractures and pseudarthrosis;
• condition after endoprosthesis replacement of large joints of the upper and lower limbs;
• obliterating diseases of the vessels of the upper and lower limbs;
• walking with prostheses due to one- or two-sided amputation at shin or thigh level;
• consequences of poliomyelitis, accompanied by paresis.

Contraindications to FES:

The FES method is a physiotherapy procedure that complies with the contraindications common to such methods.

• poor tolerance of electrical stimulations, suggesting long-term patient adaptation to the FES;
• joint contractures and serious deformations of the lower limbs, excluding the use of prosthetic and orthopedic devices;
• lack of adequate unloading of the patients' damaged spine with uncomplicated compression fractures of the vertebral bodies;
• diseases or extensive scarring in the electrode area;
• acute and chronic inflammation with localization on the affected limb or trunk;
• spasms in anamnesis;
• patients with stumps of the lower limbs and poor-quality prosthetics, with diseases and defects of the stump;
• patients with original forms of ischemic heart disease, arrhythmias and conduction, medium arterial hypertension;
• low pain threshold (poor electrical stimulation tolerance);
• resistant joint contractures and expressed deformation of the limbs with marked disturbance of the functions;
• dermal diseases or extensive scarring changes in the area of electrode application;
• acute and chronic inflammatory processes in the area of electrode application