Enhancing Recovery from Critical Care

Combining Movement Therapy and Functional Electrical Stimulation

Derek Jones PhD, MBADirector, Anatomical Concepts (UK) Ltd

Rehabilitation after critical illness

• Approx 110,000 in critical care each year in England & Wales

• Significant percentage have long-term problems

• Recognised issues - weakness, muscle loss, PTS, anxiety, depression, cognitive disfunction

• Patients at risk - start rehabilitation as early as clinically possible

NICE Guidelines - CG83

When can Rehabilitation Start?

Early!

Exercise is a therapeutic agentFirst recognised over a

thousand years ago

Exercise is Medicine

Movement therapy - machines that move the limbs

through a range of motion

Early Exercise in Critically Ill Patients Enhances Short-Term Functional RecoveryChris Burtin et al, Crit Care Med. 2009;37(9):2499-2505.

Motion Therapy

Functional Electrical

Stimulation

Bringing together

two technologiesActive Exercise by..Creating more

What Can We Expect

Improved vital signsPreserved muscle massReduced risk of Post-Intensive care syndrome & ICU-AW?Reduced risk of pressure sores

Combining Movement and Functional Electrical

Stimulation (FES)

Faster Rehabilitation

FES Cycling - used by clinics and individuals at home all

over the world

Cardiovascular fitnessMuscle tissue bulk

Bone density improvement

Activate Paralysed Musclevia Intact Lower Motor

Neurons

Application of FES• Absolute

contraindications

• Unhealed fractures in the limbs to be stimulated

• Pregnancy

• Relative Contraindications

• Denervated muscle

• Severe spasticity

• Limited range of hip/knee joint motion

• Severe osteoporosis

• Open wounds in current path

Movementcombined with FES to activate muscle -

even with an unconscious patient

FES unit

Letto2

Func

tiona

l Elec

trical

Stim

ulatio

n

FES is a tried and tested technology

Principles discovered in

the 18th Century

Sequence of precise pulses Functional & useful timingTimed to pedal movement

Adjustable intensitySafe and effective

FrequencyPulse widthCurrent

FES Controller

Feedback of..Pedal position - Speed - Power Generated

Muscle Contraction in response to FES

Some of the ways we use FES..

Create new opportunities for rehabilitation

Spinal cord injury - complete and incomplete

Stroke

Parkinson’s disease

MS

Transverse myelitis

Spinal Cord Injured client - complete lesion T8/T9

Knee flexion and extension muscles activated with “triggered” FES to enhance exercise

Trunk extension, core strength development exercises - C4 complete spinal cord injury

FES makesmovement active

safely and effectively

How could it be used?

• 3 to 4 days after admission to critical care

• Electrodes on Quads & Hamstrings, Gastronemius, Gluteals

• Stimulation intensity individually determined

• Sessions 5 times per week - up to an hour per day

Images on Page 2 - David Graham, “No Diving” ISBN 978-0-9557465-1-2

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