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  • FES to improve muscle strength

    Hi, I've been doing PT at a local hospital and I was inspired by Dr. Terry Wahls to try functional electric stimulation to improve my muscle strength and reduce spasticity but PT said it wasn't appropriate for my situation. As I understood it, FES has been well documented to help stroke issues and spinal cord injuries but less so with MS. Dr Wahls, who has MS, says she used FES with diet changes to get out of a wheelchair but there doesn't seem to be a lot of support and insurance reimbursement for this type of therapy if the MSer is still "mobile" and doesn't have obvious atrophy of muscles. Just for fun I did measure my weak leg against the strong one and there is a slight difference. One I didn't have before MS ( I always used to
    like my leg shape). I was wondering if anyone has tried FEs. My internet searches seem to suggest there may be a few places in the country that offer this type of rehab but I didn't see any near me. Here is a link that discusses recent studies using FES in MS patients
    .
    http://www.everydayhealth.com/news/p...ted-foot-drop/
    I guess I want access to this technology and i don't know how.

  • #2
    Dr wahls FES protocol

    Excerpt from: http://neurochangers.com/2013/10/04/...e-sclerosis-2/

    "Dr.Wahls also mentions the use of neuromuscular electrical stimulation to help improve muscle strength. As part of her recovery she used an FES (functional electrical stimulation) bike similar to the one provided at Aim2Walk. This type of stimulation is an electrical impulse sent to the nerve that stimulates the muscles in the leg needed to propel the bike. In the studies she read about FES, it was noted to decrease muscle spasticity and improve endurance."

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    • #3
      Ex of PT rehab center using FES

      I found this description of FES specifically for people of all levels of disability and mentioning as treatment for MS. It also mentions that it is covered under Medicare for spinal cord only. The facility is in NY, the Helen Hayes center :
      "State-of-the-art Functional Electric Stimulation (FES) equipment is currently helping many patients at HHH regain their strength and cardiovascular fitness. While FES technology has been around for more than thirty years, recent advances have made the equipment much more user-friendly. Physical therapists, who have received specialized training in the use of the equipment, including how to monitor the settings to ensure maximum benefit to the user, use the FES bicycle with inpatients and outpatients.

      FES technology can help people with many levels of disability, including those with multiple sclerosis, spinal cord injury, brain injury, Transverse Myelitis, Parkinsonís Disease, stroke and other conditions. It is also being used to help children with cerebral palsy improve their motor skills.

      This high-tech bicycle provides patterned electrical stimulation to the surface of muscles, which stimulates nerves and evokes muscle contractions and activity. Surface electrodes are placed on one or both sides of the patientís upper or lower body. The electrodes are then connected to the computerized brain of the machinery that controls speed and resistance. It also measures the amount of effort the cyclist is exerting and automatically measures each patientís progress.

      FES enables the individual who may have lost voluntary control over their muscles due to spinal cord injury to cycle or walk. Patients can even use the FES equipment without transferring from their wheelchairs. The exercise relaxes spasms, improves circulation, maintains or increases range of motion, and prevents muscle atrophy that often accompanies lack of use.

      Once patients leave the hospital to return home, they can access FES as an outpatient, or even obtain the equipment for home use. Medicare covers FES therapy for patients with spinal cord injury."

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      • #4
        Dr Wahls protocol for FES

        Here is article by dr wahls explaining how she started using FES and worked with pT and 2 different devices. She says her body was slowly getting weaker from spms and in 7 mos she was dramatically improved in strength and endurance. She seems like a reputable source. Does anyone think her improvement was exaggerated? The devices are pricey and PT isn't going to advise me in my area. On one hand the science makes sense, and it's benefited stroke suffers, but on the other hand it sounds too good, and main line medicine hasn't embraced it. I'm not sure if lack of insurance reimbursement means anything other than that. I wasn't able to find a FES device to rent. Anyone have ideas, observations, experiences with this?

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        • #5
          Article *
          http://ezinearticles.com/?Mitochondr...-MS&id=1728861

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          • #6
            Hi Suebee,

            This will be quick-in a rush. I believe FES refers to all equipment such as the bike, bioness and walkaide. Terry Wahl,s used a neuromuscular electrical stimulator for muscle strengthening. Which is electrodes you apply to a muscle group that provides a contraction thereby getting the muscle to work. It's best if you are also trying to make the muscle contract yourself connecting brain messages to the muscle. I've used this in the past with modest benefits and will start again soon. I purchased it online and had my PT show me where to place the electrodes and did it at home. The device was under $200.00. I'm in Canada so not sure about insurance, etc.

            Hope this is helpful. I'm happy to share my experiences anytime so fire away the questions. It has been my experience that PT's don't see it as beneficial for MS. I ignored that and kept pursuing it.

            Good luck and keep us posted.

            Teena Marie

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            • #7
              TM, thanks for reply! I worry sometimes about grabbing onto cures without substance, so I was reassured to hear about your experience. There are quite a few on mArket, but I have such little understanding I did not want to invest yet. Dr wahls points out that ones with 2 pads don't let you zap enough muscle groups, which made her switch to a 8 pad FES. Some Informational material talked about passive vs isometric zapping, the first helps tone and the latter strengthens. Also I read the size of pad and frequency can impact the type of twitch muscles and depth of tissue stimulation. Some commercial sites talked about the need to time the zap with the muscle contraction while exercising . But dr wahls sounds like she did both exercising and just squeezing muscles. Peer reviewed published med journal articles explain protocol but use just one muscle group and I can't get illustration of placement of pads on internet. I have not deteriorated as much as Dr wahls did before she started her protcol, but I feel my core and endurance slipping. I'm doing PT but so frustrating that walking 2 min fast, a few leg lifts, and stretches leave me taking a long rest for rest of day. I will not accept this state and I'm determined to fight this. So any more information you can give is appreciated. I also think I'm going to need to stock up on kale 😋 , per dr wahls. She says getting key nutrients is part of the equation.

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              • #8
                Journal article on dr wahls improvement with FES and diet

                Hi, I've been continuing standard Pt and investigating dr wahls protocol to determine if I could duplicate her result. Besides the outlay of cost for FES, one needs to understand placement and type if contraction needed for therapeutic result. Dr wahls had benefit of PT and her own medical background. The article link also says she worked up to over 5 hrs day of FES. Wow that us amazing and I admire that she did that but I'm not sure if that can be a realiStic goal for me. I have begun to implement the some if the diet changes, mainly more greens and fruit. I need to investigate the supplements she used some more.
                The link lists Amt and type of veggies , fruits, duration and muscle groups, and supplements. I wasn't able to get her books at library or local book store , so waiting for online delivery. If anyone hAs used FES , even for non ms muscle improvement, I d be interested in your thoughts on FES.
                Link to journal article http://www.casesjournal.com/content/2/1/7601

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                • #9
                  Hi Suebee,

                  I followed the Wahl's protocol in 2009 for many months also using some estim. It was a challenge getting that much veg into me. I'm not sure what it actually did but it was healthy eating during a stressful time of my life. Now I follow an extremely low saturated fat diet that I feel makes more sense to me. Also, good for many other potential health conditions.

                  Keep up all your amazing work,

                  Teena Marie

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                  • #10
                    Recent Electric ab muscle stim for MS

                    There was a small but promising study on using electric muscle stimulation outside the body on abs of female MS patients and it was found to improve bowel issues. I'm so glad they explored this but continue to be intrigued that overall the medical community accepts electric muscle stimulation for muscle strengthing in paraplegics, stoke victims, and elite athletes, but not MS patients.
                    Link to article

                    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854996/

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                    • #11
                      Recent trial using Electric functional muscle stim to arm of MS patients

                      Here is another recent study ...it shows statistical improvement in progressive ms patients arm strength, improved tracking, and no muscle fatigue after 18 one hr sessions over 10 weeks! It combined a robotic system to ensure correct movement and max voluntary effort.( Maybe companies will be willing to do clinical trials of such devices if they can patent the robotic. )
                      Link to article http://www.ncbi.nlm.nih.gov/m/pubmed/25823038/

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                      • #12
                        This retrospective study of Johns Hopkins MS patients which examined the effect of functional electrical stimulation (FES) cycling on disability progression in persons with multiple sclerosis (MS) and I think makes the strongest finding so far .."The use of FES may play an integral part in neurological restoration of function possibly secondary to Neurogeneration ".
                        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293536/

                        (Dr Terry Whals must be laughing!)

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                        • #13
                          Fes

                          Suebee,
                          I was reading some of your old posts about FES and was wondering what you ended up doing? I also have been very interested in this type of therapy and was able to try out an FES cycle from Restorative Therapies.

                          Unfortunately, the price tag is 20k. Ive read many of the same studies that you have and believe there is a benefit. Unfortunately, the high price means insurance will not cover the cost and many PT 's don't have access either.
                          I'm just trying to do everything in my power to keep my muscles strong as this disease is starting to take its toll.

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                          • #14
                            A quick reply to answer question- I haven't bought a FES, yet. I can't afford the cost to "experiment" with various machines and I'm afraid to commit to the time if I'm not fully versed, or versed to my satisfaction on this technique.
                            Like you, I determined that I can't afford a cycle fes combo so I naively figured a few days would amass the most important research on using the FES devices. I was wrong!

                            Dr. Wahls found it important to have a device which could raise the electrical pulse to get a significant muscle contraction. She did both passive, and active on a bike. Timing the contraction with the bike movement seems like it will take patience, practice, and a machine that will allow you to alter the pulses to match your movement. Dr. Wahls had a PT friend help her. She said she researched Soviet/Russian techniques for athletes, and that is where I found there is a lot of info. I think the current athletic FES devices use a lot of Russian research background. There are photos and diagrams by elite athletes and trainers on the web showing placement for different muscle groups, amt of htz and duration of stimulation. This made me realize it is actually quite involved to get the correct muscle stimulation and one needs at a minimum an understanding of the type of muscle one wants to stimulate, and the strength and duration of the "zap" needed to improve muscle strength. To add to this complexity, different strength "zaps" and placement can be used for reducing spacticity, or muscle recovery. (Gosh, I would be happy just to reduce spaciticity, but I couldn't get a handle on all the instructions different users give. and it wasn't for MS spacticity)

                            All this made me relook at Fes devices combined with machines. They appear to take the guess work out and have "routines" one can choose to get strength, recover, or reduce spaciticity. I even pondered the remote possibility of getting a loan. But if you read the small print, the bike fes Devices require a technician to help set up and introduce it - and the home versions are really intended for paralyzed patients. So I'm unclear if these home versions would give enough zap to help someone with MS just trying to keep walking.
                            This made me look into body wear with incorporated FES.
                            The patent Dr. Wahls has is of a body suit which has appropriately placed FES pads. This isn't on the market yet, as far as i know. Although there are some European Gyms which have a FES workout that uses a bodysuit that looks a lot like it!
                            But, I've been giving a few looks at the ab belts. You know the ones that are on late night tv info commercial and make you snicker. Well, the FDA approved one as a real ab muscle strengthener, and unaffiliated doctors put it in a clinical trial and agreed it strengthened the ab muscles. But here is the most interesting thing in my mind - the placement of the pads in the ab belt and the ones in the MS study on ab stimulation for colon health --- are exactly the same. The only thing stopping me from buying the ab belt (besides my husband and friends laughing at me) is that is about the cost of a FES device, and it doesn't say what power the zaping goes up to. But I say let's all stay tuned, I think it is only a matter of time before ab belt starts advertising it helps colon health. ...
                            I guess that wasn't short. I hope that is helpful. Anyone that has had success doing FES or has insight on how to do it without taking out a home equity loan, please chime in!

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                            • #15
                              Further medical backup for FES being a good technique...

                              Suebee:

                              Reading this series of posts for the first time. Just fabulous research resulting from very determined looking in search of answers. This helps all of us, so thankyou for sharing.

                              Have not tried FES. But they way you describe it - is very appealing, even for applications such as assisting with bowel movement type issues which is very interesting. I cannot answer any question to the degree you already have - but can add additional indirect backup to FES being viable.

                              There is an MD in the Baltimore area - who specializes in spinal cord injury and as part of his practice works with MS patients to help rehabilitate them.

                              He is one of the authors on the retrospective study on MS patients at Hopkins you located:

                              http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293536/

                              In his own practice, they utilize FES - this helps lend further medical backup to the usage of this technique. Here is a link to his pratice offering this service >> http://inirehab.com/services/

                              Here is a link to this doctor's background: http://inirehab.com/our-team/

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