Rehabilitation After Stroke Functional Electrical Stimulation FES Facilitates Walking


We’re going to have the electrodes on
all five of your major muscle groups in your leg so that it provides simulation for them. So what’s that
major muscle group down there? This is the Anterior Tibialis, it helps
to dorsiflex your foot. It helps to bring your foot up off the ground. This is your gastroc, pushes here so you can push off through
your toes when you’re walking. Otherwise known as calf. Yes Now i’m going to put the, attach the
wires all the muscles that are going to be stimulated, and this is so that this cable will talk
to the computer and it will fire the muscles at the right time
during the gate cycle, so that to simulate walking as if your muscles were
working the way they had prior to the stroke. So this is providing body weight support
so that as you start to get better contractions in your muscles that you’ll
be able to take more of your own body weight while being up on the stepper in order to simulate walking
over ground, when you would take your whole body weight. Putting Briitta’s personal ID number into the
system 12:17 so has all her settings downloaded and
saved. So we’re gonna connect the harness, to the hoist. Ready to fly? Fly like Peter Pan. Three seconds I guess to feel like I am on Broadway. We’re going to hook up the hip guides so
kind of give Britta four additional points of support to prevent her from
doing too much side to side or lateral sway or too much
front back sway. It helps to keep her posture in place because now she’s walking without
an assistive device. Should be able to get that
reciprocal arms swing. You don’t want them too tight where it holds
the patient where they’re not moving at all, but you don’t want it too lose where should be kind of all over the place. Right now you’re not going to feel any
stim, but the speed of the steppers is going to start to pick up. This is our warm-up phase when she’s about two minutes just getting your body used
to be upright in the harness, having weight going through your legs. I want you to make sure on your left leg when your leg is right underneath so you want to have your knee fully extended. Is my right leg coming close to hyper extending? Nope. So in a couple of seconds you’re going
to start to feel this stim start to turn up. Then your simulation levels of all been
set to like what you tolerate the most and where you get the best contraction. You’ve seen
that the right hamstring in front of the right thigh is where you get the best
contraction. So that’s kind of where we see the most response to the stim. The rest of the five muscle groups all are kind of at a sensory level for you. You feel it, but you’re not getting a strong
contraction yet, but you’re able to tolerate a lot more of that than we used to
when we first started using stim. Posture looks very good. I want you to try to incorporate that
right arm more into arm swing. So you got reciprocal arms swing going with your leg. Right arm moves with the left
leg. left arm moves with the right leg. And this is different from how you do walking over ground because you don’t have the cane you’re right. It doesn’t move at the same time as your
right leg. Kind of like a pseudo reciprocal. Its amazing, what was so natural before my stroke takes a lot of thought and concentration. Now you know, I’m like left leg right arm left leg right arm. Left leg right arm right, left arm right leg you know. The neural pathways are not there. The connections, but your connections keep changing, regenerating. yeah yeah improving, working hard at it. Stim is all the way up to
the level its going to stay at. You can feel on the quad we are getting a good contraction. Continue focusing on that arm swing when your head up. You can see that your weight is shifting
by the handlebars going a little bit right to left but that’s normal when we
walk it’s not that there’s a an asymmetry significantly to one side or the other. And your
weight-bearing is improving as we’re going. They were handlebars i didn’t even notice them as its black on black. Handle bars on the
black asphalt so I didn’t even notice them. Yeah and it tells you the distance we’ve
gotten in yards. Yeah that I noticed And your weight-bearing is going up
so you’re now doing seventy eight percent of the work but in only
20 and this is actually the the best that you’ve done. When we first
started on this you were only able to do 17 minutes, two minutes to warm up and
then the 15 it’s of the stimulation actual stepping
but now, and then that’s generally what we do with patients when we first start on them.
You don’t want to overtax the nervous system. A lot of times they have patients who
are aren’t used to being upright now you happened to be one of our ambulatories,
so it’s a little bit different with you but the fatigue factor can still kick in. But now last session we had I
think we’re up to 27 or 28 minutes so you’re tolerating a longer time being on here getting more stimulation, for more of that
reciprocal pattern that you know trying to send signals up to your central
pattern generators cause this is something your body does inherently you said your body didn’t used to have to think about it. So we’re trying to give input to your to your brain that we normally don’t have to have to think
about it. We just do it. yeah Good job keeping your head up, look straight ahead. Ok good job.

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