With the object of putting on the market, Functional Electrical Stimulator (FES) has been produced for hemiplegic patients who have inadequate dorsiflexion at ankle during swing phase. The pulse form obtained from this stimulator (70×62×20 mm, 100 g) is rectangular and negative. The frequency is 30 pulse per second, the pulse width is 0.3 millisecond, and the maximum output is 160 volts. The stimulator operates from a 9 volt dry cell. The foot switch contains a tape switch element at the heel area and is inserted as an insole switch into the affected side of shoe. During walking, the foot switch triggers stimulation of the peroneal nerve with surface electrodes.
Eighty patients who walked with cane or without cane and had inadequate dorsiflexion or/and eversion at ankle during swing phase were selected as clinically appropriate candidates for FES. Fifty two of 80 patients (65 percent) regained adequate dorsiflexion and eversion at ankle by FES. We found that FES was suited for patients who were categorized between IV and V in Brunnstrom stage of lower limb function and in low spacity level.
Improvement of walking speed and stride length by FES is almost similar to that of AFO. Furthermore, FES for hemiplegia has certain merits especially when used in Japanese life style.
We are introducing FES into the physical treatment program of hemiplegia. The schedule and purpose of the program using FES are shown below:
1. Therapeutic FES
Period: from just after a stroke to just before the beginning of a gait exercise
Indication: between I and III in Brunnstrom stage of the lower limb function
Purpose: 1) maintaining of the deep sensation
2) prevention of muscle atrophy
3) maintaining of the range of motion
4) psychological effects
2. Training FES
Period: from the beginning of a gait exercise to discharge
Indication: between IV and V in Brunnstrom stage
Purpose: 1) acquiring gait patterns
2) carry-over effects for paralytic muscle
3) selection of patients who are suited for daily life FES
3. Daily life FES
Period: after discharge
Indication: between IV and V in Brunnstrom stage
Purpose: 1) practical use of FES for daily activities
2) maintaining and increasing of the range of motion and muscle strength
We hope that much more physical therapists and occupational therapists use FES clinaiclly and investigate FES especially on carry-over phenomenon.
