Functional Electrical Stimulation in Lower Extremity Orthoses in Hemiplegia

An overview is given of the present use of Functional Electrical Stimulation (FES) based lower extremity orthoses in therapy procedures in hemiplegia. In one specialized FES center in Ljubljana, Slovenija, 63% of all stroke patients were treated with some sort of FES therapy in combination with classical therapies, representing around 10% of the total hemiplegic population of the nation. Verticalization, i.e., the initiation of gait and lessening of gait anomalies, has been achieved by two to three weeks of therapy using a six-channel microprocessor controlled stimulator. For orthotic purposes, during activities of daily living only various types of single channel peroneal stimulators have been used so far. Implantable versions of the stimulator have provided much better performance. The heuristic principle of synthesis of gait by FES presently in use should be replaced by a more versatile microprocessor controller based on a more complete mathematical model of the afflicted locomotor system in subjects with hemiplegia. The functional value and the acceptance of the systems by patients will remain the dominant factors in the design of a new generation of mostly implantable multichannel FES orthoses. FES based rehabilitation greatly depends on special trained physical therapists and other members of rehabilitation team.