Post-intensive care syndrome is now recognised as a spectrum of physical, cognitive and emotional problems that can stem from even reletively shorts stays in critical care units. Over 100,000 patients will be treated in critical care units each year in England and Wales alone. Most are discharged to home but a significant percentage will have persistent problems. This presentation by Derek Jones describes how motion therapy combined with a form of FES Cycling (Letto2 with FES) can help boost vital signs in even unconcious patients. The FES enhanced exercise preserves muscle mass and improves the speed and quality of rehabilitation.

1. Enhancing Recovery
from Critical Care
Combining Movement Therapy
and Functional Electrical Stimulation
Derek Jones PhD, MBA
Director, Anatomical Concepts (UK) Ltd

2. 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

3. When can
Rehabilitation Start?
Early!

4. Exercise is a therapeutic agent
First recognised over a
thousand years ago
Exercise is
Medicine

5. Movement therapy -
machines that move the limbs
through a range of motion
Early Exercise in Critically Ill Patients Enhances Short-Term Functional Recovery
Chris Burtin et al, Crit Care Med. 2009;37(9):2499-2505.

6. Motion
Therapy
Functional
Electrical
Stimulation
Bringing together
two technologies
Active Exercise by..
Creating more

7. What Can We Expect
Improved vital signs
Preserved muscle mass
Reduced risk of Post-Intensive
care syndrome & ICU-AW?
Reduced risk of pressure
sores
Combining Movement and
Functional Electrical
Stimulation (FES)
Faster Rehabilitation

8. FES Cycling - used by clinics
and individuals at home all
over the world
Cardiovascular fitness
Muscle tissue bulk
Bone density improvement
Activate Paralysed Muscle
via Intact Lower Motor
Neurons

9. 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

10. Movement
combined with FES
to activate muscle -
even with an
unconscious patient

11. FES unit
Letto2

12. Functional Electrical Stimulation
FES is a tried and
tested technology
Principles
discovered in
the 18th
Century

13. Sequence of precise pulses
Functional & useful timing
Timed to pedal movement
Adjustable intensity
Safe and effective

14. Frequency
Pulse width
Current
FES
Controller
Feedback of..
Pedal position - Speed - Power Generated
Muscle Contraction
in response to FES

15. Some of the ways we use FES..
Create new opportunities for rehabilitation

16. Spinal cord injury -
complete and incomplete
Stroke
Parkinson’s disease
MS
Transverse myelitis

17. Spinal Cord Injured client - complete lesion T8/T9
Knee flexion and extension muscles activated with
“triggered” FES to enhance exercise

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

19. FES makes
movement active
safely and
effectively

20. 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

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