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Enhancing Recovery from Critical Care with FES

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.

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Enhancing Recovery from Critical Care with FES

  1. 1. Enhancing Recovery from Critical Care Combining Movement Therapy and Functional Electrical Stimulation Derek Jones PhD, MBA Director, Anatomical Concepts (UK) Ltd
  2. 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. 3. When can Rehabilitation Start? Early!
  4. 4. Exercise is a therapeutic agent First recognised over a thousand years ago Exercise is Medicine
  5. 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. 6. Motion Therapy Functional Electrical Stimulation Bringing together two technologies Active Exercise by.. Creating more
  7. 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. 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. 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. 10. Movement combined with FES to activate muscle - even with an unconscious patient
  11. 11. FES unit Letto2
  12. 12. Functional Electrical Stimulation FES is a tried and tested technology Principles discovered in the 18th Century
  13. 13. Sequence of precise pulses Functional & useful timing Timed to pedal movement Adjustable intensity Safe and effective
  14. 14. Frequency Pulse width Current FES Controller Feedback of.. Pedal position - Speed - Power Generated Muscle Contraction in response to FES
  15. 15. Some of the ways we use FES.. Create new opportunities for rehabilitation
  16. 16. Spinal cord injury - complete and incomplete Stroke Parkinson’s disease MS Transverse myelitis
  17. 17. Spinal Cord Injured client - complete lesion T8/T9 Knee flexion and extension muscles activated with “triggered” FES to enhance exercise
  18. 18. Trunk extension, core strength development exercises - C4 complete spinal cord injury
  19. 19. FES makes movement active safely and effectively
  20. 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. 21. Images on Page 2 - David Graham, “No Diving” ISBN 978-0-9557465-1-2 Anatomical Concepts (UK) Ltd 8-10 Dunrobin Court Clydebank Business Park Clydebank G81 2QP T: 0141-952-2323 E: info@anatomicalconcepts.com W: anatomicalconcepts.com

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