Electrical stimulation for restoration of function

Electrical stimulation is a promising method for restoration of muscle and limb function for individuals with a variety of motor disabilities. Rehabilitation applications of functional electrical stimulation (FES) include restoration of standing and gait, activation of rudimentary grasp, motor retraining and bladder management. Simple standing and gait systems are technically feasible and have been demonstrated in the laboratory and with at least one commercial product. Further development must address fatigue, control, and ease-of-use challenges. Systems to restore grasp can have a significant impact on the ability of an individual with quadriplegia to live independently. A variety of systems that use surface, percutaneous and implanted hardware are commercially available. Individuals with motor disabilities as a consequence of stroke represent the largest potential target population for FES systems. To date, applications have been limited because of the difficulty of demonstrating the efficacy in motor retraining or other applications when compared to conventional physical therapy methods. Recent research and development efforts have led to renewed activity in stroke applications and FES approaches to bladder management for those with spinal cord injury reveal great potential. First-generation implanted systems are in use and second generation systems are being researched. Many challenges must be addressed before FES systems can be used by large numbers of individuals with motor impairments. Among these challenges are the rapid fatigue of stimulated muscle, the limited pool of candidates who meet all of the ideal selection criteria for FES systems, and the need to demonstrate efficacy so that health insurance providers will cover FES systems.