APPLICATION OF FUNCTIONAL ELECTRICAL-STIMULATION IN PARAPLEGIC PATIENTS

The restoration of lost motor functions after upper motor neuron lesio ns by functional electrical stimulation (FES) is not a new technique. Early feasibility demonstrations of FES assisted standing and stepping in paraplegics between 1960 and 1980 showed great promise that FES ma y soon become an effective method to regain upright mobility after spi nal cord injury. However, the difficulties encountered have been under estimated. Today, there is a wide gap between FES related research and the clinical application of FES in paraplegic patients. In this paper the scientific literature about FES and its clinical applications is carefully reviewed. The possible reasons for the low clinical relevanc e of FES and possible solutions for the development of enhanced FES sy stems are analyzed. Although the functional gain with present FES syst ems for mobility restoration in paraplegics is relatively low, FES may be beneficial to prevent secondary complications which occur after sp inal cord injuries. The development of distributed systems and selecti ve peripheral nerve stimulation techniques, the progress in microelect ronics and sensor technology, and the development of nonlinear and clo sed-loop control strategies give promise for the development of practi cal and enhanced FES systems that will offer paraplegic patients some additional degrees of freedom. (C) 1998 Elsevier Science Ireland Ltd.