Functional electrical stimulation for grasping and walking: indications and limitations

This review describes the state of art in the field of Functional Electrica l Stimulation (FES) and its impact on improving grasping and walking functi ons in acute and chronic Spinal Cord Injured (SCI) patients. It is argued t hat during the early rehabilitation period the FES systems with surface sti mulation electrodes should be used to assist training of hand and leg movem ents in SCI patients. Our clinical trials have shown that a number of acute SCI patients with impaired walking and grasping functions could improve th ese functions due to training with an adjustable FES system to the point th at they finally did not need the FES system to carry out these tasks. Other acute SCI patients, who did not recover the desired function, were enabled to perform either walking or grasping with the FES assistance. We believe that the subjects who can perform grasping or walking with the help of FES, and still use the neuroprosthesis 6 months after being subjected to the FE S training, should consider the FES system as a prosthetic device in Activi ties of Daily Living (ADL). Despite the significant technical progress achi eved in the last 10 to 15 years in the FES field, there is a general consen sus that these systems are not sufficiently advanced and that they need fur ther development. The limited acceptance of the FES technology can be in pa rt explained by the fact that it is not completely mature and that the pati ents still require daily assistance to use the FES systems. Nevertheless th e present FES treatments combined with conventional occupational and physic al therapy still remain the most promising approach in rehabilitating SCI p atients. In this review, advantages and limitations of different FES system s that are used to restore grasping and walking functions are discussed.