How FES Improves Gait in Neurological Disorders

Functional Electrical Stimulation (FES) is transforming how we address walking challenges caused by neurological disorders like stroke, spinal cord injuries, and cerebral palsy. By using electrical impulses to activate weakened or paralyzed muscles, FES helps restore more natural movement patterns. Here’s what you need to know:

• How It Works: FES sends electrical signals to muscles, bypassing damaged neural pathways. This triggers controlled muscle contractions that mimic natural walking.
• Clinical Benefits: Studies show FES improves walking speed, distance, and reduces effort. For example, stroke patients saw a 56.6% increase in muscle strength with FES therapy.
• Conditions Treated: FES helps with stroke rehabilitation, spasticity from cerebral palsy, and mobility issues caused by spinal cord injuries.
• Daily Life Impact: Patients report less pain, better mobility, and increased confidence. FES also reduces fall risks and supports long-term improvements in movement.

FES is often combined with physical therapy and other treatments for better results. Whether you’re recovering from a stroke or managing cerebral palsy, FES offers a practical way to regain independence and improve quality of life.

Gait Problems in Neurological Disorders

Neurological Conditions That Affect Walking

Walking relies on a finely tuned system of muscle coordination and posture control, which neurological disorders can disrupt significantly. When key circuits in the central nervous system are damaged, walking patterns can change drastically.

For instance, strokes – one of the leading causes of gait issues – can impair one side of the brain, disrupting signals sent to leg muscles. This often results in uneven, uncoordinated walking patterns.

Spinal cord injuries bring their own set of challenges. The severity and location of the injury determine how communication between the brain and muscles is affected. This disruption can impair muscle strength, sensation, and coordination below the injury site.

Cerebral palsy, which stems from early brain damage, impacts movement and posture from birth. Spastic cerebral palsy, the most prevalent form, affects about 87% of children with the condition. It leads to chronic issues with muscle control and coordination.

These neurological conditions create distinct walking difficulties, which are explored in more detail below.

Common Walking Problems

The type of walking problem often depends on where and how severely the nervous system is damaged. For example, a post-stroke hemiplegic gait typically features a circumduction pattern. This results from muscle weakness, foot drop, and tightness in the extensor muscles.

Spastic gait, seen in conditions like spastic cerebral palsy, involves muscle stiffness and involuntary contractions that make movement difficult. Children with this condition may develop a scissors gait, where tight hip adductor muscles cause their legs to cross with each step. This walking style demands significant effort and energy.

Foot drop is another common issue, especially in individuals with peripheral neuropathy. It often leads to a neuropathic or steppage gait, where the person lifts their legs higher than usual to prevent their toes from dragging on the ground. Additionally, balance and coordination issues can cause an ataxic gait, marked by inconsistent step lengths and timing.

Muscle weakness reduces the force needed for normal walking, while spasticity causes unwanted muscle contractions that disrupt smooth movement. These problems often overlap, creating complex walking challenges that call for targeted treatment strategies.

Such gait abnormalities directly affect daily life, as outlined in the next section.

Effects on Daily Life

The walking difficulties described above don’t just limit mobility – they profoundly affect quality of life. Gait disorders often rob individuals of their independence, increasing their reliance on caregivers.

Studies show that slow walking speeds in people over 75 correlate with shorter lifespans. On average, slow walkers live at least six years less than those with normal walking speeds, while faster walkers may live up to 10 years longer. Everyday tasks like grocery shopping, attending appointments, or visiting friends can become so challenging that some individuals stop walking altogether. This inactivity can lead to further muscle weakness, stiffness, and even social isolation.

The mental health toll is equally significant. Losing mobility and becoming more dependent on others can lead to depression and anxiety. Many people withdraw from social activities they once enjoyed, further isolating themselves.

Gait disorders also raise the risk of falls, which can result in serious injuries, hospital stays, and a loss of confidence. Among individuals with neurological conditions, 60% experience gait disturbances. These issues become more common with age: around 15% of people have a gait abnormality by age 60, and this figure jumps to over 80% by age 85.

Recognizing and addressing these challenges early is crucial to maintaining independence and preventing complications. Treatments such as functional electrical stimulation (FES) offer hope for restoring mobility and improving daily life.

How FES Works

Functional electrical stimulation (FES) offers a practical solution to address gait irregularities by reactivating muscle function that has been impaired. This technology uses low-energy electrical pulses to create body movements in individuals who have lost mobility due to central nervous system injuries. By bypassing damaged neural pathways, FES directly stimulates muscles and nerves, enabling controlled movement. Let’s break down how FES activates muscles, the components of the devices, and the physical effects that contribute to improved mobility.

How FES Activates Muscles

At its core, FES uses electrical impulses to trigger muscle contractions when the brain can no longer send the proper signals. As the Cleveland Clinic explains:

“Functional electrical stimulation (FES) is a treatment that uses electrical impulses to activate specific muscles and nerves. These impulses make muscles contract, to move a foot or lift an arm.”

The process works by evoking action potentials, which occur when the electrical potential across nerve cell membranes changes. FES operates at a frequency of 4–12 Hz, delivering impulses that activate motor and sensory nerves, leading to controlled muscle contractions that mimic natural movement. These impulses can stimulate localized muscle activity or even trigger reflexes necessary for functional movements like walking.

FES achieves this through constant frequency trains of stimulation, which target skeletal muscles to enhance motor function. This approach allows FES to support both simple and complex movements, improving mobility for individuals with impaired motor control.

FES Device Parts

Modern FES systems are designed with several key components that work together to deliver precise stimulation. These systems typically include a control box, a battery, and electrodes.

• The stimulator unit sends electrical impulses through wires to electrodes, which then activate specific muscles or nerves. Healthcare providers customize the voltage and stimulation patterns based on individual needs.
• Electrodes serve as the connection between the device and the body. They can be external sticky pads or surgically implanted units. Implanted and percutaneous electrodes offer greater precision in targeting specific areas.
• The control system regulates pulse duration, amplitude, and frequency. Current-regulated devices ensure consistent charge delivery despite variations in skin or tissue resistance, while voltage-regulated systems may require more frequent adjustments.

Some devices also include optional sensors, such as those worn in the heel, to assist with timing. However, advancements in FES technology have made these sensors less common. The specific equipment used depends on the treatment goals and the area being targeted.

Physical Effects of FES

FES delivers a range of physical benefits by engaging both motor and sensory nerves, ultimately improving walking ability. It strengthens muscles, enhances neural adaptability, and reduces spasticity.

One of the most notable benefits is muscle strengthening. Studies show that combining FES with traditional rehabilitation can boost dorsiflexor muscle strength by 56.6%. This happens as FES increases range of motion, reduces muscle weakness, and decreases spasticity.

FES also helps with spasticity reduction by exercising spastic muscles to fatigue them, which minimizes excessive excitatory signals. This is crucial for individuals with conditions like multiple sclerosis, where 60-84% experience involuntary muscle contractions.

Additionally, FES promotes neuroplasticity, encouraging the brain to develop new pathways for motor control. By antidromically activating motor nerve fibers, FES supports neural remodeling, leading to sustained improvements in movement.

The treatment can also enhance muscle mass by influencing muscle-specific mechanisms. It increases IGF-1 expression while reducing MuRF-1 and Atrogin-1, proteins associated with muscle degradation. Beyond physical changes, FES helps patients reconnect with their bodies, improving spatial awareness and a sense of limb ownership.

Safety remains a top priority in FES design. While electrical currents can potentially harm tissue, modern devices use biphasic, charge-balanced pulses to minimize risks like decreased excitability or cell damage. This ensures that FES remains a safe and effective option for rehabilitation.

Clinical Benefits of FES for Walking

Clinical research highlights that Functional Electrical Stimulation (FES) can enhance muscle strength, gait speed, and overall mobility when integrated into rehabilitation programs.

FES for Stroke Patients

FES has shown specific benefits for stroke survivors, a group where more than 80% experience challenges with walking. By targeting the muscles responsible for walking, FES helps address these mobility issues effectively.

Studies have demonstrated that incorporating FES into traditional rehabilitation significantly boosts muscle strength. For example, dorsiflexor muscle strength increased by 56.6% in patients undergoing both FES and conventional therapy.

In 2006, Tong et al. found that combining FES with gait training yielded better outcomes compared to gait training alone for acute stroke patients. After just four weeks, participants showed notable improvements in balance, walking ability, and functional independence, with these benefits lasting up to six months. Similarly, a large-scale study by Bethoux et al., involving 495 individuals with foot drop post-stroke, revealed that using an FES device for six months enhanced walking speed, endurance, and mobility scores. Awad et al. further reported that stroke patients experienced stronger propulsive force during walking, along with better functional balance and walking ability after 12 weeks of FES treatment.

FES for Cerebral Palsy

FES therapy has also proven beneficial for children with cerebral palsy, a condition often associated with gait difficulties. A meta-analysis of nine studies involving 282 children found that FES significantly improved gait speed and step length compared to control groups.

Eight weeks of daily FES sessions have been shown to improve how children perceive their walking, with many reporting less pain and better mobility after treatment. For children with hemiplegic spastic cerebral palsy, FES has been particularly effective in addressing foot drop. After using an FES device for four months, these children demonstrated better ankle and foot movement, reducing awkward toe-dragging motions. Combining FES with Botox injections has further amplified improvements in muscle control and walking function, offering a more comprehensive approach to treatment. Similar benefits have been observed in individuals with spinal cord injuries, expanding the scope of FES applications.

FES for Spinal Cord Injuries

For individuals with spinal cord injuries, FES therapy offers meaningful improvements in mobility and independence. A systematic review of 37 clinical trials involving 192 patients highlighted the potential of electrical stimulation for aiding motor recovery.

In one study by Triolo et al., FES applied to specific pelvic muscles helped stabilize the pelvis and trunk, reducing effort and improving manual wheelchair propulsion for six participants with spinal cord injuries. Another study by Kapadia et al. showed that 16 patients who received FES combined with assisted walking experienced gains in both the Spinal Cord Independence Measure and the Functional Independence Measure, which evaluate daily activities like self-care and mobility.

FES therapy can be customized to each patient by adjusting settings such as frequency, amplitude, and pulse width. Additionally, FES-assisted gait training has shown promise for individuals with incomplete spinal cord injuries, leading to better motor control and greater independence in everyday tasks.

Adding FES to Complete Treatment Programs

Incorporating Functional Electrical Stimulation (FES) into neurological rehabilitation involves creating coordinated care plans that combine FES with other therapies. This approach addresses a wide range of neurological challenges and enhances recovery outcomes.

Patient Evaluation for FES

The process starts with a detailed, hour-long assessment to determine a patient’s responsiveness to FES. During this evaluation, clinicians examine gait patterns, test muscle strength and control, and assess muscle activation potential using surface stimulation techniques .

“To determine whether you’re a good candidate for this type of treatment, a healthcare provider will offer an assessment. They’ll see how your body responds to FES. In some situations, your body won’t respond, like if you have damage to nerve fibers between your muscles and spinal cord.” – Cleveland Clinic

This evaluation focuses on identifying issues like muscle weakness, impaired movement, or underlying central nervous system conditions that affect mobility. Cognitive abilities and medical history are also reviewed to ensure the treatment is both safe and effective.

Certain medical conditions make FES unsuitable for some individuals. For instance, patients with implanted electrical devices, active cancer, osteomyelitis, epilepsy, or severe muscle spasticity are not ideal candidates. Other contraindications include a history of blood clots or bleeding disorders, osteoporosis, or pregnancy. This thorough screening ensures that only appropriate candidates proceed with FES therapy.

Once the evaluation is complete, healthcare providers integrate FES with other therapies to maximize its benefits.

Using FES with Other Treatments

FES achieves the best results when combined with traditional rehabilitation methods. Studies have shown that pairing FES with supervised exercises significantly improves gait speed in stroke patients compared to exercises alone.

Physical therapy is a key complement to FES. When these two are combined, patients often see improvements in the swing phase of gait, better activation of ankle dorsiflexor muscles, and enhanced cortical function compared to standard physiotherapy alone.

Another effective combination involves standing frame training. Research has demonstrated that FES, when paired with this training, leads to greater improvements in balance and stability – measured through Berg Balance Scale scores – than either treatment on its own.

The impact of FES on muscle function is also noteworthy. For example, pairing FES with physiotherapy results in significant gains in muscle amplitude (13.2 ± 2.11 μV), mean power frequency (5.5 ± 0.80 Hz), and median power frequency (6.5 ± 0.90 Hz) in the tibialis anterior muscle, outperforming conventional therapy.

FES can also be integrated with assistive devices like canes, walkers, or ankle–foot orthotics, allowing for tailored treatment plans that meet individual patient needs.

These combined approaches create a more comprehensive and effective path to recovery.

Complete Care Approach

At HML Chiropractic & Functional Care, FES is part of a broader treatment strategy that addresses both motor and non-motor challenges. This clinic specializes in functional neurology and incorporates FES into comprehensive care plans for conditions like traumatic brain injuries and other mobility-related neurological disorders.

Treatment begins with setting clear, measurable goals and designing personalized exercise programs that incorporate FES. These plans are tailored to the patient’s specific condition, needs, and recovery objectives.

The table below highlights how FES is applied for different conditions:

Treatment plans are adjusted regularly to maintain effectiveness. Factors like timing and intensity are customized based on the patient’s condition and stage of recovery . Acute cases often require short-term, intensive protocols, while chronic conditions may benefit from longer-term strategies.

Patient education is another critical component. Providers teach energy conservation techniques to help patients better tolerate rehabilitation. Proper placement of wires and pads is also emphasized to minimize discomfort during FES sessions.

Advanced approaches, like integrating FES with visual feedback balance training, further enhance outcomes by improving balance control through sensorimotor integration. This is particularly important, as a significant percentage of individuals with spinal cord injuries (69%–78%) and stroke survivors (73%) experience falls each year.

To ensure successful implementation, hands-on training for clinicians is essential. Tools like the FES Clinical Decision Making Tool help optimize stimulation parameters. Additionally, planning for the space requirements of FES equipment in clinical or home settings is key to effective treatment delivery.

Conclusion

FES, or Functional Electrical Stimulation, plays a crucial role in helping individuals with neurological disorders regain natural walking patterns. By delivering precise electrical impulses to targeted muscles and nerves, it has proven effective for patients dealing with conditions like stroke, spinal cord injuries, cerebral palsy, and multiple sclerosis.

Clinical studies highlight the impact of FES: 65% of participants experienced faster walking speeds, and standardized walking test times improved by 36%. Beyond physical gains, FES enhances foot clearance, stabilizes gait, and reduces the mental effort involved in walking. It even lessens the cognitive strain during dual-task activities, allowing patients to better focus on their surroundings and maintain independence.

The benefits of FES aren’t just short-term. A six-year study focusing on adults with cerebral palsy showed remarkable progress, with 72% of participants continuing regular use of FES devices. Over time, walking speeds increased significantly, from just 0.01 m/s at the start to 0.24 m/s after four years of consistent use. These results emphasize how the advantages of FES can grow with ongoing application.

FES also improves daily life in meaningful ways. It reduces pain, boosts mobility within the community, and encourages greater social participation. For individuals with multiple sclerosis already using medications like dalfampridine, FES offered an additional 16.3% improvement in walking speed.

At HML Chiropractic & Functional Care, FES is seamlessly incorporated into patient care. Through detailed evaluations, personalized treatment plans, and continuous support, FES is tailored to meet each individual’s specific neurological challenges. When combined with comprehensive rehabilitation programs, FES does more than improve walking – it restores independence, builds confidence, and enhances overall quality of life.

This holistic approach ensures that patients achieve their full mobility potential while reclaiming their freedom and self-reliance.

FAQs

How does Functional Electrical Stimulation (FES) help improve walking in people with neurological disorders?

Functional Electrical Stimulation (FES) is a rehabilitation approach designed to improve walking ability for individuals with neurological conditions like stroke, spinal cord injuries, and cerebral palsy. What sets FES apart from traditional methods like electrical muscle stimulation (EMS) or devices such as ankle-foot orthoses (AFOs) is its ability to stimulate the nerves responsible for movement directly. This helps create more natural muscle activation patterns.

Research highlights several benefits of FES, including improved gait speed, balance, and muscle coordination, along with a reduction in spasticity. Another key advantage is its role in promoting neuroplasticity – the brain and nervous system’s ability to relearn motor functions. By supporting long-term recovery, FES has become a valuable tool for enhancing mobility and fostering greater independence in individuals with neurological challenges.

What are the risks or side effects of using FES to improve gait in neurological conditions?

While functional electrical stimulation (FES) is widely regarded as a safe and effective way to improve gait in patients with neurological conditions, there are a few potential risks and side effects to keep in mind. For instance, skin irritation or redness can sometimes appear around the electrode sites. In rare cases, extended use might lead to more serious issues like skin breakdown or even electrical burns.

Some patients may also notice muscle fatigue or mild discomfort as their body adjusts to the stimulation. This temporary fatigue could slightly raise the chance of falling during this adaptation period.

In very rare situations, improper use or excessive stimulation – particularly with implanted devices – might result in nerve damage. To minimize these risks, it’s crucial to collaborate closely with a healthcare provider. They can help ensure FES is used safely and tailored to your specific treatment needs.

Am I a good candidate for FES therapy to improve my gait?

Functional Electrical Stimulation (FES) therapy offers a promising treatment for individuals dealing with neurological conditions like stroke, cerebral palsy, or spinal cord injuries that impact their ability to walk. This therapy is particularly beneficial for those with upper motor neuron pathway impairments who respond well to nerve stimulation, often experiencing improved movement or relief from issues like foot drop.

To determine if FES therapy is a good fit, a healthcare professional will review your medical history, assess your mobility, and consider your specific neurological challenges. If you’re struggling with walking difficulties linked to a neurological condition, consulting a specialist can help you understand whether FES could be a helpful option for your recovery.