By Charlie DeArmond
In the last issue, we reported that functional electrical stimulation is becoming more sophisticated and widespread. As promised, here is a follow-up with a few users of next-gen FES.
Scott Fessler, C5, enjoys more
independence while eating.
Scott Fessler didn’t let a 2006 motorcycle accident and C5 injury stop him from getting back to his career as a financial planner, but he needed a little extra help getting his right hand back to work. He finally got that help last June when he received FES implants at the Cleveland FES Center. The implants allow him to grasp and improve his reach and have helped him with routine tasks, such as eating. “I had to temper down my expectations, but it’s worked out well,” he says.
To grip or extend his reach, Fessler twitches his neck in different ways. “It was a little awkward at first, but it just becomes natural,” he says. “When I first did it, I was crushing cans, crushing cups when I was trying to drink, and I felt like Arnold Schwarzenegger.”
Typically about six hours, the procedure is as long as some common cardiac surgeries. “I think my wife was more worried about the surgery. Me, I was ready to go,” says Fessler, who lives in Hewlett, N.Y. He recommends it to others with similar injuries. “This device will certainly give them another level of independence,” he says. “Not full independence, but another level of it. And any little thing is a world of a difference: to be able to just pick up your own fork and eat by yourself, to hold your own toothbrush, your own pen, to color with your daughter.”
The process required a little over a month of automated exercise at home, followed by another week at Cleveland FES Center for rehab, training and adjustment. He then returned to Cleveland in late December for further adjustments and will be back for another round of refinement in late spring or early summer.
Fessler says SCI survivors should be persistent in pursuing opportunities like FES, pointing out that he spent about two years working his way into the clinical trial. Even with the long wait and many calls, he has nothing but praise for Cleveland FES Center. “These guys are world-class people,” he says. “They really care.”
Visit Cleveland FES Center for more info on hand grasp systems.
Up and Around
Jennifer French also sings the praises of the Cleveland FES Center and the promise
of new FES technology. A member of the 2012 USA Paralympic Sailing Team and a C6-7 incomplete quad, French has 13 years of experience with FES. In 2010 she received an upgrade to her stand-and-transfer system, which added 16 new implanted electrode channels to her existing eight. This newer system added trunk control to her functional restorations and, in general, is more refined in its movements than her first system. “It’s great to have the option to stand or have trunk control when you need it,” she says. “I miss it when I don’t have it available.”
“The user interface is very intuitive,” adds French, 40, from St. Petersburg, Fla. “It’s like learning to use an iPhone.” The technology does, however, require a certain level of dedication. FES “is not a flip of the switch for function,” she cautions. “Time is needed to prepare the muscles and build them up.” And the system itself is, of course, not perfect. “There can be improvements to make the movements more fluid and a more intuitive, natural control,” she says. And she hasn’t been able to use this technology in the surf. “Salt water and electronics do not mix,” she notes. The more fully-implanted systems under development by Cleveland FES Center should eventually get her right in the water without fear of damage, but those options are still in pre-clinical trials.
This new upgraded system required a 7.5 hour surgery for implantation and required a lengthy adjustment time. French blogged about her entire clinical trial experience, from pre-op to final testing more than a year later. There were many discoveries along the way, such as the benefits of her new system for wheelchair propulsion and pressure relief. “I have no regrets,” she says. “The FES Center team was extremely thorough to explain the entire process.” French kept an equally thorough blog on her experiences and thoughts at www.FEScenter.org.
Multiple Sclerosis Minus the Waterworks
I was growing very weary of 16 to 20 trips to the bathroom per day. With my MS, just transferring to the toilet from my power chair was tiring. Often I would be busting to go, but my bladder did nothing but contract in uncomfortable spasms.
After my urologist did an ultrasound and cystoscopy, I tried three different prescription medications that didn’t help. Instead I was dizzy and constipated, and one of the drugs actually worsened my symptoms.
Next was pelvic floor rehab, which theoretically uses biofeedback to isolate and control the pelvic floor muscles to enable proper urination. Lacking full sensation, this was also a no-go for me.
So I was down to a surgical option, a device called Interstim, which is like a pacemaker for the bladder. I was intrigued and eager to try it. First I had a trial run, referred to as “percutaneous nerve evaluation.” Under local anesthetic, two wires were inserted on either side of the spine in the sacral area next to the nerves to the bladder. The electrodes were taped in place and connected to a battery pack. When the power is turned up very gently, you feel a slight tingle in your vaginal or back area. The pacemaker ideally should regulate the bladder into a more normal pattern.
Over the next three days I was told to keep a log of the frequency and exact amount I voided on each trip to the bathroom. I started with the left electrode plugged into the battery pack. After one day I swapped and tested the right. The battery pack was hooked on to my waistband, and I had to be very careful not to catch my fingers, or clothing in the wires. I hooked the wire that wasn’t in use up under my bra.
It was immediately obvious that the left electrode worked really well. I was emptying a record 10 fluid ounces of urine, on average every three hours, but sometimes longer. Visits to the bathroom in the middle of the night stopped, and I slept through the night. Alleluia! I was delighted.
Two weeks later I underwent surgery to permanently implant the device. The wire was positioned by my sacral nerve and tested under local anesthetic.
The battery pack was then inserted under general anesthesia. The doctor positioned it through an incision under the skin of my back. It sits just below my waist, but above my left buttock. I am vaguely aware that it’s there, but I am only three days post-op, so it’s early yet. However, the results have been instantaneous. I am down to only five or six bathroom trips per day, and I totally empty my bladder each time.
Medtronic, makers of the Interstim gave me a card to always carry with me. This explains that I have metal implanted in me, so on no account can I have an MRI. Also it prohibits me from going through x-ray devices at airport security. If those are the only drawbacks, then it’s well worth it!
— Clare Willson