- Thierry Keller – TECNALIA. Título: Clinical experience with wearable FES Technologies

1. Jornada Wearables para la salud y prevención de riesgos laborales
Thierry Keller
Donostia – San Sebastián, 12 de noviembre 2019
Clinical Experience with Wearable
FES Technologies

2. Índice Pág.
FES Dropfoot
Upper Limb FES
Maxsens
07
12
03
Clinical Experience with Wearable FES
Technologies

3. 3
Conclusion for Functional Electrical Stimulation in Lower Extremity
There is strong (Level 1a) evidence that FES and gait retraining results in improvements in hemiplegic
gait.
Functional Electrical Stimulation combined with gait training improves hemiplegic gait.
http://www.ebrsr.com
FES Dropfoot
Evidence FES in Stroke Rehabilitation , Canadian Stroke
Network (CSN), Lower Extremity FES after Stroke

4. 4
Stripe multi pad
electrode
Counter
electrode
Deep peroneal
nerve for
dorsiflexion and
superficial branch
for plantar flexion
are stimulated IMU for gait phase detection:
Position on shank or foot
under investigation
FES Dropfoot
Multi-pad FES Dropfoot
System

5. 5
Position and variability of selected pads for dorsiflexion and plantar
flexion in 20 clinical sessions (N=10):
DorsiflexionPlantar flexion
Mean selected pad centroid variability (N=10, 20 trials):
• 2.72 cm for dorsiflexion
• 2.21 cm for plantar flexion
FES Dropfoot
Results in sub-acute and chronic
stroke subjects
[Malešević J et al,“A decision support system for electrode shaping in
multi-pad FES foot drop correction”, J NeuroEng & Rehab 14:66, 2017]

6. 6
Assistive vs. therapeutic effect in ankle joint angle (dorsiflexion)
FES Dropfoot
Results Dropfoot RCT in Sub-
acute Stroke Subjects
Gait speed: FES vs. Control
[Dujovoic S., et al., L., NeuroRehabilitation, 41(4):791-800, 2017]

7. 7
Conclusions Regarding the Efficacy of FES Therapy in Acute Stroke
There is strong (Level 1a) evidence that FES treatment improves upper extremity
function in acute stroke.
Among the studies evaluating ES in the acute stage of stroke, most assessed the same treatment
comparison, physical therapy plus FES (or sham FES) vs. physical therapy alone. The results most of
the studies indicated that FES was an associated with improvements in motor function, ADL and
dexterity.
http://www.ebrsr.com
Upper Limb FES
Evidence FES in Stroke Rehabilitation, Canadian Stroke Network
(CSN), Upper Extremity FES in Acute and Subacute Stroke

8. 8
Conclusions Regarding the Efficacy of FES Therapy in Chronic Stroke
There is strong (Level 1a) evidence that FES treatment improves upper extremity function in chronic
stroke.
There is moderate (Level 1b) evidence that EMG-triggered FES is not superior to cyclic FES.
Functional Electrical Stimulation therapy improves hemiparetic upper extremity function.
http://www.ebrsr.com
Upper Limb FES
Evidence FES in Stroke Rehabilitation, Canadian Stroke Network
(CSN), ), Upper Extremity FES in Chronic Stroke

9. 9
Description of the Upper Extremity FES System
1. Multipad electrodes in a streachable garment designed to stimulate all
the forearm muscles needed to produce a functional grasp
2. Inteligent stimulator communicates over bluetooth interface to the PC,
tablet or smartphone
3. Sensor glove enables automatic electrode calibration.
Main Features:
• Multi-field electrodes for higher selectivity and better functional
performance
• Easy donning/doffing
• 8 distinct functional activation primitives
• Automatic calibration algorithms (in development)
Upper Limb FES System
Upper Limb FES

10. 10
✗
✗
✗
Upper Extremity FES: Results
Achievable Grasps
Upper Limb FES

11. 11
Spatial and temporal change of
stimulation zones
Upper Limb FES
Subject 1 Subject 2 Subject 3 Subject 4

12. 12
Spatial Stimulation zones for Finger, Wrist,
and Thumb Extension (N=12)
Upper Limb FES
[J. Malesevic et al., “Temporal and spatial variability of surface motor activation zones in hemiplegic
patients during 20 FES therapy sessions”, Artif Organs 44:166-77, 2017 2017]

13. 13
Focus of the research in the MAXSENS project is to
investigate advantages of time and space
distributed stimulation using array electrodes for
afferent stimulation.
MAXSENS stimulation device should provide the
user proprioceptive and sensory feedback from the
artificial hand through electrotactile stimulation.
Aim is to define intuitive feedback mapping
through stimuli localization and parameters of
electrical stimulation.
Maxsens
Maxsens, Afferent
Feedback

14. 14
Maxsens
Maxsens Functions

15. 15
Success Rate: discrimination of
dynamic afferent stimulation patterns
Maxsens
This demonstrates that the amputees were able to consistently discriminate a set of presented dynamic patterns after
very short training despite the diversity of the individual characteristics, such as, amputation level, type of trauma,
surgical procedure, time elapsed after the procedure, overall physical and psychological condition of the subject, and
even the location of the electrotactile feedback
The average SR was very high for 6 amputees and 10 able-bodied subjects when discriminating the dynamic
stimulation patterns. Able-bodied subjects were able to perceive and identify stimulation patterns with an average
SR of 99 3%. The average SR for amputees was 86 10%.
Štrbac, M., et. Al. (2016). Integrated and flexible multichannel interface for electrotactile stimulation. Journal of Neural Engineering, 13(4)

16. 16
Summary: Preliminary
clinical results
Maxsens
• MaxSens working principle has been tested in 15 upper limb
amputees
• Amputees were able to
recognize 8 prosthesis states
with more than 90% accuracy
• It required only 20
minutes of training

17. GRACIAS
THANK YOU
ESKERRIK ASKO
MERCI
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