Our professional Frequently Asked Questions aim to answer the questions we hear most often from clinicians considering introducing FES therapy into their practices:
FES



Why should I use FES ?

Functional electrical stimulation is a modality commonly used in rehabilitation which has been researched for over 25 years producing hundreds of peer reviewed articles in scientific journals. 

FES has been shown to reverse muscle disuse atrophy, improve local blood circulation, reduce spasms/spasticity, as well as many other physical integrity and health benefits. 

Many patients who have neurological impairments with resultant paralysis or paresis have very limited ability to engage in physical activity without assistance.

FES works by applying surface electrodes to the patient's skin and delivering an electrical impulse stimulating the lower motor neuron which produces an involuntary muscle contraction.

Use of functional electrical stimulation (FES) powered systems such as the RT300, RT200 and RT600 provide a safe and effective means by which weak or paralyzed muscles can undergo progressive resistive exercise (PRE) so the patient can experience a multitude of therapeutic as well as positive health outcomes.



How many channels of FES are available ?

All of our FES therapy systems can be supplied with 6 or 12 channels of FES using RT60 stimulators and a stimulation cable to connect the patient's electrodes.  Up to 4 additional wireless FES channels can be added using RT50 single channel stimulators.



Which muscles can be stimulated?

Any of the major muscles groups in the lower extremities, upper extremities including shoulders and core can be selected for FES depending upon the patient's needs and the specific FES therapy system model being used.

RT300, RT200, RT600 with leg FES:
Tibialis Anterior, Gastrocnemius-Soleus complex, Quadriceps, Hamstrings, Gluteals, Erector Spinea, & Abdominals.

RT300, RT200 with arm FES:
'Shoulder’ (to correct subluxation), Scapular stabilizer (to improve scapular positioning/winging), Anterior Deltoid, Posterior Deltoid, Biceps, Triceps, musculature to effect the wrist/grip, Erector Spinae, & Abdominals.
Intrinsic muscles in the hands can also be stimulated.



What is the benefit of so many FES channels ?

Multiple channels of FES allow for whole body/limb activation within a patterned activity.

Increased muscular activity of the larger muscles of the body create increased sensory feedback and demand on the cardiorespiratory system.
The effect of stimulating multiple muscles is greater than the sum of the muscles individually. 

Additionally, stimulating multiple muscle groups during a single session allows for improved time efficiency.



Will it be painful if my patient has sensation ?

All Restorative Therapies systems have a wide range of FES parameters available which can be easily adjusted to ensure that your patients with sensation can tolerate the stimulation.  

Training on use of our products includes sessions on how to optimize FES parameters for best outcomes including patient comfort.

Precautions



Could my patient become dysreflexic ?


Yes, patients can experience autonomic dysreflexia with the use FES especially if they have an SCI above T6.  However this is most often manageable or preventable.

When the FES amplitude initially ramps up the patient may exhibit some symptoms of dysreflexia and stimulation intensity should be limited and symptoms as well as BP monitored.  

There are many stimulation settings as well as the system’s therapy parameters that can be adjusted to decrease the likelihood of the patient developing dysreflexia and to help them accommodate to the stimulation.  

Most individuals who initially exhibit some dysreflxia will accommodate to FES over time.  With regular use the body adapts to this stimulation and the patient no longer becomes dysreflexic.



Can I use FES if my patient has an implanted device ?


In most cases yes, however a physician’s clearance should be obtained.  Using FES with an implanted device may also require special consideration for electrode placement.



Can I use FES if my patient has an orthopedic implant ?


Yes, however there may be a limited time immediately after implantation during which FES should not be used to allow for adequate tissue healing.
This should be determined by the patient’s physician.



Can I use FES if my patient is on a ventilator ?


Yes, FES can be used by patients on ventilators.  
You may want to have your patient’s nurse or respiratory therapists present at the initial session(s) to make any ventilator adjustments if needed.

Patient Questions



Should I use FES if my patient has an upper motor neuron SCI ?


Yes, upper motor neuron lesions are a primary indicator for FES.



Should I use FES if my patient has a lower motor neuron SCI ?

Lower motor neuron lesions are not contraindicated for use of FES.  
Your patient may not experience muscle contractions initially or possibly at all however many clinicians do persist with FES and eventually see patient benefit.



Should I use FES with my patient with Brain Injury?


FES Powered systems are indicated for reduction of spasticity, improving or maintaining range of motion, improving localized circulation and reducing muscle disuse atrophy all of which may be part of the treatment plan for patients with Brain Injury. 

Many patients with Brain Injury benefit from use of FES powered systems during inpatient and outpatient rehabilitation programs to aid in achievement of functional goals.  Additionally, many patients with Brain Injury continue use of FES systems such as the RT300 and RT200 as part of their ongoing home therapy program for long term physical integrity and health benefits.



Should I use FES with my patient with Multiple Sclerosis?


Yes.  Initial studies are showing very positive outcomes in patients with MS.  Many patients with MS benefit from the use of FES powered systems during inpatient and outpatient rehabilitation programs to facilitation of functional goals. 

Additionally, many patients with MS continue use of FES systems such as the RT300 and RT200 as part of their ongoing home therapy program for long term physical integrity and health benefits.  The treatment approach with MS often differs from that of other neurologic diagnoses and the clinicians at Restorative Therapies can assist you in understanding the current research and treatment approaches to customize your program.



What if my patient has high tone and / or spasticity ?


Spasticity is an indicator for use of FES.  It has been well established in research the FES can reduce spasms/spasticity.  Many patients benefit from using FES paired with the movement of the ergometer such as in the RT300 or RT200 as a long term method of naturally managing their spasticity.



Should I use FES if my patient has sensation ?


Yes, Restorative Therapies’ FES systems are highly customizable.  Each individual FES channel can be adjusted allowing even the most complex patients to receive the maximum benefit from the therapy within their tolerance.  The clinicians at Restorative therapies provide training in how to optimize stimulation parameters to achieve the best response within the patient’s tolerance.



What if my patient has had an amputation ?


RT300 leg and arm: In most cases yes.  Certain therapy settings can be adjusted to allow for accurate session results in the event of loss of limb.  Accommodations can also be made if the prosthesis is donned. RT200: In most cases yes.  Certain therapy settings can be adjusted to allow for accurate session results in the event of loss of limb.  Accommodations can also be made if the prosthesis is donned. RT600:  This system may be contraindicated with a patient with a lower extremity amputation.  Each case would need to be considered individually by the clinician.



What happens when my patient is discharged ?
Will the gains be lost ?



Many patients of varying neurological disorders receive significant functional gains as well as health benefits from use of FES powered systems such as the RT300, RT200 or RT600 as part of their inpatient and/or outpatient rehabilitation program.  Patient’s who have limited ability to continue volitionally participate in traditional exercise will demonstrate decline, muscle mass loss and in some cases increased issues with spasticity when discontinuing FES therapies. 

FES powered systems, most commonly the RT300 and RT200, can be prescribed for use in the home or accessed in a community-based wellness program so that patients can continue to build on the gains they made in their rehabilitation programs.



Should I introduce my patient to FES if I think they can't afford a home system ?


You should introduce all your appropriate patients to FES therapy and allow Restorative Therapies to work with patients and their family to find funding.

Wealth is not a predictor of who gets an FES system for home.

We have a whole arsenal of tools and techniques which we can apply to each individual situation.  Our insurance reimbursement success rate is high because we have made an unmatched organizational commitment to reimbursement through the use of individualized strategies and tenacity. 

Children



Which systems can I use with children ?


All of the Restorative Therapies products can be utilized with Children depending on the size of the child.  The RT300 leg ergometer has a lower extremity pediatric pedal set which can often accommodate children as small as 2 years old depending on the lower limb length and range of motion for leg sessions. 

The RT300 arm sessions can be utilized in several different ways with children as young as 3 years old depending on the upper extremity limb length and range of motion. Please note that the RT300 arm and leg system may require a special seating option in order to position the child properly for a session. 

The RT200 can be used with children who are at least 4’10” or taller.  The RT600 FES stepping system can be utilized with pediatric build-ups as well as pediatric harness for children as young as 2-3 years old depending on the lower limb length and range of motion.

See some RT300 pediatric setups



Are there any extra precautions for children ?


There are several additional considerations for children and one precaution relating to maintaining wrist stability while arm therapy.  The controller of all of the Restorative Therapies systems can be positioned so that it is not within reach of the child for safety purposes.  In addition, children often require specialized seating systems to accommodate the appropriate range of motion.  Each case must be individually evaluated by a therapist in order to determine the best system and set-up for the child depending on their size and need.
Therapy questions



How long does it take to setup a patient ?


Setting up a patient on the RT200 or RT300 typically takes about 10 minutes depending on the number of stimulation channels utilized and your experience with the device.  Experienced users will typically complete a set-up in under 10 minutes.

Setting up a patient on the RT600 typically takes about 10-15 minutes due to the added time required for harnessing and hoisting the patient into position.



What is an effective dosage ?

It is recommended that FES be applied to each muscle group for a minimum of 3 hours per week to see improvements in muscle mass. When new to use of FES, patients typically start with a 15 minute session and build-up gradually to complete 1 hour sessions for leg and 30-40 minutes sessions for arms.



Is it difficult to learn how to use FES ?


Restorative Therapies training makes it very easy to learn and become comfortable using FES with your patients.  

Our training program includes several means including Internet based, remote via Skype, on-site in your facility or hands on at our Clinical Training Center.

This variety of training opportunities will help you learn how to utilize FES in a way that best fits your needs.

Training



Do I have to be licensed ?


The use of FES as a modality within the Plan of Care by a licensed and certified PT or OT is based on state requirements.  Please check with your state practice act to ensure compliance. The use of our FES systems by non-licensed professionals should be directed and under the plan of care determined by the patient's physician.



How do I become expert ?


1. The purchase of a Restorative Therapies FES Powered System will come with the following facility training:
a. Web course: 4 hour web-based introductory training course to the specific system purchased
b. Onsite installation and training after initial delivery: This may range from 1 to 3 full days depending on system purchased.  These are delivered by your dedicated Restorative Therapies Clinical Representative, an FES Powered Systems expert.
c. Regular onsite and/or remote training at your facility to ensure full competence and confidence for all users of the systems at your facility

2. CTC courses: Our Clinical Team offers 2 1/2 day CEU accredited FES Powered Systems training courses 6 times per year.  These courses are held in the Clinical Training Center at Restorative Therapies in Baltimore, MD and offer a the opportunity to gain advanced knowledge and experience working with the latest FES Powered Systems: RT200, RT300 and RT600. Please see our current schedule.
3. Web courses: In addition to the introductory courses, there are many learning modules offered to our users under the Education page on RTIlink.com.  

Billing



How do I bill for FES therapy sessions ?


It is always best to consult with the Financial counselor or representative at your organization, as well as your therapy practice act, to ensure best practices within your state and field.  Below are suggestions for billing.

Billing for the documentation of skilled set-up and application of the RT300, RT200 or RT600 can all fall under Therapeutic Exercise 97110: Therapeutic exercises to develop strength and endurance, range of motion, and flexibility. 

FES Powered Systems offer Progressive Resistive Exercise, regardless of the individual’s volitional movement. You may choose to bill for Therapeutic Activities 97530 if the patient is engaging in dynamic activities (transfers, sitting or standing balance for electrode application, etc) to improve functional performance during the skilled set-up of the system. RT600 can be billed as Gait Training 97116 during the duration of the upright application of the device.

SAGE Stimulator Activities may fall under Neuromuscular Reeducation 97112, Electric Stimulation attended 97032, or Therapeutic Exercise 97110, depending on the application and intent of the training activity.

Financing



Is financing available ?


Yes, in the US. Restorative Therapies works with a number of organizations that will finance your new FES therapy system.  If you reside outside of the US. or would like information, please contact a Restorative Therapies sales associate for more information.



How long will it take for me to get my investment back ?


Typically less than 1 year.
Please see our business case flyer for further details.