新規理学療法ジャーナル

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Functional Electrical Stimulation (FES): Transforming Clinical Trials to Neuro-Rehabilitation Clinical Practice- A Forward Perspective

Gad Alon

Presenting a forward perspective on the topic of personalized functional electrical stimulation (FES) and discussing its critical role in clinical practice is a challenge, particularly when the goal is to provide biomedical engineers and clinicians with a guide to bridge the gap between laboratory, clinical research, and clinical practice. There are several dimensions to the complexity of the topic. First, is the prevailing and misleading terminology, inadequate evidencebased training of physicians and rehabilitation therapists, and the recognition that until recently most existing FES systems were not designed as wearable systems and are “not patient or therapist friendly”. Most importantly, is the wellestablished phenomenon, that following damage to the musculo-skeletal system or brain, patients’ profile of functional recovery and thus utilization FES as part of the recovery is highly variable, prolonged and largely unpredictable. As a result, legacy research and training methods that depend on interpretation of statistically significant and clinically meaningful findings are inherently limited addressing the needs of most patients. This monograph will focus on: 1) identifying the specific deficits and recovery profiles that each patient presents, 2) providing examples of the diverse modes of actions (mechanisms) that govern wearable FES utilization, 3) the latest developments and shortcoming of wearable FES technologies, and 4) the recognition that FES has limited value if applied in isolation. Finally, an example of personalized training paradigm, centered on individual patient’s needs and measureable progress in functional outcomes will be presented.