Do you want the best FES Bike?
Introduction
A Functional Electrical Stimulation (FES) Cycling system (sometimes known as an FES bike) is a truly empowering exercise tool designed to be used by persons following a neurological injury or condition. Many of our clients have experienced a spinal cord injury and have complete or partial limb paralysis but the technology is also useful for conditions such as a stroke, MS, Parkinson's Disease and Transverse Myelitis. Each condition would be approached somewhat differently and the objectives of exercise might be different but the general benefits of using a FES bike could fundamentally be the same.
This innovative type of product, our version is called the RehaMove, uses electrical currents to stimulate your muscle contractions in sync with the movement of the bike pedals, giving you the ability to actively cycle against resistance, even if your voluntary control of the limbs is limited or absent.
It's not just about physical movement, though. FES Cycling is also about enhancing your cardio-respiratory fitness, improving your muscle tone, helping preserve bone density and boosting your overall circulation. It's about taking control, pushing boundaries, and reaping the rewards of your efforts in terms of recovery and rehabilitation. If recovery is not possible, using an FES bike can help reduce the risk of long term health complications.
Here is a brief video introduction to today’s article.
The origins of the concept of FES Cycling
The concept of FES Cycling finds its roots in the pioneering work of researchers and physiologists who sought to leverage electrical stimulation as a safe and effective way to enhance movement in people with neurological conditions.
An iconic testament to the efficacy of this technology is the use of an FES bike by the late Christopher Reeve. Best known for his role as Superman in the 1978 film, Reeve experienced a severe spinal cord injury in 1995 that left him paralysed. However, he refused to be limited by his condition. His regular and dedicated use of the FES bike was a crucial element of his rehabilitation programme.
Despite the severity of his injury, Reeve was able to regain some motor and sensory function, which was considered remarkable by medical professionals at the time. A useful reminder that what is accepted wisdom at some point in time often proves to be far from wise later.
Reeve himself believed his improved function was the result of intense physical exercise. Five years after his injury, Reeve noticed that he could voluntarily move an index finger, and then he began an intense exercise programme. He used daily electrical muscle stimulation to build mass in his arms and legs, rode an FES cycling system, did spontaneous breathing training and participated in hydrotherapy. In 1998 and 1999, Reeve underwent treadmill training to encourage functional stepping.
His journey illustrates the transformative potential of FES Cycling, not merely as a tool for physical rehabilitation, but as a symbol of determination and the power of perseverance.
Since that time a significant amount of research has been conducted on the benefits of FES Cycling for spinal cord injury and many neurological conditions.
Basic principles of an FES bike
A RehaMove FES Cycling system based on a MOTOmed Muvi
An FES bike consists of a stimulation module with multiple channels and a passive/active (motorised) bike. Such passive/active bikes have a motor and are capable of moving paralysed legs passively when not using muscle stimulation. This has some benefit but using FES amplifies the benefit to a significant effect.
The stimulator and the bike communicate with each other during an exercise session, passing data back and forward. The stimulator always needs to know the position of the pedals so that it can decide which muscles should be active at any instant. As the pedal speed increases, the software will typically adjust the stimulation automatically to suit. Of course, the stimulator software is watching for error situations which might indicate a problem, such as an electrode becoming detached or when the pedals stop moving suddenly due to a leg spasm.
As we described in the introduction, FES cycling programmes are designed to synchronise the stimulation delivered to the major muscles with the movement of the bike’s pedals. The quadriceps, hamstrings and other muscle groups involved in a stimulation programme are effectively turned "on and off" at the necessary times during each revolution. This means that a user with paralysed limbs can still exercise these limbs actively against resistance. There are versions of these bikes that can work with the arms and shoulders too.
Which is the best FES bike?
There are a number of bikes on the UK market with different features and benefits. They all basically aim to do the same things and rely on the same basic principles but there will be differences in the manner of presentation.
We believe it's a good idea to compare the various systems if you are in the market for one of these bikes. They are not inexpensive so it should be a decision you think about carefully. You need to be the one that judges which is best for your situation. You will need to look behind the features and question whether you really need what is on offer. Any supplier will want to make what they have to offer seem like the best option.
On some occasions, Case Managers or Therapist's will refer clients to us for an FES bike and this is greatly appreciated because to us it reflects the fact that we are trusted providers.
Medical products like these need to be safe first of all, and then effective. It's always important to check that a product would be safe for you to use as an individual. All products will have largely similar indications and contraindications for use but the product user manual will always state these and it's best not to assume that something will be suitable in all cases.
Whilst it is obvious to compare the product's features, benefits and prices, we feel it is equally important to know whether you are going to be supported both in your use of the product and in those (hopefully rare) situations when something goes wrong.
Are More Features Necessarily Better?
There a few questions that arise fairly frequently.
How many stimulation channels do I need?
Is it safe for me to make my own changes to stimulation settings?
Can you make changes to stimulation settings remotely?
When it comes to channels of stimulation It is tempting to think that adding more channels is necessarily going to be better. We don't think that is necessarily the case. Probably four channels is a useful minimum and our RehaMove system currently supports 8 channels which is enough for most applications in our experience. Eight channels would, for example allow you to work all the muscle groups of the lower legs - supporting knee flexion and extension and foot and ankle dorsiflexion and plantarflexion.
Sometimes people say they would like more to have more channels so they can work both arms and legs at the same time, or they feel that stimulating more muscles at the same time has to be better.
There are problems that come with adding more channels. First of all, it adds to the setup time.
Pairs of Electrodes are used for each muscle group
Although it does not seem like a big deal, we know that the most important thing with any FES bike is that it is actually used on a regular basis. It needs to become a habit. If the setup time takes to long it becomes a barrier to use. Adding a few minutes for the extra time for setup is definitely a barrier to use for some people.
The second problem is the cost of electrodes. Some clients wont worry about this but remember that each muscle you work with requires two electrodes which adds more cost. Trying to balance the contractions to produce a smooth cycling action can be difficult sometimes but once you try to involve both arms and legs the effort becomes much greater.
The bottom line is that adding more muscles to stimulate does not necessarily add up to greater fitness benefit.
Exercising the legs with FES Cycling remains important because it is very difficult to exercise paralysed legs any other way. Our RehaMove unit can be detached from the bike and used to augment other types of exercise. This can be an important benefit for some people; especially those who can work with a therapist and create custom programmes for whatever might be needed on the persons rehabilitation journey. Typical programmes might allow "sit to stand" exercises, upper limb/hand movement, shoulder stabilisation exercise or whatever is need at the time.
Making changes to stimulation settings is needed from time to time. We have always believed that we should train the home user and their care team to make the changes whenever possible. Each system will make this easier or harder to accomplish. The RehaMove system is relatively easy to operate so we have tried not to create a dependency on us for the long term which tends to be costly for the client.
Some systems have allowed stimulation settings to be changed remotely. We have never favoured this as we feel it is best if the user has control; they are "in the room" and best placed to understand what is needed. Having the user in control we feel is important for continued use of an FES bike. Of course, during the pandemic we learned we could provide quite a lot of support remotely using Zoom and similar technologies at relatively low cost. We find some clients are really interested to know how to fine tune settings for themselves and others want everything done for them. It just comes down to personal preference.
What would be our perfect FES bike?
After some sixteen years of experience of working with FES bikes we have some idea of what our perfect FES bike's features would include.
Adjustable deployment to suit a wide range of individual statures so that one product would be suitable for adults and many children
No electrode cables!
Support for tSCS (transcutaneous spinal cord stimulation)
Remote monitoring of performance data
A stimulator that is not dependent on a particular exercise bike or even type of equipment.
A stimulator that can be programmed to produce stimulation sequences to augment other types of exercise for any application.
A "smart' stimulator that can work for clients uninterested in the science of electrical stimulation but with a professional mode allowing fine tuning of stimulation settings.
Oh - and at a price where many more people could using them.
Conclusion
Choosing an FES bike is an empowering step towards reclaiming your fitness, independence, and overall quality of life. It's a commitment to overcoming barriers and embracing the possibilities that technology and determination can bring. It's not a decision to be made lightly, but with careful consideration and a clear understanding of your unique needs and circumstances. Remember, more channels or features don't always equate to a better experience, but a bike that you feel comfortable with, that supports your goals, and encourages regular use, will invariably lead to the best outcomes. Harness the power of FES bikes to unlock your potential and remember, every pedal, every revolution, is a triumphant stride towards your fitness journey.
Related Related Articles
FES Cycling system adjustments
https://www.anatomicalconcepts.com/articles/fes-cycling-system-adjustments
Is electrical stimulation safe?
https://www.anatomicalconcepts.com/articles/is-electrical-stimulation-safe
Why is electrical stimulation used in rehabilitation?
https://www.anatomicalconcepts.com/articles/why-is-electrical-stimulation-used-in-rehabilitation