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RISE Stimulator
Introduction:
The RISE stimulator is a major
breakthrough in the field of “Functional
Electrical Stimulation” (FES) a field
where electrical stimulation is used
to create a functional movement.
Until now only individuals who have
Paralysis where their nerves to the
effected muscles are undamaged will
respond to being stimulated with FES
so benefiting from the electrical stimulation techniques. These individuals are
classed as having ‘Upper Motor Neuron
Lesion’ (UMN). A large European Union
research project led to a scientifically
breakthrough with the development
of the RISE Stimulator. This method
of stimulation ensures people with a
flaccid paralysis (lower motor neuron
lesion, abbreviated LMN) finally enjoy the
amazing benefits that FES has to offer.
People who have a flaccid paralysis
in their legs often suffer from pressure ulcers (bed sores) due to
poor blood circulation and these
pressure ulcers often prove difficult
to cure. To recover it is sometimes
necessary for them to lie in bed for
weeks or even months at a time,
which can bring a lot of unpleasant
consequences with it. The RISE
Stimulator is a main solution when it
comes to prevention and the reoccurrence of these pressure ulcers. A
prolonged recovery where the individual
is inactive is no longer necessary.
The RISE stimulator has many more
major benefits, a summary of all the
important benefits are put on
a list below:
- Reactivation of the muscles
- Improved blood circulation
- The recovery of muscle mass and fiber size
- Restoration of the muscle fiber structure
- The prevention of pressure ulcers (bed sores).
- Can be used on Children.
- Can be used for arm with smaller electrodes (brachial plexus)
- Improved skin condition
- A healthier look (aesthetics) of the limbs
RISE Stimulator
What is RISE Stimulator?
The RISE Stimulator is the result
of an EU project, which has taken
place over the last ten years. Over this
period scientists and physicians from
Austria, Germany, Italy, United Kingdom, Slovenia and Iceland researched
and investigated the possibility of such
a system. The results of this long term
joint study have now resulted in an
ingenious device which is designed
to benefit people with a flaccid paralysis
(lower motor neuron lesion (LMN)).
As the picture shows, the RISE
stimulator is a simple control box that
has a display and keypads with two
channels and specially made electrodes
being attached to the RISE Stimulator.
With a specific gel to act as a medium
the electrodes are placed on the desired
muscle group and are held in place with an
elastic strap. Setting the stimulator
is the last thing that you have to
do, before the training can start.
Given the compactness and high usability
of this great machine it allows this form of
training to be easily performed at home.
Operation
By the nature of Spinal Cord Injury
(SCI) with LMN there is muscle denervation which starts to occur immediate after the on-set of the disability,
there is no nerve innervation and
resulting in a flaccid paralysis.
Through RISE, the mucle can
be stimulated directly. For muscles
with an intact lower motor neuron
causes activation of the neuromuscular
level that all muscle fibers are
activated. Once the nerve to the
muscle stops functioning, muscle
contraction can only be achieved by
stimulating each individual muscle fiber.
To provide sufficient fibers to activate at
one time, at the height of the muscle
contraction, a homogeneous electric field
has to be created. With RISE it is even
possible that surrounding muscles are
going to be activated at the same time.
The research data which are available
now have been shown that muscles
that have been inactive for more than
10 years are able to recover. Those
muscles were needed to be stimulated
for many years daily. These electrical
stimulation pulses should be used with
a much higher intensity, an intensity
which is much higher than the current
pulses of current FES applications.
RISE Stimulator
As the muscle recovers, there is less
intensive FES needed. When muscles
denervated for no more than two
years the application of the RISE
Stimulator is much easier and takes
significantly less recovery time.
Practice
Scientists and physicians
had
researched the results of the RISE
Stimulator during the stimulation
program in a two year study. Twenty
subjects with a flaccid spinal cord injury
participated in this Stimulation program.
During this program, the quadriceps
has been stimulated with the RISE
Stimulator for five days a week, fifteen
minutes long. In the table below
you can see what the difference
is between the Functional Electrical
Stimulation parameters for upper
and lower motor neuron lesions.
These are optical microscopic
photographs, where the muscle fibers
of the quadriceps are visible. In picture
A you see a healthy muscle,
it contains large muscle fibers.
Picture C shows the muscle of a person
who has twenty years of spastic muscle paralysis (UMN). The muscle fibers
are shrunken and you could say that
it is a very poorly trained muscle
If we take a look at the pictures of
people with a flaccid paralysis (LMN)
pictures E ( LMN 1 year) & G (LMN
4 years), then you will see that the
muscle fibers have reduced much more.
RISE Stimulator
After the stimulation program for two
years, the following results are visible.
Person 1 LMN for 1 year
Photo A: Muscle fibers before
Photo B: Muscle fibers after
Person 2 LMN for 2 years
Photo C: Muscle fibers before
Photo D: Muscle fibers after
Person 3 LMN for 3 years
Photo E: Muscle fibers before
Photo F: Muscle fibers after
Person 4 LMN for 8 years
Photo G: Muscle fibers before
Photo H: Muscle fibers after
Also based on a CT scan the progress is clearly visible. On the picture
below is a cross section of the upper
leg is visible. The colored part, are
the quadriceps. The muscle mass is
indicated by red and the connective
tissue with blue and fat with yellow.
This is an electron microscope vertical photo
of a healthy muscle
where the Z-lines and M
lines are clearly visible.
Picture A is a similar picture, only this time
taken from a person, which has a flaccid
paralysis for 10 months. After eighteen
months stimulation the
Z-lines and M-line are becoming visible again. This
progress is also shown
in photo F, the result
after 2.1 years of stimulation to a person with more
than 20 months LMN.