Volume 1 Number 2

Welcome to the 2^nd Edition of the International Functional Electrical Stimulation Society, Inc.™ (IFESS) News & Views. This edition of News & Views follows the annual meeting of the Society held in Ljubljana, Slovenia in June 2002. Therefore, many issues discussed here relate to events linked to this Conference.

News from the meeting of IFESS Board of Directors:

The Board of Directors of the IFESS, and several other individuals involved in the organization of the Society agreed upon the following: IFESS will continue to organize annual meetings on the three-year rotation basis (Europe, North America, Australia/Pacific). This schema should provide easier participation of students form different regions at least every three years, but what is more important the globalization of IFESS ideas.

· The preparations for Twin Waters Resort Sunshine the 2003 meeting, to be held from 1^st to 5^th July 2003 in Australia, Queensland (Novotel Coast, http://www.asiatravel.com/australia/novoteltwin/), are on the track. Prof. Glen Davis, President of the Organizing Committee of the 2003 IFESS Conference, is guarantying that the conference location is nice and attractive, and that the prices for accommodation are very reasonable, especially for students who plan to share rooms. The Australian meeting will have somewhat different format compared with the previous IFESS annual conferences; the format will follow the model of Neural Prostheses meetings that were organized several times in United States of America (Potosi, Deer Creek) as well as the Neural Prostheses meetings organized in conjunction with IFESS annual conferences in Burnaby, B.C, Canada (1997), and Aalborg, Denmark (2000). This format promotes more discussions and ad hoc sessions and includes a lot of time for chatting and brainstorming. The Co-chair of the Australian 2003 IFESS annual conference is Dr. James Middleton. The complete information is available at the site: http://dcconferences.com.au/ifess/

· Dr. Ian Swain is the Conference chair for the 2004 meeting that will be held 7^th-10^th September in Bournmouth International Centre, United Kingdom. Further details on the meeting will be available in the nearest future at the site: http://www.salisburyfes.com/.

· The IFESS 2005 Conference will be organized in Montreal, Canada. The Conference Chair of this event will be Dr. Mohamad Sawan.

· The Board of Directors decided to accept the invitation from Dr. Manfred Bijak to host the Annual Conference in 2010 in Vienna, Austria. This annual Conference will be organized in conjunction with the 10^th triennial Vienna International Workshop on FES.

It was discussed how IFESS invitations will be evaluated. A committee, consisting of Jimmy Abbas (Coordinator), Ron Triolo, Glen Davis, Ian Swain, Manfred Bijak, and Paul Meadows, was formed. This committee should formulate guidelines “How to get an IFESS meeting” and guidelines for the conference organizers.

Where to publish your papers?

Dr. Ross Davis, the former President of IFESS, is greatly helping to the awareness of the IFESS activities. He was instrumental for the development of relations with the International Society for Neuromodulation and excellent relation of the Journal of Neuromodulation with the IFESS Society. At the moment, IFESS contributions cover almost one third of the papers in the Journal of Neuromodulation, yet there is still space for more. Members of the Society are strongly encouraged to consider publishing in the Journal of Neuromodulation. The Journal publishes only original papers, and it is peer reviewed. The Journal of Neuromodulation is indexed and covered by SciSearch, ISI Alerting Services, and Neuroscience Citation Index. The journal is published four times a year and broken into two sections - one dedicated to articles traditional to INS (pain modulation, basic and clinical research) and the other to IFESS. For details how to submit a paper to the Journal, please see the site: http://www.blackwellscience.com/journals/neuro/

Another suggestion where to submit your work, especially if it is the area of engineering, is IEEE Transactions on Neural Systems and Neurorehabilitation Engineering (http://www.ieee.org/organizations/pubs/transactions/tre.htm.) This journal publishes regularly contributions that are closely related to IFESS activities. Dr. Charlie Robinson, member of the Board of Directors of the IFESS, instituted the Journal. Presently, the editor is Dr. Zev Rymer, a distinguished professor with important contributions in the fields of rehabilitation and motor control.

IFESS booth

Thanks to the efforts from the SMI people at Aalborg University, Aalborg, Denmark, the IFESS Society now has a visible booth (please see the picture of Paul Meadows, Vice President, and Prof. Glen Davis, Chairman of the IFESS 2003 Meeting in Australia, standing in front of the booth at the Ljubljana IFESS 2002). An easily transportable, robust booth would be required. The Board of Directors will try to find a sponsor for this long term Society booth. As transportation always is a problem, people volunteering to transport the booth to a meeting will be granted the IFESS conference fees. The purpose of the booth is to display information material.

A Committee for the booth was formed: Prof. Roger Nathan (coordinator), Paul Meadows, and Prof. Thomas

Sinkjær.

Paul Meadows completely rebuilt the IFESS home page. Now the page has online data submission, links, lots of educational stuff, and a newsletter. Congratulation to Paul for the design of the home page and excellent material that is posted!

The IFESS annual Conference was another success of the Society. Congratulation to the Conference organizers chaired by Drs. Tadej Bajd and Uros Stanic from Ljubljana! The team behind the scene from the Faculty of Electrical Engineering, Ljubljana, as well as from the Cankarjev Dom, Ljubljana, prepared a wonderful environment for the scientific part of the meeting, embedded the work in a world famous hospitality and social life, and made sure that more than 230 people felt important and welcome.

Dr. James Reswick, one of the pioneers in the field of modern external control of human extremities, presented a keynote speech at the official Conference dinner in Cankarjev Dom.

Dr. Thomas Mortimer gave an interesting and inspiring keynote address at the opening session of the scientific program.

Dr. Zlatko Matjacic, from the Institute for Rehabilitation, Ljubljana was responsible for an interesting and efficient visit to the Slovenian Institute for Rehabilitation (http://www.ir-rs.si/)

l 24 student papers competing for the Vodovnik award. The award committee selected the following Conference paper to receive the award: Biocompatibility Testing of Platinum Metallized Silicon Rubber authored by V. Vince, M-A. Thil, C. Dicara, K. Kolev, J. Delbeke, I.M. Colin and C. Veraart.

l European Commission support from the project Quality of Life was approved (45000 €)

l The Proceedings from the Conference comprise all the highlights from the meeting. The Proceedings are available in hardcopy or on CD.

On important element of the IFESS 2002 Conference was the pleasant and friendly series of social events. The weather helped the organizers, so the excursion to the beautiful Lake Bled was a memorable event. The Excursion included the gondolas ride to the island in the lake (see pictures).

FESnet Conference in Glasgow

The first FESnet Conference was organized in Glasgow, Scotland between the September 1 and 3, 2002. The conference aimed to attract people from many FES research centres and user communities, and provide an opportunity to share ideas, innovations, research and experience. Full information can be found at: http://fesnet.eng.gla.ac.uk/

The following plenary sessions were planned: 1) T. Bajd: Neurorehabilitation System for Re-education of Walking, 2) T. Sinkjær: Pattern Peripheral Nerve Stimulation in Neurological Rehabilitation, and 3) J.Jarvis: Functional Muscle Grafting: Principles and Prospects. The conference included the following technical sessions (oral presentations): Standing and Cycling, 2) Upper Limb, 3) Clinical, and 4) Gait. The conference also included poster sessions.

The conference organizers were: Dr. Malcom Granat (Conference Chairman) from the Department of Bioengineering, University of Strathclyde, and Dr. Kenneth Hunt (Co-Chairman) from the Department of Mechanical Engineering, University of Glasgow. The Conference Administrator was Ms. Nicola Coffield, from the Department of Mechanical Engineering, University of Glasgow.

Annual Conference CD-ROM

The IFESS CD-ROM was developed to disseminate scientific research findings in the field of electrical stimulation to as broad an audience as possible and to make available the collective works of our Society since the formation of IFESS in a simple and easily obtainable format. We hope that you find the information contained herein useful and easily accessible. The CD includes the following:

The CD-ROM is available for the extremely low price of only $35 plus shipping. For volume purchasing, please contact the editor, Paul Meadows. (paul.meadows@bionics.com)

CD-ROM “Advances in External Control of Human Extremities (ECHE) I-X”

Thanks to the efforts of Dr. Dejan Popovic the long pending project of producing a CD-ROM comprising ten hard to get proceedings "Advances in External Control of Human Extremities I-X,” published by the Yugoslav Committee for ETAN, Belgrade, Yugoslavia was finalized. These proceedings contain reports from the well-known Dubrovnik meetings held between 1962 and 1990. The CD-ROM is now available from Center for Sensory Motor Interaction (SMI), Aalborg University, Denmark (e-mail: susanne@smi.auc.dk), or from Dr. Paul Meadows (e-mail: paul.meadows@bionics.com). Detailed information can be found at www.smi.auc.dk/publications.

International IFESS Corporate Office:

Dr. Manfred Bijak, Ph.D.
University of Vienna
Department of Biomedical Engineering and Physics, AKH - Ebene 4/L
Waehringerguertel 18-20
A-1090 Vienna, Austria

Contact Information in U.S.A:

Paul Meadows
c/o Advanced Bionics Corporation
Neurological Devices Division
25129 Rye Canyon Loop
Valencia, CA 91355 USA,

Message from the Temporary Editor

I am glad that the Board of Directors decided to prolong my temporary duties to compile and edit the News & Views of IFESS. The plan is to publish the News & Views and post it on the official web site of the Society at least twice a year. This N^o2 of IFESS News & Views provides general information, presents initiatives and short reports from the meetings, yet it also continues the story on what FES is and what it could and should be in the part “An educational corner”. The history of FES is certainly of interest for many people in this field, because in many ways it shows the directions, yet also that the field needs break through devices and methods in order to become a routine clinical practice and important contribution to the quality of life. The main reason for this message is to ask members to allow me to edit the News and Views, and not to make them on my own. I call all the members to send their suggestions, contributions, comments, reports, and other material that they feel is of interest for IFESS membership to the editor of News & Views (dbp@smi.auc.dk)

Functional Electrical Stimulation: How and when it started? (part 2)[2]

The basic ideas developed in 18^th century have been described in Part 1 (IFESS News and Views Vol. 1, N^o 1).

A 19^th century stimulator model used a wet battery. The faradaic stimulator was the first device that could produce controlled and sustained muscle contractions. It was self-contained with its own power source, and its output frequency could be adjusted to easily exceed the stimulation rate of 100 pulses per second. The output level was also controllable. A device of this type was used to great advantage by Guillaume Benjamin Armand Duchenne to study the anatomy and functional movements of specific muscles by using moistened electrodes on the skin surface over the muscles (Duchenne, 1867).

In the 20^th century the discovery of the diode tube by Fleming in 1904 and De Forest's invention of the triode in 1906 made the design of the stimulators less complicated. In parallel, the understanding of action potentials in nerves and muscles, conduction velocities, membrane biophysics, and musculo-skeletal junction transmission provided much better guidelines of what a stimulator should do. Electronic stimulators using vacuum tubes replaced the earlier electromechanical stimulators resulting in improved reliability and stimulus control. These devices were hardly wearable because of the bulk and weight of the components used.

A major breakthrough occurred in 1947 when Bardeen, Brattain, and Shockley invented the transistor (Bardeen and Brattain, 1948; Shockley, 1948). Later, Kilby, and Noyce developed techniques to simultaneously manufacture multiple transistors together with other electronic components such as resistors, capacitors, and diodes into monolithic integrated circuits. This permitted sophisticated electronic circuits to be incorporated into very small devices.

Liberson and his co-workers are generally credited as the first investigators to utilize electrical stimulation to restore functional control of a paralyzed limb muscle on a continuous basis (Liberson et al., 1961). They treated foot drop in hemiplegic patients by placing conductive rubber electrodes on the skin over the peroneal nerve. Activation of this nerve by a transistorized stimulator resulted in contraction of the tibialis anterior m. and elevation of the foot. A switch was placed in the sole of the shoe, causing current to flow through the nerve during periods when the foot was lifted off the ground. Over 100 patients were treated with this technique, and it was claimed that all of them obtained some degree of gait improvement (Liberson, 1972). However, patient acceptance was limited by factors such as skin irritation caused by the electrodes, the need for precise electrode placement each time the system was to be used, breakage of electrode wires, and limited benefits as compared with the hassle of applying and maintaining the equipment. Liberson called his technique "functional electrotherapy." For some reason this term did not gain widespread acceptance. Moe and Post introduced the term Functional Electrical Stimulation (FES) (Moe and Post, 1962).

The term FES is generally used to describe a neural prosthetic technique that utilizes stimulation of neural tissue for the purpose of restoring function. Because this can include a broad range of neural systems, the term Functional Neuromuscular Stimulation (FNS) is often used to indicate the subcategory of FES that restricts stimulation to the neuromuscular system.

Long and Masciarelli, intrigued by the novel application of therapeutic stimulation to the lower extremity reported by Liberson and his colleagues, developed an FNS-assisted splint for control of the hand in high quadriplegic patients (Long and Masciarelli, 1963). They incorporated the FNS-assisted splint into the hand splint an electrode that activated the extensor digitorum m, that is, hand opening. The splint braced the thumb and wrist in a fixed position. The middle and index fingers were held together in a hinged splint and brought into opposition by a spring. By controlling the amplitude of stimulation to the extensor digitorum m, the patient could overcome the spring force and separate the fingers from the thumb. Proportional control of the stimulation channel was facilitated by a potentiometer in series with the output of the stimulator. The potentiometer was mounted beneath the bearings of a balanced forearm orthosis of the opposite arm, permitting voluntary control of the system. The splint was used by a patient with C4-C5 tetraplegia, permitting activities such as grasping, holding, and releasing objects, that is, performing some daily activities. Although the patient's tolerance of the device was reported as excellent, the system did not gain widespread clinical acceptance.

Peckham and his colleagues pioneered the FNS grasping device. They worked with C5 tetraplegic patients, and their device provided two types of functional hand grasp (palmar prehension and release as well as lateral prehension and release) using electrical stimulation with percutaneous electrodes implanted chronically in the forearm muscles (Peckham et al., 1980a). The same investigators also reported augmenting tenodesis grip in C6 quadriplegic patients using similar techniques (Peckham et al., 1980b).

In spinal –cord injured paraplegic patients, restoration of the functional abilities to stand from a sitting position and to walk with a minimum of bracing has been the goal of several research groups. In 1960 Kantrowitz reported a paraplegic patient with surface electrodes over the quadriceps m. and gluteus m. who was able to rise from a sitting to a standing position without braces, and who was able to maintain the standing position for a few minutes when stimulated (Kantrowitz, 1960). Cooper and his co-workers implanted electrodes bilaterally on the femoral and sciatic nerves in a Tll-12 paraplegic patient. They claimed the patient was able to ambulate up to 40 feet when using a walker for stability (Cooper et at., 1973). Using implanted stimulators with electrodes on branches of the femoral nerves bilaterally, Brindley and co-workers were able to demonstrate standing from a sitting position and limited biped gait assisted by elbow crutches, but without braces or a walker, in a paraplegic patient. In this case, femoral nerve stimulation was essentially providing knee splinting that the patient controlled with a switch (Brindley et al., 1978). These early studies were soon followed by more sophisticated multichannel systems (Kralj et al., 1983; Marsolais and Kobetic, 1983).

The above-cited early attempts to restore limited upper and lower limb functions were valuable prototypes for elucidating the problems that needed to be solved before genuine practical neural prostheses could be developed for control of paralyzed extremities. Some of the more significant problems were lead and electrode breakage, electrode positioning and stabilization, inadequate stimulus specificity, insufficient muscle force, muscle fatigue, involuntary muscle spasms, hyperactive muscle contractions, reliable sources of control signals, and limited functional gains for the patients.

Literature

1. Bardeen J, Brattain WH. (1948) Three-electrode circuit element utilizing semiconductor materials. U.S. Patent No. 2,524,035.

2. Brindley GS, Polkey CE, Ruston DN. (1978) Electrical splinting of the knee in paraplegia. Paraplegia 16:434-441.

3. Cooper EB, Bunch WH, Campa JH. (1973) Effects of chronic human neuromuscular stimulation. Surg Forum 24:477-479.

4. Duchenne GBA. (1867) Physiologie des mouvements demontree a l'aide l'experimentation electrique et de l'observation clinique, et applicable a l'etude des paralysies et des deformations. Paris.

5. Kantrowitz A. (1960) In: Electronic Physiologic Aids: A Report of the Maimonides Hospital pp. 4-5. Brooklyn, NY.

6. Kralj A, Bajd T, Turk R, Krajnik J, Benko H. (1983) Gait restoration in paraplegic patients: A feasibility demonstration using multichannel surface electrode FES. J Rehabil Res Dev 20:3-20.

7. Liberson WT, Holmquest HJ, Scot D, Dow M. (1961) Functional electrotherapy: Stimulation of the peroneal nerve synchronized with the swing phase of the gait of hemiplegic patients. Arch Phys Med Rehabil 42:101-105.

8. Liberson WT. (1972) Functional neuromuscular stimulation: Historical background and personal experience. In: MA LeBlanc (Ed.) Functional Neuromuscular Stimulation: Report of a Workshop. April 27-28, 1972, pp. 147-156. Washington, DC: National Academy of Sciences.

9. Long C, Masciarelli V. (1963). An electrophysiological splint for the hand. Arch Phys Med Rehabil 44:449-503.

10. Marsolais EB, Kobetic R. (1983) Functional walking in paralyzed patients by means of electrical stimulation. Clin Orthop 175:30-36.

11. Moe JH, Post HW. (1962) Functional electrical stimulation for ambulation in hemiplegia. Lancet, 82:285-288.

12. Peckham PH, Mortimer JT, Marsolais EB. (1980a) Controlled prehension and release in the C5 quadriplegic elicited by functional electrical stimulation of the paralyzed forearm musculature. Ann Biomed Eng, 8:369-388.

13. Peckham PH, Marsolais EB, Mortimer JT. (1980b) Restoration of key grip and release in the C6 tetraplegic patient through functional electrical stimulation. J Hand Surg, 5:462-69.

14. Shockley WB. (1948) Circuit element utilizing semiconductor material. U.S. Patent No. 2,569,348.

[1] The report was contributed by Dr. Tomaz Karcnik, member of the organizing Committee of Ljubljana IFESS 2002 Conference

[2] The text is based on Hambrecht FT, (1992) A Brief History of Neural Prostheses for Motor Control of Paralyzed Extremities, In Stein RB, Peckham EP, Popovic D (Eds.) Neural Prostheses, Oxford Univ Press, London, pp. 3-16.