Introduction:The RISE stimulator is a major breakthrough in the field of “FunctionalElectrical 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 stimu-lation 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 paralysisin their legs often suffer from pres-sure ulcers (bed sores) due to poor blood circulation and thesepressure ulcers often prove difficultto 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 reoc-currence 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 King-dom, 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 de-nervation which starts to occur imme-diate after the on-set of the disability, there is no nerve innervation and resulting in a flaccid paralysis.

Through RISE, the mucle canbe 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.

PracticeScientists 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 mus-cle 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 yearPhoto A: Muscle fibers beforePhoto B: Muscle fibers after

Person 2 LMN for 2 yearsPhoto C: Muscle fibers beforePhoto D: Muscle fibers after

Person 3 LMN for 3 yearsPhoto E: Muscle fibers beforePhoto F: Muscle fibers after

Person 4 LMN for 8 yearsPhoto G: Muscle fibers beforePhoto H: Muscle fibers after

This is an electron mi-croscope 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 be-coming visible again. This progress is also shown in photo F, the result after 2.1 years of stimula-tion to a person with more than 20 months LMN.

RISE Stimulator

Also based on a CT scan the pro-gress 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.

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