March 8, 2013 To Whom It May Concern, As a home user of the ...
March 8, 2013 To Whom It May Concern, As a home user of the ... March 8, 2013 To Whom It May Concern, As a home user of the ...
March 8, 2013 To Whom It May Concern, As a home user of the Motomed Viva2 and the RehaMove FES I'm happy to provide feedback on my progress and my experience with the equipment as it pertains to my specific condition (C4 tetraplegia – ASIA C). My first experience with a Motomed cycle was at a rehabilitation centre around nine months after my injury in 2006. Up until that time (due to retaining full sensation post injury) I had faced a horrible daily struggle with pain as a result of my new 'seated' lifestyle. Once on the cycle and for the first time since my injury I was effectively pain free while seated, a result of the pressure relief and increased circulation achieved from the continuous leg movement. As soon as I could, I acquired one for my home and to this day after my pain threshold has been reached sitting in my chair I am positioned with my feet on the cycle. With passive slow cycling I can spend my day productively using switch and voice-activated smart phone and computer technology, without being further disabled from the focus and concentration depleting effects of pain. Secondary to this has been the reduction in muscle tension and spasticity as a result of daily cycling. This means that my limbs are much easier for caregivers to manipulate, my body easier to hoist and I am able to maintain lying positions for longer before requiring adjustments or turning. After researching the beneficial effects of FES cycling for those with spinal cord injury on the Internet I was excited to find it available as an option on the Viva2 via the RehaMove system and went ahead with the purchase which was possible due to the excellent service and effort provided by my New Zealand Motomed distributor. In using the FES with my cycle the first obstacle for me was to overcome extremely high muscle tone in the opposing muscle groups. For example while my quadriceps were being stimulated to contract, muscle tone in the hamstring muscles would be preventing a clean contraction in the quadriceps. The solution for me was to only train quadriceps in combination with tibialis anterior, and not the hamstrings as the extra residual tone from hamstring stimulation was making smooth cycling impossible and therefore not allowing the switch to active training mode. Also, I had to focus on relaxation and reduce any environmental stimuli as even the slightest increase in adrenaline during stimulation would greatly increase the muscle tone. With those muscle groups selected and my focus on keeping myself relaxed during training it was all about time, and it probably took two or three weeks of very slight incremental resistance increases using flywheel mass for my muscles to learn to contract/relax at the right times and enable whole gear selection to increase resistance to an effective level. Another obstacle was uncontrollable lower leg spasm caused by the sensation on the sole of my foot as it pushed on the pedal and also an oversensitive Achilles tendon stretch reflex. I found the way to prevent this from occurring in most training sessions was to either spend time on the tilt table or undergo foot massage/Achilles tendon stretches immediately prior to training in order to desensitize the foot and stretch reflex. A high enough current for good tibialis anterior contraction and therefore good foot dorsiflexion helped me here also as long as it is not so high to fatigue the muscle before the conclusion of training which has the opposite effect of causing spasm.
<strong>March</strong> 8, <strong>2013</strong><br />
<strong>To</strong> <strong>Whom</strong> <strong>It</strong> <strong>May</strong> <strong>Concern</strong>,<br />
<strong>As</strong> a <strong>home</strong> <strong>user</strong> <strong>of</strong> <strong>the</strong> Motomed Viva2 and <strong>the</strong> RehaMove FES I'm happy to provide<br />
feedback on my progress and my experience with <strong>the</strong> equipment as it pertains to my<br />
specific condition (C4 tetraplegia – ASIA C).<br />
My first experience with a Motomed cycle was at a rehabilitation centre around nine<br />
months after my injury in 2006. Up until that time (due to retaining full sensation post<br />
injury) I had faced a horrible daily struggle with pain as a result <strong>of</strong> my new 'seated'<br />
lifestyle. Once on <strong>the</strong> cycle and for <strong>the</strong> first time since my injury I was effectively pain<br />
free while seated, a result <strong>of</strong> <strong>the</strong> pressure relief and increased circulation achieved<br />
from <strong>the</strong> continuous leg movement. <strong>As</strong> soon as I could, I acquired one for my <strong>home</strong><br />
and to this day after my pain threshold has been reached sitting in my chair I am<br />
positioned with my feet on <strong>the</strong> cycle. With passive slow cycling I can spend my day<br />
productively using switch and voice-activated smart phone and computer technology,<br />
without being fur<strong>the</strong>r disabled from <strong>the</strong> focus and concentration depleting effects <strong>of</strong><br />
pain. Secondary to this has been <strong>the</strong> reduction in muscle tension and spasticity as a<br />
result <strong>of</strong> daily cycling. This means that my limbs are much easier for caregivers to<br />
manipulate, my body easier to hoist and I am able to maintain lying positions for<br />
longer before requiring adjustments or turning.<br />
After researching <strong>the</strong> beneficial effects <strong>of</strong> FES cycling for those with spinal cord injury<br />
on <strong>the</strong> Internet I was excited to find it available as an option on <strong>the</strong> Viva2 via <strong>the</strong><br />
RehaMove system and went ahead with <strong>the</strong> purchase which was possible due to <strong>the</strong><br />
excellent service and effort provided by my New Zealand Motomed distributor.<br />
In using <strong>the</strong> FES with my cycle <strong>the</strong> first obstacle for me was to overcome extremely<br />
high muscle tone in <strong>the</strong> opposing muscle groups. For example while my quadriceps<br />
were being stimulated to contract, muscle tone in <strong>the</strong> hamstring muscles would be<br />
preventing a clean contraction in <strong>the</strong> quadriceps. The solution for me was to only<br />
train quadriceps in combination with tibialis anterior, and not <strong>the</strong> hamstrings as <strong>the</strong><br />
extra residual tone from hamstring stimulation was making smooth cycling impossible<br />
and <strong>the</strong>refore not allowing <strong>the</strong> switch to active training mode. Also, I had to focus on<br />
relaxation and reduce any environmental stimuli as even <strong>the</strong> slightest increase in<br />
adrenaline during stimulation would greatly increase <strong>the</strong> muscle tone. With those<br />
muscle groups selected and my focus on keeping myself relaxed during training it<br />
was all about time, and it probably took two or three weeks <strong>of</strong> very slight incremental<br />
resistance increases using flywheel mass for my muscles to learn to contract/relax at<br />
<strong>the</strong> right times and enable whole gear selection to increase resistance to an effective<br />
level.<br />
Ano<strong>the</strong>r obstacle was uncontrollable lower leg spasm caused by <strong>the</strong> sensation on <strong>the</strong><br />
sole <strong>of</strong> my foot as it pushed on <strong>the</strong> pedal and also an oversensitive Achilles tendon<br />
stretch reflex. I found <strong>the</strong> way to prevent this from occurring in most training sessions<br />
was to ei<strong>the</strong>r spend time on <strong>the</strong> tilt table or undergo foot massage/Achilles tendon<br />
stretches immediately prior to training in order to desensitize <strong>the</strong> foot and stretch<br />
reflex. A high enough current for good tibialis anterior contraction and <strong>the</strong>refore good<br />
foot dorsiflexion helped me here also as long as it is not so high to fatigue <strong>the</strong> muscle<br />
before <strong>the</strong> conclusion <strong>of</strong> training which has <strong>the</strong> opposite effect <strong>of</strong> causing spasm.
Finally, in having full pain sensation I found <strong>the</strong> current I required for effective<br />
contraction <strong>of</strong> my quadriceps to be unbearable with <strong>the</strong> smaller electrodes. After I<br />
changed to <strong>the</strong> large electrode size <strong>the</strong> larger surface area reduced <strong>the</strong> burning pain<br />
considerably and allowed me to reach <strong>the</strong> current I required to increase resistance<br />
once I had <strong>the</strong> solutions to <strong>the</strong> first two pre-mentioned obstacles.<br />
Anyway, now I am able to go as high as gear 11, progressing upwards during <strong>the</strong><br />
workout over 35-45 min with 50-50 or close to symmetry (left leg requires extra<br />
current to achieve this and pulse-width/current adjustments with each gear<br />
increased). I wouldn't say I am able to lift my heart rate as high as I would like (due to<br />
my limited muscle group selection as well as my pain, muscle tone and spasm<br />
threshold limits) but I can still get at least 10 to 15 bpm above resting and <strong>the</strong> feeling<br />
<strong>of</strong> well-being after active training (having worked out with my own muscles) is<br />
priceless. Additionally I have noticed fur<strong>the</strong>r muscle tension/spasticity reduction with<br />
active training on top <strong>of</strong> that already achieved through passive training.<br />
That about covers my experiences with Motomed and RehaMove FES, equipment<br />
that has a tetraplegic I would never want and could not imagine being without. One<br />
final note, I would like to commend <strong>the</strong> quality <strong>of</strong> construction on <strong>the</strong> Motomed cycle<br />
as although I now have a new Viva2 for use with my FES Training, I am still using my<br />
original Motomed cycle complete with black-and-white screen for my passive training.<br />
So far that's five and a half years, 365 days a year, 4 to 6 hours per day <strong>of</strong><br />
continuous passive cycling without a single mechanical or electrical issue.<br />
Impressive.<br />
Thank you,<br />
Mat<strong>the</strong>w Allan BSp&ExSc.