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.

Finally, in having full pain sensation I found the current I required for effective
contraction of my quadriceps to be unbearable with the smaller electrodes. After I
changed to the large electrode size the larger surface area reduced the burning pain
considerably and allowed me to reach the current I required to increase resistance
once I had the solutions to the first two pre-mentioned obstacles.
Anyway, now I am able to go as high as gear 11, progressing upwards during the
workout over 35-45 min with 50-50 or close to symmetry (left leg requires extra
current to achieve this and pulse-width/current adjustments with each gear
increased). I wouldn't say I am able to lift my heart rate as high as I would like (due to
my limited muscle group selection as well as my pain, muscle tone and spasm
threshold limits) but I can still get at least 10 to 15 bpm above resting and the feeling
of well-being after active training (having worked out with my own muscles) is
priceless. Additionally I have noticed further muscle tension/spasticity reduction with
active training on top of that already achieved through passive training.
That about covers my experiences with Motomed and RehaMove FES, equipment
that has a tetraplegic I would never want and could not imagine being without. One
final note, I would like to commend the quality of construction on the Motomed cycle
as although I now have a new Viva2 for use with my FES Training, I am still using my
original Motomed cycle complete with black-and-white screen for my passive training.
So far that's five and a half years, 365 days a year, 4 to 6 hours per day of
continuous passive cycling without a single mechanical or electrical issue.
Impressive.
Thank you,
Matthew Allan BSp&ExSc.