FES Guidance Note Leg Spasm Reduction Introduction Leg spasms, or so-called “spasticity” in the muscles of the legs, are frequently encountered issues in persons who have had a spinal cord injury. These spasms range in intensity and the degree of inconvenience they present to a person. Medication for spasticity is frequently prescribed but it can be difficult to find the optimum dose. An alternative regime of FES Cycling, stretching and physically “challenging” the muscles has been suggested as practical methods of reducing or even eliminating these leg spasms. This note represents practical guidance on using an FES Cycling programme to help reduce leg spams.
Using an FES Cycle Typically a new user of an FES Cycling system will be guided to actively exercise three times per week - or on alternate days - for 30 - 40 minutes of muscle stimulation. Many users cannot actively exercise for a full 30-40 minutes initially due to muscle fatigue. The aim is to gradually increase the amount of active exercise to develop the potential to receive some key benefits. • improve peripheral circulation and cardiovascular fitness • reduce the risk of pressure sores • potentially maintain bone density Consensus suggests that the maximum benefit of FES in the reduction of spasticity may not be realised until a system has been used for 1-2 hours per day for 1-3 months. It is equally important to realise that a reduction of spasticity may increase joint range of motion and unmask existing voluntary muscle control. If FES is discontinued, spasticity can usually be expected to return. For this reason, many clients elect to continue FES throughout their life. The side effects of FES for spasticity are minimal. If spasticity is made worse initially, the effect will generally subside within 1-2 hours. If this should happen, a preliminary trial of low intensity, or sensory level FES is indicated. If the client is using their spasticity to initiate movement or to stabilise a joint, then the reduction of spasticity may make them temporarily less capable. So, it is important to utilise the expertise of a therapist who can evaluate the effects of FES on spasticity and provide an FES training protocol to improve muscle performance and provide suppression of spasticity over time. It is important to note that each individual will vary in their response. In that respect it is no different from any other therapy or medication.
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