Patient Screening

It's just all combined you know giving you motivation to go and do the cycling. And I did as many cycling sessions as I could. I never skipped on any of my sessions. So, I'm still holding the record as the most cycling sessions.

- FES cycling user

Indications

  • Muscle atrophy
  • Reduced lean body mass
  • Reduced muscle cross sectional area
  • Poor insulin sensitivity
  • Poor glucose control
  • Cardiovascular deconditioning
  • Unhealthy or unfavourable adipose % or body mass index
  • Loss of bone density in lumbar spine and/or lower extremities
  • Loss of lower extremity strength
  • Reduced power output in lower extremities
  • Presence of spasticity
  • Poor quality of life
  • Reduced self esteem
  • Poor sense of wellbeing
  • Reduced VO2 max and physical endurance
  • Reduced lung health and function
  • Excessive fatigue
  • Presence of edema
  • Presence of pain
  • Presence of spasms
The RT 300 FES motorized cycle ergometer is classified as a Class 2 medical device by Health Canada.28 The specific indications for the RT 300 include:
  • Muscle re-education
  • Prevention or delay of disuse atrophy
  • Maintain or increase range of motion
  • Increase local blood circulation
  • Relax muscle spasms

Relative contraindications, absolute contraindications and comorbidities

While some contraindications are common when considering many different types of interventions, it is important to think about contraindications that may be unique to FES and/or FES cycling and how these might interact with any comorbidities the patient may have.

Highest risk of harm or injury
Moderate risk of harm or injury
Special consideration
Lowest risk of harm or injury
Comorbidities*
 

*Comorbidities refer to other medical conditions that may interfere with how patients respond to FES cycling. Some of these conditions may put them at higher risk of unfavourable outcomes or may prevent them from being able to participate in the program.

Relative contraindicationsDescriptionSeverity
Thrombosis
  • Recent, untreated venous thromboembolism (within past 3 months)
  • Current deep vein thrombosis or pulmonary embolism
Cardiovascular disease
  • Chronic arterial disease
  • Unstable cardiovascular disease
  • Uncontrolled arrhythmia
  • Angina
  • Congestive heart failure
Malignancy
  • Lower limb malignancy
  • T6 and below spinal malignancy
  • Consult with oncologist
Endocrinopathies
  • Severe diabetes
  • Uncontrolled hyperglycemia or HbA1c >7%
  • Untreated thyroid disease
Clotting abnormalities and prolonged bleeding times
  • Full dose anticoagulation
  • Thrombophlebitis
Medications
  • Chronic steroid treatment
Regenerating nerves in the treatment area 
Hypertension
  • Uncontrolled hypertension
  • Understand what constitutes high blood pressure on an individual basis for each patient, this number may vary
Autonomic dysreflexia (AD)
  • Uncontrolled or poorly controlled autonomic dysreflexia
  • Severe AD in response to electrical stimulation
  • Vasomotor instability
  • Frequent or severe bouts of AD
Diseases of bone metabolism
  • Osteoporosis
  • Diseases or medications known to affect bone metabolism
  • Dual Xray absorptiometry T-score less than -2.5
Less severe pressure injury
  • Pressure injury lower than grade 2
Seizures/Epilepsy
  • Seizure history
  • Diagnosis of epilepsy
Joint instability
  • History of knee subluxation or dislocation
  • Hip dislocation
Allergies
  • Allergy to electrodes
  • Skin reactions to electrodes or FES
Active epiphysis 
Severe pain
  • Uncontrolled pain
  • Complex regional pain syndrome
Metal implants
  • Newly placed
Heterotopic ossification
  • Severe joint calcifications
  • Away from site of stimulation
Contractures
  • Contractures of hip and knee preventing full ROM on bike
  • Less than 90 degrees flexion of hip and knees
Active infectious disease
  • Consider site of disease and severity
Psychological/cognitive disorder
  • Cognitive difficulties or disorders
  • Psychological instability
  • Severe symptoms of depression or anxiety
  • Recent history of alcohol abuse for which treatment was recommended
Lower motor neuron involvement
  • Lower motor neuron injury
  • Absence of spinal reflexes
  • Neurological degenerative diseases
  • Total denervation that precludes the use of FES
  • Flaccid paralysis in response to FES
Highest risk of harm or injury
Moderate risk of harm or injury
Special consideration
Lowest risk of harm or injury
Comorbidities*
 

*Comorbidities refer to other medical conditions that may interfere with how patients respond to FES cycling. Some of these conditions may put them at higher risk of unfavourable outcomes or may prevent them from being able to participate in the program.

Absolute contraindicationsDescriptionSeverity
Pregnancy
  • Not been tested in pregnant women
Fractures
  • Recent unstable fractures
  • Long bone or pelvic fractures
  • Fragility fractures
  • Lower limb fractures in the past 6 months
Cardiac demand pacemaker (if applied to thoracic wall)
  • Details provided in pop-out box
Pressure ulcers in buttocks or legs
  • Recent pressure injury
  • Pressure injury greater than grade 2
  • Skin breakdown that limits the ability to sit for 30 mins
Rotator cuff tear
  • Grade 3 or greater rotator cuff tear
PROCEED WITH CAUTION

Discuss with healthcare team before using FES cycling with a patient who has a pacemaker or implantable cardiac defibrillator.

PROCEED WITH CAUTION

Discuss with healthcare team before using FES cycling with a patient who has a pacemaker or implantable cardiac defibrillator.

Consider having a conversation with the healthcare team about using FES cycling with a patient who has a pacemaker or implantable cardiac defibrillator. There is limited information that directly discusses FES use for cycling with patients with spinal cord injury who also have a pacemaker (PM). However, inferences are made about a similar treatment (TENS) and the effects on cardiac pacemakers or implantable cardiac defibrillators (ICDs).
It is possible that devices that use electrical stimulation, such as TENS or FES, may interfere with a PM or ICD. This can include administering extra shocks or preventing shocks from occurring altogether. It appears that the risk is higher when the machine’s electrodes are placed closer to the thoracic wall or the site of device implantation and lessens as they are placed further from this site. The settings used on the machine may also have implications on the risk associated with a PM or ICD.

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