RehaMove – Motion Training with Functional Electrical Stimulation (FES)

What is RehaMove?

RehaMove is an FES Cycling system that allows individuals with weakness or paralysis of the legs to actively cycle a stationary bike, by stimulating the muscle with a small electrical current.

Active cycling means the individual will use their own muscle power to create force. By activating the muscle, the patient will receive immediate benefits through improved muscle tone, increased strength, reduced spasm and better circulation, alongside the many long term benefits of light cardiovascular exercise.

The RehaMove system combines the expertise of our FES stimulator "RehaStim2" and the respected RECK system, MOTOmed. The RehaMove is also available with an Upper Limb hand crank and software modules for upper body exercise.

What does RehaMove do?

RehaMove combines sophisticated FES technology with a reliable bike system to enable active exercise for people with weak or paralysed limbs.

The RehaMove has 8 channels to stimulate up to 8 muscles with attached electrodes. Electrodes (flexible, sticky pads) are placed over the muscles you want to activate and connected to the stimulator. The stimulator then sends a safe and controlled amount of electrical stimulation to the muscle, enabling it to contract.

Once you begin a training program, the system detects the position of the foot pedal (or hand crank) and stimulates the correct muscles in the correct sequence to produce a fluid cycling (or cranking) movement. Where the patient cannot yet power the bike actively for the whole rotation or training session, the bike will sense the assistance required within seconds and assist with motor power.

Like all physical training the muscles will adapt and require more challenge. Once the patient’s muscles can actively cycle for the desired training time you can increase the difficulty by raising the gear of the bike, therefore providing resistance to cycle against.

What are the benefits of RehaMove?

The main benefits of using RehaMove are the huge short and long term health impacts. These include but are not limited to:

  • Improvement of cardiovascular system
  • Preservation of plegic muscle structure
  • Functional recovery of paretic muscles
  • Prevention of secondary diseases
  • Relax muscle spasms
  • Increases local blood circulation
  • Maintain/building musculature
  • Improve muscle coordination

The system can be setup for use my multiple users. There are no limits to the number of users or programmes so you can have as many clients on the software as you wish.

The system can store multiple training programmes per user. Once you have setup a programme you can save it under a unique name for immediate and quick start at their next session. Multiple programmes give you choice, adaptability and variety.

Once familiar, a user can be setup and working in a matter of moments! This gives you the ability to maximise your therapy time by supervising and instructing additional patients, setting up new tasks, completing admin etc.

The system has 8 channels, allowing you stimulate 8 muscles simultaneously. This means, for example, you can stimulate both the upper and lower leg to create a smooth cycling motion, or choose to add in glutes or abdominals with the upper leg for additional benefit.

Sequence mode software brings unlimited possibility. With the addition of sequence mode software, the RehaMove stimulator can be used independently from the MOTOmed. It can be used to activate single muscles or programmes to assist in exercises such as the ‘Sit to Stand’ or in shoulder stabilisation. There are multiple inbuilt safety mechanisms for peace of mind. If i client is working on their own you needn’t worry about their safety. The system has a safety Stop button to immediately halt the programme and inbuilt cut offs e.g.. if an electrode becomes disconnected.

The system has a small blueprint and easy to move. When not in use the RehaMove can be stored safely out of the way and easily rolled back into position when needed.

You’re a leader! FES Stimulation is widely recognised and praised for its excellent health benefits. By adopting the RehaMove you show your willingness and interest in future health technologies and your commitment to your patients rehabilitation and long term health.

The system can be set up for one user. The software will start showing only your profile options. Training starts with the push of a button. Once your electrodes are in place training can begin with a single click! You don’t have to worry about adjusting settings or parameters each time. The system can store multiple programmes to include different muscle groups. You can setup as many training programmes as you like e.g.. adding in glutes / abs. This means you can work on a different training programme each session introducing a but of variety! The system has a small blueprint and easy to move. When not in use the RehaMove can be stored safely out of the way and easily rolled back into position when needed.

How does RehaMove work?

In order to best understand how RehaMove works, it is important to know the basics of FES (Functional Electrical Stimulation) and its function in the system. FES is when low level electrical impulses are sent through muscles, usually by electrodes, in order to stimulate and contract the weak or paralysed muscle. Effectively the FES replaces the signal from the brain that travels through the spinal cord and stimulates the muscle into action. It is more effective than simply using passive motion as the muscle tissue itself is activated, bringing with it a host of benefits.

Why integrate FES with the MOTOmed?

Countless patients have experienced the health benefits of consistent use of the MOTOmed, particularly in its ability to assist when little or no power can be given by the patient. An opportunity was seen to integrate FES technology - mixing the technological expertise of electrical stimulation from Hasomed with the intuitive and assistive power of the MOTOmed - and the RehaMove was born.

Both Hasomed and RECK have been committed to refining the system over the last 10 years and will continue to ensure it consistently exceeds expectations and remains a leader in FES rehabilitative technology.

Seamless, functional integration

The FES stimulator is programmed to know the exact position of the pedals or hand crank at any time. It assesses which muscles should be activated in order to complete the movement and sends stimulation (based on therapist parameters) at exactly the right timing in order to produce a smooth cycling or cranking motion.

At the same time the MOTOmed is measuring the amount of power the patient is providing to produce the movement. If the patient fatigues, the MOTOmed will give assistance by taking over with the motor. This is measured on a moment to moment basis, so, if the patient recovers the MOTOmed will back off and allow the patient to actively cycle again. The stimulator has a variety of displays to let you see patient performance and make program changes in real time.

At the end of the training program you will see a results screen. Over time this becomes an excellent tool to assess progress and make considered changes to the parameters. To further assess training results, you can download all data to a USB key and see in great detail a variety of progress parameters using PC Software provided.

The First Session

Once the patient has been set up as a user, you can begin to create training profiles. On creating a new profile you can select whether it is a unilateral or bilateral training program, whether the stimulation is constant or adaptive, and whether to use a premade training template or to create your own. This gives you extensive control over the type of training.

Assuming you select a program template, you can place the electrodes on the patient as indicated by the diagram on screen, and connect them to the color coordinated cables. One by one, you test the stimulation you want to be delivered to the muscles. By turning the knob on the stimulator you can slowly increase the stimulation until you see and feel the desired contraction in the muscle. Once this has been completed for each muscle you can start the training.

You can wake the MOTOmed at this point by pressing the start button on its interface, then begin training from the stimulator. We always recommend a period of passive cycling before turning on the stimulation to allow the muscles to warm up. When stimulation begins, the stimulator will sense which position the pedals are in and begin to stimulate the correct muscles in order to start active cycling. The stimulation is based entirely on the position of the pedals to maintain a smooth cycling motion.

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Who can use RehaMove?

Patient Use

It can be used wherever there is a weakness or paralysis of the muscle, as long as there are no contraindications for use. We have a number of available for your interest. Increasingly, many patients purchase a RehaMove system for home use - with and without continued supervision by a clinician.

RehaMove is widely used by patients:

  • following spinal cord injury
  • following stroke
  • following TBI (traumatic brain injury)
  • with Multiple Sclerosis (MS)
  • with Parkinson's Disease
  • with Amyotrophic Lateral Sclerosis (ALS)
  • with Chronic Polyarthritis (Rheumatoid Arthritis)
  • other neurological challenges

Clinician Use

RehaMove is used extensively in hospitals, rehabilitation units, private clinics and in the community by clinicians, Physiotherapists, Occupational Therapists and more to enhance the recovery and long term care of their patients. There is extensive Research into the use effective use of RehaMove in different environments available.

Contraindications

We know there is no perfect product and the RehaMove system may not be suitable for everyone. As such there are a number of contraindications and considerations that should be addressed before a trial of the system. The majority of these contraindications are most specific to those patients with spinal c injury but are applicable across the board.

When should FES and the RehaMove system not be used?

  • patients with epilepsy
  • patients with known allergies to electrode gel
  • patients with metal implants directly underneath or near the muscle groups which are to be stimulated
  • pregnant women – the possible adverse effects of stimulation are unknown and have not yet been rigorously investigated
  • contractures that are severe enough to prevent cycling motion of the legs
  • severe osteoporosis (thin, weakened bones)

Extra considerations

  • People who use cardiac pacemakers (depending on type - most modern designs are fine)
  • People who have a history of leg fractures
  • People who have severe spasticity. Moderate spasticity is often helped by this exercise although it make take up to 3 months for the benefits to be apparent.
  • People who have experiences autonomic dysreflexia

How is RehaMove used?

The RehaMove system is available in a number of configurations to offer the widest range of training options for your patients needs. In its basic form RehaMove can be made available as lower or upper body training.

RehaMove_FES-Cycling

Lower body training

The lower body training modules allow the active exercise of the legs through a number of unilateral and bilateral training programmes.

Hasomed

Upper body training

The upper body training modules allow the active exercise of the arms and shoulders through a number of unilateral and bilateral training programmes.

Sequence Mode

When sequence mode is included the FES stimulator can be used independently of the MOTOmed. It can be adapted to augment the use of other exercise equipment, and assist with common therapy exercises including Sit to Stand exercises, FES Walking and FES Rowing. When sequence mode is included the FES stimulator can be used independently of the MOTOmed. It can be adapted to augment the use of other exercise equipment, and assist with common therapy exercises including:

  • Sit to Stand exercises
  • FES Walking
  • FES Rowing

What is the science mode of RehaMove?

RehaMove3 is a medical device for scientists. It is controlled via serial interface with a precompiled C-library (download file at the media center below). This allows flexible control of the device. The control can be carried out via script languages (C, C++, Python, MATLAB etc.) or via graphical programming systems (LabVIEW, Simulink etc.). Scientists can define various stimulation patterns.

RehaMove3

Specifications

Mobile

  weight: 280 g, rechargeable battery
small (50 x 73 x 32 mm)
powerful (4 channels up to 130 mA)
stimulation unit

Fast

  High performance of commands
Minimal latency

Feedback

  Electrode error detection
Battery state

Full control

  Full control over stimulation parameters
Each channel can be configured with individual current: ± 130 mA, pulse width: 20-16000 µs, frequency: 1 - 500 Hz and pulse form: 1-16 points. These values depend on active channels and settings of other parameters.

Easy integration

  Easy integration into your application
Uses a virtual serial port interface (FTDI)
The provided C-library can be interfaced from most programming languages and is available for the most common compilers and platforms.

RehaMove communication protocols

Low-Level
Define individual stimulation pulses, which has to be triggered by the user.

RehaMove 3

Mid-Level
Stimulation pulse is initially defined and repeated with a fixed frequency till an update is made or the treatment is stopped.

RehaMove 3

Research with RehaMove

ScienceMode3 protocol is unique and has a broad range of applications for scientists around the world. HASOMED likes to promote innovative applications for clinical use.

RehaMove3

CONTACT FOR RESEARCH APPLICATIONS

+49 391 610 76 45

This device is part of a project that has received funding from the European Union‘s Horizon 2020 research and innovation programme under grant agreement No 644721.

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How can I get to know RehaMove?

Medica 2019: Innovative HASOMED medical devices at the World Forum of Medicine

The UN forecasts a world population of more than 9.7 billion people by 2050. A challenge for medical care and a task that physicians and manufacturers of medical technology can master together. Medica 2019, World Forum of Medicine, creates the link between medicine and medical technology, present and future. HASOMED is there.

May
2
Sat
2020
CYBATHLON – moving people and technology @ SWISS Arena
May 2 @ 9:00 – May 3 @ 18:00
  • Races in six disciplines
  • Two-​day competition, attractive supporting programme and scientific symposium
  • The Italian team POLIMI RehaMove participates on behalf of the Politecnico di Milano in the category FES Bike teams.
Nov
16
Mon
2020
Medica 2020 @ Convention Center Düsseldorf
Nov 16 – Nov 19 all-day

Medica is the largest international trade fair for the medical industry. More than 5000 exhibitors from all over the world present innovations for outpatient and clinical care, supplemented by forums and specialist lectures, in Düsseldorf, Germany.

What are the most frequently asked questions about RehaMove (FAQ)?

Medical questions

FES is a therapy method where nerves are stimulated with electrical current in order to cause a muscular contraction. The aim is to produce a functional movement.

TENS

  • stimulation of blood circulation, muscle relaxation and pain reduction
  • no or low physiological contraction/movement
  • no building up muscle strength
  • no complex stimulation

Usual devices for electrotherapy

  • only few channels
  • no complex functional movement

Advantages FES with RehaMove

  • stimulation of functionals movements
  • motorlearning and call up of neuromuscular patterns
  • cycling due to connection with the MOTOmed
  • external trigger (cause stimulation via manual switch)
  • different training options: sequens, adaptive/constant mode
   Current   Frequency   Pulse   Main Application   Indication 
 FES with
 RehaMove 
 Alternating 
 Current
 (AC) 
 10-50 Hz  20-500 µs   Maintenance of muscle function or limitation of athropy   Movement disorders after SCI and central lesion 
 Galvanisation   Constant current and direction       Iontophoresis: improvement of motor excitability etc.   Arthrosis, Spondylosis, Tendinosis, Ligamentosis, Neuralgia, etc.
 Russion stimulation   Alternating current (AC)  2,5 Hz  Rectangular pulses in "bursts" (pulse sequences)     
 TENS   Stimulation current with weak AC   2-220 Hz   Monophasic or biphasic pulses 50-200 µs   Especially used for pain treatment (Analgesia)   Chronic, causally untreatable pain 
 Diadynamic currents   Currents with direct current (DC) and pulse current proportions   50-60 Hz   Sinusoidal half-waves, pulse width 8-10 ms   Analgesic, anti-inflammatory, reducing nerve pain, etc.   Rheumatic diseases, pain, Sudeck's Atrophy in case of disuse atrophy 
 Faradic current   Low-frequency stimulation currents (rectangular pulse)   40-80 Hz   Width: 0,5-5 ms, monophasic or biphasic   Motor stimulation   Normally innervated, weak muscles, mild paresis
 Exponential current   Rectangular pulse with pulsesof increasing intensity   < 1000 Hz   100 ms - 800 ms   Maintenance of muscle function or limitation of atrophy  Completely denervated muscles

Sources: Bossert (2006) Guideline Elektrotherapy; Robertson et al. (2006) Electrotherapy explained-Principles and practice

FES Cycling

  • Physiological muscle activation with high training intensity
  • Strong effects on the cardiovascular system by using the major muscles of the body
  • High neuronal input by stimulation a high number of afferences
  • Severe aspects: muscle buildup
  • Physiological effect: patients can "use" their arms and legs again

Motion training without FES

  • Passive movement of paralysed muscles, thus only low or no physiological activation
  • generally applicable in lesions with an intact lower motoneuron
  • Spinal cord injury
  • Stroke
  • Traumatic brain injury (TBI)
  • Multiple sclerosis
  • Guillain-Barré syndrome
  • Parkinson's disease
  • Chronic polyarthritis (Rheumatoid arthritis)
  • Cerebral palsy
  • ALS (Amyotrophic Lateral Sclerosis)
  • Orthopaedic diseases
  • Muscle weakness and paralysis due to
  • Impairments of the peripheral nerve

[Note: Patient‘s individual physical constitution or contraindications may forbid an FES application. Please consult your doctor before!]

  • generally every paralysed muscle with an intact lower motoneuron
  • the surface of the muscle must be large enough for electrode placement

FES and the RehaMove should not be used by a few people:

  • who use cardiac pacemakers
  • with unhealed fractures in lower extremities if the legs shall be trained; in upper extremities, the area of the shoulder girdle and upper ribs if the arms shall be trained
  • with damages of the rotator cuff or the potential luxation of the shoulder joint, if the arms shall be trained
  • with epilepsy
  • with known allergies to electrode gel
  • with metal implants underneath or near the muscle groups which are to be stimulated
  • pregnant women should desist from using stimulation because the possible adverse effects are unknown
  • and have not yet been rigorously investigated
  • depending on the patient, the clinical picture, and the training aim
  • patient should be able to get used to the therapy
  • training start: 5-10 minutes as the muscles are untrained and fatigue quickly
  • up to 1 hour training per day is possible when training regularly
  • higher therapeutic effect when training 3-4 times per week for 30 minutes
  • Electrical pulses activate the peripheral motor nerves leading to the corresponding muscles.
  • Pulses pass between two electrodes and thus activate the nerves between the electrodes.
  • Each nerve has a particular threshold (all-or-nothing principle) triggering an action potential.
  • Activation can take place when stimulation intensity is high enough (increase pulse width or current) in order to exceed this threshold.

Innervation:

  • supply the human organism with nerves for stimulus conduction
  • intact connection between nerve and muscle

Denervation:

  • no intact nervous connection between organ/ muscle and brain

Disuse atrophy:

  • muscular atrophy

Afference:

  • all information are transferred via neuronal afferences from the periphery (arms, legs) to the central nervous system (CNS)

Afferent stimulus setting:

  • conscious and arbitrary muscle activation in order to produce a directed movement

Reafference:

  • information from the central nervous system to the periphery

Muscle tone:

  • tension of the muscle
  • can be infl uenced by the number of activated motor units or by excitation frequency
  • higher muscle tone in case of spasms
  • muscle tone depends on malpositions and contractures

Spasticity:

  • increased muscle tension with increased muscular proprioceptive reflex

Adduction:

  • movement towards the center of the body or towards body axis (e.g. foot lifting)

Abduction:

  • lateral movement of a body part

Technical questions

  • in general: the bigger the electrode the better (more comfortable for the user due to a lower current density)
  • electrode size depends on the area of the muscle to be stimulated: for small muscles it’s recommended to use small electrodes and the other way round
  • electrode forms: oval or rectangular
  • centrally on the muscle belly
  • for a higher therapeutic effect, electrodes have to be placed with a handbreadth between them
  • shave if necessary to improve electrode adhesion and skin contact
  • due to guarantee and warranty claims we recommend the use of HASOMED electrodes
  • adhesive electrodes of the company HASOMED can be used for up to 15 applications
  • application note: adhesive electrodes should not be used on skin where e.g. body lotion has been applied
  • stimulation with biphasic rectangular pulses
  • the negative pulse ensures an active disloading to prevent electrolytic effects or skin irritations
  • stimulator and MOTOmed communicate via data cable
  • data exchange of all relevant parameters (angle or position of the crank arm, rpm and rotational direction, symmetry, gear, time, distance)
  • stimulation sequences of controlled channels are triggered by angle-based MOTOmed data; thus, the stimulator “knows” when to stimulate which muscle

RehaMove

Frequency

  • number of pulses per second, indicated in Hertz (Hz)
  • stimulation frequency determines the type of muscle fi ber, which is activated, and which muscular strength is achieved
  • optimum frequency for a muscle depends on the individual distribution of muscle fi bers
  • if the frequency is set too low, the muscle reacts only with twitching without strength
  • between 10-50 Hz

Current

  • charge flowing per time, measured in Milliampere (mA)
  • between 0-130 mA
    alternating current is used (balanced charge)

Pulse width

  • duration of pulses, measured in Microseconds (μs)
    between 20-500 μs
  • generally depending on the clinical picture of the patient
  • start with low values and carefully increase gradually
  • aim: a smooth and powerful contraction
  • in case of spasticity, better use less Hz fi rst to avoid an excessive increase of the muscle tone (up to 30 Hz)
  • it’s advisable to massage muscles before training to desensitize them, longer warm up phase
  • in case of maintained sensitivity: the tolerance limit of the patient is the limit of stimulation (after familiarization phase, intensity can generally be increased gradually)

Complete SCI

  • Current: 40-90 mA
  • Pulse width: 250-500 µs
  • Current test starting with 0 mA/250 µs
  • MOTOmed: servo cycling with gear 0-1

Stroke, TBI and spinal cord lesion with (residual) sensibility

  • Current: 30-40 mA
  • Pulse width: 100-300 µs
  • Current test starting with 0 mA/100 µs
  • MOTOmed: servo cycling with gear 0-6
  • for strength training higher frequencies are necessary (starting with 30 Hz)
  • for endurance training only lower frequencies are used (up to 30 Hz)
  • Type of muscle fiber:

Type I fibers slow twitch

    • contract and relax slowly
    • resistant to fatigue
    • for endurance-type activities
    • well supplied with blood: red
    • stimulation with frequencies < 30 Hz

Type II fibers fast twitch

    • quick and powerful contraction
    • white muscle fibers
    • for "sprint" and muscular strength
    • 2 subtypes:
      • fast-fatigue-resistant
      • fast-fatigable
    • stimulation with frequencies > 30 Hz
  • pulse width is built slowly and gradually
  • especially suitable for sensitive and anxious patients
  • example: ramp 5; pulse is built in 5 steps with increasing intensity
  • depends on the patients adapting threshold and sensitivity
  • during training, current can be adjusted for each channel; frequency and pulse width can be
  • adjusted for all channels

only use the RehaStim2 with the MOTOmed viva 2 (without light version) as arm and leg trainer

  • in general: therapist decides on the patient group to be treated
  • adaptive training: adapts automatically to the patient’s performance
  • stimulation is adapted to the residual muscle function of the patient
  • mostly used in incomplete and central paralysis: stroke, TBI
  • adjustment of maximum and minimum pulse width:
    • when a certain speed is reached, stimulation will stop slowly
    • stimulation starts again below this speed
  • in general: therapist decides on the patient group to be treated
  • constant training: stimulation intensity remains constant even if the patient pedals faster and more powerful
  • mostly used in complete paraplegia

Sequence training with RehaStim

  • RehaStim can be used without the MOTOmed as stand-alone device
  • cyclical movements of arms and legs can be trained (e.g. grasping, flexion)
  • for activation or movement of single muscles
  • in order to increase training intensity, e.g. alternating activation of quadriceps muscle and biceps muscle
  • Sequence training is used where the RehaMove cannot be applied, e.g. when reinitiating complex motion sequences like grasping
  • RehaStim includes templates for the most common applications e.g. FES walking, crawling, sit-to-stand or shoulder stabilization

Complete SCI

  • Current: 40-90 mA
  • Pulse width: 250-500 µs
  • Current test starting with 0 mA/250 µs
  • MOTOmed: servo cycling

Stroke, TBI and spinal cord lesion with (residual) sensibility

  • Current: 30-40 mA
  • Pulse width: 100-300 µs
  • Current test starting with 0 mA/100 µs
  • MOTOmed: servo cycling with gear 0-6

Can be activated via additional licenses for present stimulators.

  • percent sequence training includes all templates for gait training/FES walking in percentage according to the natural gait phases in a complete gait cycle
  • second sequence training includes templates in seconds (start + duration of each single muscle in seconds)
  • duration of the complete sequence is adjusted
  • periods are adjustable in seconds
  • there is always a break between single sequences
  • break times can be selected in steps of one second
  • Sequence training offers a manual or automatic triggering
  • an additional external trigger software with external single or double trigger is available

Media Center

  • RehaMove

    Catalog with complete overview

  • RehaMove

    Information sheet - The aims of the therapy, settings & training forms

  • RehaMove

    Flyer: Overview of functional electrical stimulation

  • RehaMove

    Therapy overview

  • RehaMove

    Studies

  • RehaMove

    Videos

Dates

FAQ

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