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Functional Electrical Stimulation (FES) and its clinical use with our Ekso Bionics Exoskeleton

What is FES?

Functional Electrical Stimulation is a technique that makes use of low energy electrical impulses to artificially produce body movements in individuals who have been paralyzed due to some sort of Central nervous system insult. It aims to close the feedback loop within the central nervous system. It is aimed at individuals with spinal cord injuries, stroke, and other neurological conditions causing lower extremity weakness.

The benefits of using FES?

  • It allows earlier mobility.
  • It can provide muscle stimulation to individuals who may already show signs of existing muscle activation.
  • It increases the rehabilitation spectrum of individuals who can use it. (Pre-ambulatory to almost independent).
  • When used in combination with the Exoskeleton, it provides muscle stimulation throughout the gait cycle, aiming to correct any muscle imbalances.
  • We can utilise strength as well as endurance protocols in our walking programs, improving the depth of the therapy and experience.


Adjustability is one of the first practices in South Africa to be equipped with the FES component with our Exoskeleton. Our Biokineticists use it as a tool in our therapy, and we have seen the most benefits in combination with an exercise program.


Alliance of South Africa Independent Practitioners Association (ASAIPA) is an organisation that represents the interest of healthcare throughout South Africa. It allows independent practitioners to form and alliance with other practitioners that have similar interests.

ASAIPA hosts the National Medical Awards annualy , through these awards, they are able to recognize and acknowledge primary healthcare practitioners who exemplify the highest values of volunteerism, community engagement, leadership, innovation and dedication to their profession, community and to their patients.

Justin Jeffery was awarded the Primary HCP excellence award at the end of 2020 , and we could not be more proud to be apart of such and exceptional honour.



Adjustability In Times Of COVID

The world was taken by storm in 2020 by the COVID-19 pandemic. This resulted in the disruption of millions of lives and livelihoods, and impacted in particular on the health and wellbeing of individuals. The COVID-19 virus comes like a thief in the night, challenging social relations, personal appearance and confidence and one’s very treasured health. Some patients
that have experienced COVID-19 have reported changes in breathing patterns, fatigue and sleep pattern disruptions. This pandemic has interrupted active lifestyles and has made the importance of exercise and a healthy lifestyle ever so clear.

As such, a lot of research has gone into the role of exercise in post-covid recovery in order to get individuals back to their healthy selves or to a new state of health. Evidence shows that exercise can help to “improve fitness, reduce breathlessness, improve your energy and improve muscle strength”. Additionally, exercise can help to prevent blood clots and improve your mental health.

Although exercise is beneficial in the recovery after COVID-19, exercise should also be monitored by a professional as severe cases of COVID-19 impact very negatively on one’s health and can result in undetected complications. It is for this reason that “return to exercise guidelines” have been developed.

The image below is a “return to exercise guideline” developed by David Salman form the British Medical Journal.

If you have had COVID-19 and are struggling to bounce back to your old self or are still struggling with the after effects, please do not hesitate to contact your closest exercise specialist so that they can aid you in your post-covid journey.

Spinal Cord Injury

Traumatic spinal cord injury (TSCI) is a frequently occurring injury with an incident rate of 75.6 per million individuals living in South Africa and results in motor, sensory and autonomic impairments, as well as functional limitations, reduced independence and altered social roles. These injuries occur as a result of assault (60%), vehicular-related accidents (26%) and falls (12%), however little epidemiological information is available in a South African Context.

Typically, following TSCI, individuals are transported to the nearest trauma centre to undergo surgical interventions and initial phase inpatient rehabilitation. Unfortunately, the largest public-sector rehabilitation centre, situated in Cape Town, services only 40% of individuals originally admitted to the facility, leaving a large shortfall in the availability and access to rehabilitation services. As acute-phase and continued rehabilitation following TSCI has been shown to increase the individual’s independence, physical functioning and quality of life, this shortfall of service deliver has lasting implications.

Rehabilitation following TSCI is an intricate process consisting of three phases, namely the acute, subacute and chronic phases. These phases correspond with processes underlying neurorecovery, with the acute and subacute phases lasting generally 12-18 months post-injury, progressing into a period of plateaued neurorecovery, the chronic phase. The focus of rehabilitation varies throughout these phases, as highlighted below.

  • Acute and Subacute phases
    • Preventing secondary complications
    • Promoting and enhancing neuroregeneration
    • Maximizing functional capacity
  • Chronic phase
    • Promoting compensatory or assistive movements to overcome limitations in functioning

When considering the rehabilitation process following TSCI, it is important to consider the timing of the intervention, the intensity and duration of the intervention strategy, as well as individual characteristics.

Timing Intensity and duration Individual characteristics
Research shows that with a longer duration between injury and initiation of rehabilitation, the lower the gains in physical function. Therefore, a greater availability to quality rehabilitation promotes improved therapeutic outcomes. Numerous gait retraining protocols have been developed, however body-weight supported training has shown the greatest benefit. Functional Electrical Stimulation (FES), involving low-level stimulation of affected muscles, has shown to improve muscular strength and function. Numerous characteristics affect therapeutic outcomes, including the individual’s age, medical aid status and availability to resources, muscular compensation patterns and alcohol consumption following injury. Furthermore, the characteristics and severity of the TSCI will largely affect rehabilitation outcomes.

Considering the above, it is clear that rehabilitation interventions play an important role in maximising physical functioning and promoting healing following TSCI. Unfortunately, access to these intervention strategies is limited in South Africa.

Author details:

Sasha Payne
BA (HMS) Biokinetics (Hons)
ACSM Certified Exercise Physiologist


Joseph, C.; Scriba, E.; Wilson, V.; Mothabeng, J.; Theron, F. 2017. People with Spinal Cord Injury in Republic of South Africa- Country Report. American Journal of Physical Medicine & Rehabilitation. [Online]. 96(2), pp.109-111. [Accessed 31 January 2019]. Available at: Burns, A.; Marino, R.; Kalsi-Ryan, S.; Middleton, J.; Tetreault, L.; Dettori, J.; Mihalovich, K.; Fehlings, M. 2017. Type and Timing of Rehabilitation Following Acute and Subacute Spinal Cord Injury: A Systematic Review. Global Spine Journal. [Online]. 7(3S), pp 175S-194S. [Accessed 31 January 2019]. Available at: