P E D A L P O W E RFES Cycle for People with Traumatic Spinal Cord Injury

G E T M O V I N G .

Exercise is an important and powerful tool in rehabilitation and is vital for a healthy lifestyle. Exercising on cool equipment in a motivational atmosphere makes it all the more fun.

People with a traumatic spinal cord injury now have the opportunity to use a new state-of-the art FES cycle at the Mary Free Bed YMCA, a universally designed fitness facility for people of all abilities.

Functional Electrical Stimulation – FES – is a successful exercise technique that uses pulses of electrical current to stimulate nerves in paralyzed or weakened muscles to improve strength and stamina for those who respond positively to electrical stimulation. FES cycling can help:

• Reduce muscle atrophy• Increase local blood flow• Maintain or increase range of motion• Reduce spasms/spasticity• Re-educate muscles

Thanks to a generous grant from the Craig H. Neilsen Foundation, this new community FES cycling program at the Mary Free Bed YMCA is offered for eligible members.

I N T E R E S T E D ? H E R E ’ S W H AT Y O U N E E D :

1. Diagnosis of traumatic spinal cord injury

2. Medical clearance and signed physician referral (form at right)

3. Evaluation for appropriateness and program established by a specially trained physical therapist

4. Current YMCA membership (inquire about our financial assistance program)

Questions? Call 616.885.5931

F U N C T I O N A L E L E C T R I C A L S T I M U L AT I O N ( F E S ) C Y C L E P H Y S I C I A N C L E A R A N C E A N D R E F E R R A L

Physician’s name: ____________________________________________________  Date: ________________________

Mary Free Bed YMCA member/client name: ________________________________  Date of birth: __________________

Your patient wishes to begin an exercise program at the Mary Free Bed YMCA using the RT300-SL FES cycle. A signed referral/prescription from a physician familiar with the patient’s condition is required to order a physical therapy evaluation. Indications for FES cycling include:

• Reduce muscle atrophy• Increase local blood flow• Maintain or increase range of motion• Reduce spasms/spasticity• Re-educate muscles

Ideal candidates are those with upper motor neuron injuries (diagnosis of traumatic spinal cord injury) and positive response to electrical stimulation.

PLEASE REVIEW THE FOLLOWING:

Absolute contraindications

• Cardiac demand pacemakers• Unhealed lower extremity fractures• Pregnancy

Relative contraindications

• Denervated muscle in lower extremities• Severe spasticity• H.O./Limited Range of Motion• Severe osteoporosis• Dysaesthetic pain syndrome• Pressure ulcers or open wounds in area of treatment• Recently (<three months) implanted plates, pins,

screws and other hardware

Cautions

• Any implanted medical device • Suspected/diagnosed heart problems• Suspected/diagnosed epilepsy• History of uncontrolled autonomic dysreflexia• History of lower extremity stress fractures• History of severe spasticity/spastic response to FES• Recent surgical procedure (muscle contraction

may disrupt healing process)

Special considerations

• Orthostatic hypotension• Respiratory complications• Cancerous lesion• Infection in area of electrode placement• High fever, high blood pressure or high heart rate• UTI (may increase probability of autonomic dysreflexia)

PHYSICIAN CLEARANCE AND REFERRAL

Based upon the health status of (patient’s name): __________________________________________________________

r I know of no reason to rule out participation.r May proceed with the following restrictions/precautions/considerations: _______________________________________

_________________________________________________________________________________________________

Physician signature: __________________________________________________ Date: ________________________

Physicians: please fax this form, along with a Physical Therapy Evaluate and Treat for upgrading Exercise Program Including FES prescription, to Mary Free Bed Outpatient Scheduling at 616.840.9642.

YMCA.104.6.18

Mary Free Bed YMCA5500 Burton St. SE

Grand Rapids, MI 49546

616.885.5931grymca.org