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Seven Reasons to Add Stim2Go to the Bike You Already Own After Spinal Cord Injury
Many people have a motorised passive-active bike at home. They use it for a year or two, usually a MOTOmed or a THERA-Trainer, and they use it most days. Their legs go round. The question is whether their legs are getting anything from it beyond going round, and whether the electrical stimulation they saw on the bike in the spinal unit gym could ever come home.
Passive cycling does beneficial things, and adding synchronised electrical stimulation provides a measurable step on top. And the part that has changed recently is that the stimulator no longer has to arrive bolted to a new bike. For many years, we worked with the RehaMove system, which integrated an 8-channel stimulator with a version of the MOTOmed bike. We were always aware that the total cost of the system meant that many people could not adopt it. And as the stimulator needed to communicate directly by cable with the bike, we were restricted to one or two models of MOTOmed. Why should they give up the bike that they were already using and replace it with one that happened to support FES cycling?
Things have changed now with the arrival of Stim2Go. The bike you already own, whatever the make, is the awkward part of an FES cycling system, and you already have it. Let's see whether adding Stim2Go would be worth it.
Two Levels at Once: Stimulating the Neck and Lower Back Together
Stim2Go from Pajunk is proving a very popular system for electrical stimulation due to its flexibility. In addition to supporting FES Cycling, it boasts many novel applications and the ability to create custom applications. Amongst its programs, there have been a number of transcutaneous spinal cord stimulation (tSCS) applications. Up until now, these were typically utilised to target severe spasms or pain.
We're getting to grips with some new cervical tSCS programs and two combined cervical-lumbar tSCS programs. These place one electrode on the neck and another on the lower back, and run both in the same 20-minute session. It is in beta testing, available under European and UK medical device rules only, and not cleared in the United States. I want to walk through the idea behind this configuration and what the human evidence shows.
The Stages of Electrical Stimulation: A History in Seven Turning Points
Over roughly 250 years, therapeutic electrical stimulation has jumped to a new level perhaps seven times, and each jump was made possible by a new technological development. It might have been a way of handling current, storing it, generating it, shaping it, measuring it, timing it, or using it to tune the nervous system rather than drive it, and finally today triggering it from the person's own movement or intention. These are the stages I allude to in the title.
The first stimulator I worked with, as a PhD student in the late 1970s, filled a good part of a laboratory bench and needed someone who understood it standing beside it. The Stim2Go electrical stimulation device I carry to homes or clinics now is the size of my hand. It can be strapped to a client's thigh, senses when they start to move, and is set up from an app on my phone. Both deliver a pulse of current to a nerve. Almost everything else about them has changed.
Heel Protection for the Plus-Size Patient: What the Guidelines Do Not Say
You might expect the guidance on pressure ulcer prevention to have plenty to say about protecting the heels of larger patients, but that is not the case. In this article I want to show where the guidance goes quiet, what the research evidence really says about body size and heel ulcer risk (it is not what most people assume), and how I suggest thinking about the problem instead: as a question of equipment fit rather than a question of risk scores.
A note on language before we start. Following the Obesity UK "Language Matters" guidance, I use person-first phrasing for people, and I keep the word "bariatric" for equipment, pathways and products, where it remains the standard term. In manual handling circles, "plus-size" is the preferred word for the person, and I follow that convention here.
Pressure and Shear: What the Words Mean, and Why Living Tissue Makes It Complicated
Clinical guidelines name pressure and shear as the cause of pressure ulcers, but rarely explain what the words mean. Drawing on thirty years in rehabilitation engineering, I unpack pressure, shear, stress and strain in plain language, show why the skin check can look normal while damage develops over the bone, and explain why the heels are so vulnerable. This one of our longer articles.
Spasticity and Muscle Spasms: A Plain English Guide for People Living With Them
When I demonstrate an FES cycling system, spasticity is usually in the room before I have finished setting up. A leg that will not settle onto the pedal. A knee that pushes out straight at the wrong moment. A foot that starts bouncing the instant it takes any weight. The person in the chair rarely calls it spasticity. They say their legs have a mind of their own, or that everything goes rigid when they transfer, or that the spasms wake them at three in the morning. The clinical word comes later, if it comes at all.
This article is for the person who has just been introduced to that word, or who has lived with the thing itself for years without anyone quite explaining it. I want to cover what spasticity and spasms actually are, why they happen after a spinal cord injury, a stroke or with multiple sclerosis, what they do to daily life, and what genuinely helps, from medication through to electrical stimulation. I will try to be clear about what the evidence shows and what it does not; if different people have told you contradictory things, that is partly because the field itself contains genuine uncertainty.