Anatomical Concepts (UK)
Masters of Rehabilitation Engineering
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How much does an FES cycling system cost?

One of the first questions that potential FES cycling system owners might want to know is how much does a system cost?  I guess from a potential client’s point of view there is not a lot of point in finding out about all the features and benefits if the cost is out of reach.  In this article I can give you some guidance on the approach to pricing we apply to our RehaMove FES Cycling range. 

Although pricing will obviously depend on the exact specification of a system, I can do my best to explain some of our thinking at Anatomical Concepts. We haven't set out to offer the least expensive or the most expensive FES bike and ultimately you will judge for yourself whether we offer good value.

Pricing
Purchasing an FES cycling system involves a significant expense - for a RehaMove 2 system the price is typically between £10,300 and £11,400 (excluding VAT) at the moment for a version that supports leg and upper body exercise.  There are specific versions for young children and for intensive care use but 95% of our clients will find that the above prices apply.  Most clients won't have to pay VAT due to their medical condition.

There is a “favourite option” for our system called “Sequence Mode” that offers the freedom to use the FES component independently from the bike. This adds a few hundred pounds to the cost but can be a very powerful addition for some people who want to augment other forms of exercise with FES.  There are some other options but they are generally needed to enable easier use of the product and we don't tend to add extra for these options.

RehaMove FES Cycling system

The RehaMove FES Cycling system
Our FES Cycling system is built on a combination of two products - the popular Reck MOTOmed Viva2 unit from Germany and the RehaStim FES unit from Hasomed.  This cooperation has a resulted in a product called the RehaMove which is now sold in many countries around the world.

In the UK we collaborate with the Reck dealer, Medimotion Ltd who provide sales and support for the conventional Reck products and we offer the FES-enabled, RehaMove systems.  If you contact us for a MOTOmed only we will always connect you to Medimotion.

This collaboration has had the benefit of allowing many persons who first of all bought or rented a MOTOmed Viva2 to upgrade their unit to full FES Cycling capability (for around £6,600 at the time of writing.)

We would expect that you want to explore all possibilities to make sure that you make the best purchase decision for your personal situation.  At the moment, as exchange rates of the Euro against the UK Pound are not in our favour, there is likely to be some uncertainty about pricing moving forward.  If you need current details we always provide a detailed quote following an assessment.

Operating philosophy
One of our operational principles is that there are no perfect products or technologies. It is entirely possible that you might prefer another FES Cycling solution to the one we offer. If that is the case, it is to your advantage that you learn this as quickly as possible.  We will never pretend that we are the only possible providers of FES cycling systems and we suggest that you carefully research the best solution for you.

When we quote a price we will always include all hardware, software, shipping, initial training and follow-up costs. The reason for bundling everything together in this way is that we believe we are offering a solution rather than just a product.  In other words, the way we provide advice, assess clients, setup a system, follow-up and train people is just as important to us (and when you think about it especially to you) as the product.  

We tend to favour direct follow-up contact with clients via a therapist or competent person when it comes to long term support for the RehaMove system.  

The RehaMove system doesn’t offer internet support for remote adjustment of FES settings.  This may be a good (if expensive) option for some people, however from the beginning we have preferred a different approach with a “human touch”.  We have always felt that making adjustments to stimulation settings was best done via personal supervision.

This might amaze some people that know how much of a technology advocate I am, but we have generally favoured a two pronged solution - one that doesn't create a dependency on ourselves to make adjustments but allows for some coaching input and support when this is needed.

We have had hundreds of clients that have learned they can safely and effectively make stimulation adjustments for themselves.  At the same time, we understand that a lot of individuals like the fact that having a person visit to make adjustments can work really well as it provides that detected, objective, human touch - an element of effective coaching perhaps.  Sometimes a personal visit is a necessity when something has changed clinically; or a client needs a carer to operate a system and their previous carer has moved on.

Again I would encourage any client to consider the total package they need and not just the features and benefits of the hardware.

Historical perspective
I will come back and explain a bit more about our approach shortly but first It may help to give a bit of history to how we got involved in this area.

Some 10 years ago, we started to work with the RehaMove FES cycling system after an approach by the then clinical director of the Scottish Spinal Injuries Unit, David Allan. They had been amongst a number of international research groups working with FES Cycling at the time. They had been involved in research with the University of Glasgow and University College London which clearly showed the value of this technology for a range of neurological conditions.  

As you are probably aware, with spinal cord injury, for example, there are many well-evidenced positive benefits from using FES Cycling such as improved long-term cardio-vascular fitness, preserved bone density, reduced risk of pressure sores and so on.  Following the research, the next logical step was to make the technology available to the people who could benefit from it.  The research group’s commercial partners, Hasomed GmbH from Germany, were looking for ethical representation in the UK and they found us.  

My academic and research background has taught me that fashion and trends have an impact on rehabilitation

My academic and research background has taught me that fashion and trends have an impact on rehabilitation

At this point we were convinced of the clinical benefits of FES Cycling but we were not at all sure that we would actually ever sell any systems.  I had personally been involved in applying FES in the 1970’s when I was involved in my PhD research and again when working in children’s neurorehabilitation in Canada in the late 70’s and early 1980s.  However, applying something in research and having individuals using the ideas successfully at home is always a bit of a leap.  So often it does take a few decades to get right!

I could instantly see that the ability to fund the purchase of an FES bike might be a barrier to adoption.  In addition to this, I had some concerns about whether people would actually continue to use their RehaMove systems for the long term.  Simply put, there are lots of people who purchase gym memberships but after a few months it seems they don't actually find the time to get to the gym on a regular basis.  We hated the idea of people buying expensive systems they would never use.   Thankfully, we have found that many FES Cycling users actually are strongly motivated to use these products and so do continue to invest in their use for the long term.

We were not the first onto the UK market with an FES Cycling system.  Cyclone, representing the Restorative Therapies products from the USA, had already introduced the products to the UK market and these were doubtless being adopted by those recovering from trauma by the time we came along.

Who uses an FES Cycling system?
The majority of FES Cycling systems are still purchased today as a result of insurance or medico-legal claims and whilst this is obviously great for these individuals, unfortunately we know that literally thousands of persons who could benefit from access to this technology probably are not able to get easy access to it.  People recovering from Stroke, or who are managing MS, Parkinson’s and many other conditions can really benefit from FES Cycling technology but the likelihood is that a majority of people in this situation will not have the personal resources to purchase a bike for themselves.

There are a remedies to give broader access including having a number of FES bikes available in the community for individuals to use. Companies might also offer rental or hire purchase models.

In our case, we have a number of clinical partners who do have access to our RehaMove system in their facilities and it is certainly possible for many more persons now to access these bikes via this growing partner network on a “pay as you go” basis.  

Our general view about this is that our partners should not charge an inflated “extra” premium for allowing individuals access to an FES bike. If you are visiting one of our partners for a session they probably will not be focusing on a particular product anyway - in rehabilitation everything should focus on the client’s particular need at that time not on one or other product.  However, if a client has been properly assessed and is cleared to use these bikes it certainly provides a way to “try before you buy” for a while.  We never pay our partners a commission for a RehaMove system so it provides an ethical firewall between the assessment and sales process.

As I said above, we are solution providers and we try to wrap the best knowledge and know-how around our products so that people who engage with us get great results.  For this reason we are linking with therapy practices who are willing to work with us and share our values.

We have seen in the last few years some growth in the adoption of these bikes by the NHS for neurorehabilitation.  For best results, regular and early access to this technology is recommended and in some situations even though FES bikes are in place, access might be restricted because of overall staff resource limitations.  

Of course some individuals who have had catastrophic injuries and no insurance funding do manage to access alternative sources. Some clients have fund-raised for bikes and some charity involvement has provided individuals with help.  Companies and trade unions have stepped forward to help out employees and members. The Regain Sports Charity have engaged with us in re-purposing second hand FES Cycling systems on a few occasions. As one example, they were able to support Drew Graham who became quadriplegic in 2014 and Drew is working to establish a “pop-up gym” in the North East of England. Drew is one of a number of individuals committed to providing lower cost access to rehabilitation technology including FES bikes like the RehaMove see https://www.gofundme.com/popupgym

In some areas it has been possible for a few clients to access funding via their health authority but it is fair to say that growing pressures on the NHS means that the burden of proof to show clinical value to the individual is set quite high.  Unfortunately no one ever complained that they got too much rehabilitation in hospital. In the short term, home based, or community based provision of FES cycling seems to be the way forward.

Derek Jones

For more technical details of the RehaMove system see https://www.fescycling.com

This short video shows a RehaMove in action

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