Clinician FAQs

Restorative Therapies’ integrated FES incorporates functional electrical stimulation (FES) integrated with task specific or motor assistance/resistance activities to optimize therapeutic goals. Our proprietary software provides real-time biofeedback, data tracking and sophisticated control algorithms that are designed for a wide range of neurological impairments.

Traditional FES has been widely used for rehabilitation and motor recovery for over 50 years, demonstrating to further aid in restoring neurological function, gait training, and treatment of comorbidities or secondary health complications.

Integrated FES has been shown to reduce muscle disuse atrophy, improve local blood circulation, reduce spams/spasticity, as well as many other physical integrity and health benefits.

Many patients who have neurological impairments have a limited ability to engage in physical activity without assistance. Use of Restorative Therapies’ integrated FES systems provide a safe and effective means by which weak or paralyzed muscles can undergo progressive resistive exercise (PRE) so the patient can experience a multitude of therapeutic as well as positive health outcomes.

All our integrated FES therapy systems can be used with up to 12 channels of stimulation. Clinicians can choose muscle groups in the upper and lower extremities as well as the core.

Restorative Therapies systems provide 6 to 12 channels of electrical stimulation to maximize therapeutic outcomes and stimulate all of the major muscle groups.

More stimulation channels mean you can target more muscle groups at the same time and achieve a more efficient and comprehensive therapy session. The number of channels needed varies for individuals.

All of Restorative Therapies integrated FES systems allow the clinician to adjust FES parameters for individual muscle groups. This customization helps to ensure that even patients with full sensation can benefit from this therapy.

Training includes instruction on how to optimize FES parameters for best outcomes including patient comfort.

Yes, patients can experience autonomic dysreflexia with the use of integrated FES, especially if they have a spinal cord injury above the T6 level. However, this is often manageable or preventable through customization of stimulation and therapy settings.

When the stimulation initially ramps up, the patient may exhibit symptoms of dysreflexia. The clinician is able to adjust the stimulation in real-time while monitoring patient symptoms.

If the patient does experience symptoms of dysreflexia, the clinician is able to customize the patient’s program to help them accommodate to the stimulation to minimize symptoms in future sessions. With regular use, the body adapts to this stimulation and the symptoms of dysreflexia often resolve.

In most cases yes, however, a physician’s clearance should be obtained. Using integrated FES with an implanted device may also require special consideration for electrode placement.

Yes, however, there may be a limited time immediately after implantation during which integrated FES shouldn’t be used to allow for adequate tissue healing. This should be determined by the patient’s physician.

Yes, integrated FES can be used by patients on ventilators. You may want to have your patient’s nurse or respiratory therapists present at the initial session(s) to make any ventilator adjustments if needed.

Yes, upper motor neuron lesions are a primary indicator for integrated FES.

Lower motor neuron lesions are not contraindicated for use of integrated FES. Your patient may not experience muscle contractions initially or possibly at all; however, many clinicians do persist with integrated FES and may see sensory or motor benefit.

Restorative Therapies’ stimulators have the capability to deliver expanded pulse widths, which may be beneficial for individuals with lower motor neuron injuries.

Integrated FES systems are indicated for reduction of spasticity, improving, or maintaining range of motion, improving localized circulation, and reducing muscle disuse atrophy, all of which may be part of the treatment plan for patients with brain injury.

Many patients with brain injury benefit from the use of integrated FES systems during inpatient and outpatient rehabilitation programs to aid in the achievement of functional goals. Additionally, many patients with brain injury continue the use of integrated FES systems such as the RT300 and RT200 as part of their ongoing in-home therapy program for long-term physical integrity and health benefits.

Yes, studies show positive outcomes in patients with MS. Many patients with MS benefit from the use of integrated FES during inpatient and outpatient rehabilitation programs to achieve functional goals.

Additionally, many patients with MS continue to use integrated FES systems such as the RT300 and RT200 as part of their ongoing in-home therapy program for long-term physical integrity and health benefits. The treatment approach with MS often differs from that of other neurological diagnoses and the clinicians at Restorative Therapies can help you in understanding the current research and treatment options to customize your program.

Spasticity is an indicator for the use of integrated FES. It’s been well established in research that integrated FES can reduce spasms/spasticity. Many patients benefit from using integrated FES because the stimulation is timed with massed practice movement as a long-term method of spasticity management without the need for medication or implanted devices. Spasticity is not a barrier to use of a Restorative Therapies’ integrated FES system because clinicians can customize stimulation and therapy settings to manage spasticity.

All of Restorative Therapies integrated FES systems allow the clinician to adjust FES parameters for individual muscle groups. This customization helps to ensure that even patients with full sensation can benefit from this therapy.

Training includes instruction on how to optimize FES parameters for best outcomes including patient comfort.

In most cases RT300 and RT200 can be utilized. Clinicians can adjust therapy settings to allow for accurate session results in the event of loss of limb. Accommodation can also be made if the prosthesis is donned. The RT600 may be contraindicated for a patient with a lower extremity amputation. Each case would need to be considered individually by the clinician.

Many patients with varying neurological disorders achieve functional gains as well as health benefits from the use of integrated FES as part of their inpatient and/or outpatient rehabilitation program. Patients who have limited ability to volitionally take part in traditional exercise may demonstrate functional decline, muscle mass loss, and increased spasticity when discontinuing integrated FES therapies.

integrated FES systems, most commonly the RT300 and RT200, can be prescribed for use in-home or accessed in a community-based wellness program so that patients can continue to build on the gains they made in their rehabilitation programs.

Reduced mobility commonly contributes to a variety of secondary health complications as well as re-hospitalization. Because of this, it’s very important to continue ongoing integrated FES therapy to avoid gaps, regression, or other complications.

Wealth is not a predictor of who gets an integrated FES system for home.

You should introduce all your appropriate patients to integrated FES therapy and allow Restorative Therapies to work with patients and their families to find reimbursement coverage, funding, or financing options.

Many insurance companies cover our systems. Restorative Therapies offers insurance reimbursement services with a full-time internal expert reimbursement team, at no cost to the patient. Our reimbursement team is dedicated and determined to help patients optimize their health insurance reimbursement outcome.

We are proud of our success in helping people secure insurance coverage. In many cases we have successfully done this after an individual has already purchased a system so you do not have a lapse in your ongoing continuum of care and can continue to help your patient achieve therapeutic benefits.

We take the burden off of the patient and work directly with their insurance company with their involvement along the way.

Our reimbursement process includes:

• Ensuring the prescription and Letter of Medical Necessity are complete and accurate.
• Interacting with the patient’s insurance company on their behalf
• Working through the insurance company’s application and appeal process

Each case must be individually evaluated by a therapist in order to determine the best system and set-up for the child depending on their size and needs. Specialized training is provided in pediatric settings for considerations related to physical setup, stimulation and therapy settings.

Setting up a patient on a Restorative Therapies’ integrated FES system takes about ten minutes, depending on the number of stimulation channels utilized and your experience with the system. Experienced users will typically complete a set-up in under ten minutes.

Muscle testing during an initial setup will take a few extra minutes, but these settings will be saved under the unique identification number to be used during subsequent sessions.

Through analysis of data from thousands of sessions available on Restorative Therapies’ database, we have learned that users who completed 3-5 integrated FES sessions per week demonstrate the highest percentage of improvement in performance. When new to use of integrated FES, patients typically start with a 15-minute session and build up gradually to complete 30–60-minute sessions. Dosage may vary in a clinical environment based on individual needs and plan of care.

In a clinical environment, integrated FES systems can be used as a preparatory activity. Immediate effects of motorized integrated FES systems, such as nervous system excitability and reduced spasticity, can be utilized to increase safety and independence in functional activities that follow.

Physical and Occupational Therapists have to be licensed in the state in which they practice. The use of electrical stimulation as a modality within the plan of care is governed by each state’s practice act. Please check with your state’s practice act to ensure compliance.

Restorative Therapies recommends all clinicians utilizing integrated FES systems be fully trained and complete the competency process prior to use. Contact your clinical representative for further assistance.

Restorative Therapies training makes it quite easy to learn and become comfortable using integrated FES with your patients. We offer training through several methods. Our dedicated clinical representatives provide training in your facility during the initial installation of the system as well as continued on-site training and support. We also offer online learning opportunities, remote support via Skype, or hands-on courses at our Clinical Training Center in Baltimore, Maryland.

Please consult your organization’s billing practices. The specific code that is billed depends on the patient-specific goal for use of an integrated FES system.

Common codes that may apply include:

• Therapeutic Exercise
• Neuromuscular Re-Education
• Therapeutic Activities
• Electrical Stimulation (manual) Attended E-Stim