AFESK™ technology - Basic principles of operation

Adaptive Functional Electrical Stimulation Kinesitherapy

Basic principles of operation

Movement Repetition
Targeted goals
Bilateral exercises

Functional Electrical Stimulation

  • The patient’s request for voluntary movements is associated with electrical stimulus.
  • The combination between FES, creation of a specific motor pattern and voluntary gesture leads to increased phenomena of plasticity. (1) (2)
  • Several studies have shown the effectiveness of FES on foot drop and wrist extensors deficiency with a greater carryover effect and greater function compared to traditional physiotherapy. (3)
  • Studies highlight the effectiveness in reducing spasticity,in the increase of ROM and the movement of functional outcomes. (4)
  • It has been shown that there is a clear correlation between the duration of rehabilitation session with electrostimulation and the maintenance of the effects at the cortical level over time. (4)


  • Exercise based therapy has the potential to promote neurological recovery and improve gait in individuals with incomplete spinal cord injury. (1)
  • The reduction of muscle mass paretic limbs plays a significant role in secondary complications after spinal cord injury. Research in the area of neural recovery suggests that neural circuits in the spinal cord shut down following forced inactivity due to paresis and these circuits can be reactivated with intensive and repetitive training. (1)
  • The administration of tensive and compressive forces to the tissues, even in paretic patients, results in a combination of endogenous and exogenous load administration. The load administered, through the mechanotransduction process causes a cellular response to mechanical stimuli and a therapeutic use of the same in order to promote tissue remodeling at the cellular level. (2) (3)
  • Our idea of kinesitherapy focuses both on the use of preserved muscles to achieve compensatory functions, and on sub-lesional muscle activation, with the aim of re-training the nervous system to recover a specific motor task.


  • The facilitation of functional gestures allows to support aerobic and cardiovascular exercise, which can increase the state of fitness.
  • The fitness status of (hemiplegic) subjects with neurological impairment is particularly low and may worsen disability.
  • There is clear evidence that cardiorespiratory training improves walking performance measures (walking speed and walking capacity) and reduces dependence on others; some effects of training have been maintained over time.

Saunders et al. 2016 Cochrane Review


  • Repetitive movement practice has been shown to be useful in inducing motor learning. (1)
  • Repetition of the gesture leads to increased strength in AASS and AAII, even in very weak subjects. (2)
  • High repetitions allow faster recovery of motor and gait patterns and seem to induce greater neuroplasticity, observed by fMRI. (3)

Nielsen et al 2015(1), Desousa et al 2018 (2), Scrivener et al 2012 (3)


  • The use of pre-determined goals in terms of time and repetitions, and the continuous feedback provided by the technology allow for greater intensity of work, through a greater number of repetitions performed by the patient in a single session.
  • Session intensity (understood as reps/time) is a key parameter in neurological rehabilitation.
  • It appears that in order to improve desired functional outcomes, a certain threshold of intensity must be achieved. (1)
  • The possibility to reproduce different functional gestures, from walking to reach and grasp allows the patient to repeat specific tasks and skills, having as effect more neuroplasticity and learning. (2) (3)

Hillig et al 2019 (1); Ericsson, 2004, 2008, 2013 (2); Ericsson, Krampe, & Heizmann, 1993 (3).


  • When one side is more affected and one side is less affected, bilateral exercise provides greater strength gains in both sides. (1)
  • Bilateral exercise provides a gain in long-term motor skills in the upper extremity, both proximally and distally. (2)
  • Symmetric movements of the paretic and nonpartial sides improve motor control of the paretic side through disinhibition of ipsilateral pathways of the unaffected hemisphere. (3)

Ehrensberger et al 2016 (1); Hung et al 2019 (2); Cunningham et al 2015 (3).

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