Functional electrical stimulation cycling strategies tested during preparation for the First Cybathlon Competition - a practical report from team ENS de Lyon.

Whether it is from the patient's or the physical therapist's point of view, FES cycling can be considered either as a recreational activity, or an engaging rehabilitation tool. In both cases, it keeps patients with lower-limb paralysis motivated to sustain a regular physical activity. Thus, it is not surprising that it was selected as one of the six disciplines of the first Cybathlon competition held on October 8, 2016. However, many unresolved issues prevent FES cycling from being an activity practiced outdoors on a daily basis; such as, low power production, rapid muscle fatigue, precise electrode positioning, lack of systematic procedures to determine stimulation patterns, and the difficulty of transferring disabled riders from their wheelchair to the tricycle. This article documents the challenges we faced during preparation for the Cybathlon 2016 FES cycling race, and provides results obtained during different phases of the process. A particular specificity of our team was that, unlike most other teams where pilots were mainly paraplegic, both the primary and backup pilots for team ENS de Lyon are C6/C7 tetraplegics, with neither voluntary control of their abdominal muscles nor hand grip, and only partial use of their arms.