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Highlights From the 11th Vienna International Workshop on Functional Electrical Stimulation.

This Special Issue on Functional Electrical Stimulation (FES) is composed of highlights from the “11th Vienna International Workshop on FES,” which was held in September 2013 and hosted by the charming university city Graz, south of Vienna, and cradle of biomedical engineering in Austria, decades ago. The Vienna FES Workshop has accompanied the art since 1983, when this triennial event was initiated with the first meeting, and was able to document the most actual developments and trends over the years in a regular series of proceedings. Highlights of the workshops were also regularly selected in a competitive procedure, and authors were invited to provide a manuscript for a Special Issue in Artificial Organs, which has always been an incentive for outstanding contributions and led to most recognized series of scientific articles on at the time recent FES accomplishments. Based on this tradition, we are able to present the edition with again an exciting spectrum of utmost interesting and relevant front-end work in the field. Looking through the selected contributions, we find them widely spread between clinical, experimental, and engineering work, which is not surprising, as FES had relied on multidisciplinary collaboration right from the beginning. Engineering inputs in electrical stimulation are documented in literature as early as the mid 18th century, and already at that time, technical support was the indispensable basis for medical accomplishments. Neuroprostheses as known today originate from availability of portable and implantable electronics beginning with the 1960s, again as a combination of complex technical developments and comprehensive expertise in applicationspecific physiological and clinical expertise. The classical paradigm of substituting paralyzed functions directly by neuromuscular or muscular electrical stimulation has still validity for many established therapy concepts, but in the recent years, we have observed a strong movement toward stimulation of afferent nerve structures to influence the central state of excitability, in particular in the lumbar spinal cord. This novel approach is addressed by four contributions, which present work on neurophysiological background, clinical application, and technical developments for noninvasive application. Milan Dimtrijevic is a leading pioneer with his exemplary work on human neurophysiology for restoration of movement. Ursula Hofstötter et al. present clinical work on gradual modification of movement patterns from a recent study. Matthias Krenn et al. discuss advanced technical solutions to achieve increased selectivity of stimulation of posterior roots with application of electrode arrays, and Laura Cretu et al. report on the interesting alternative of magnetic impulse fields applied to the lumbar spinal cord by a coil applicator. We have three contributions with special focus on clinical practice of electrical stimulation, a field of particular importance for acceptance of FES in general in the healthcare system. More and more carers request objective evidence for efficacy and efficiency of treatment options. Ines Bersch et al. provide a critical review of daily practice of FES application in the prestigious “Swiss Paraplegic Center Nottwil.” Gustavo Braz et al. present work on assessment of cardiorespiratory and muscle metabolic responses to FES-based training strategies. These systemic benefits turn out to be even more convincing than functional achievements in movement restoration and have not been recognized enough in older FES studies. Renato Varoto and Alberto Cliquet report on the extensive clinical FES program for spinal cord injury rehabilitation, established for many years at Campinas, Brazil, and how it is integrated in education and research. There are only very few centers worldwide that have been able to build up and maintain a similar treatment culture in this dimension, and this successful initiative could be exemplary for many other clinical rehabilitation programs. doi:10.1111/aor.12613 bs_bs_banner