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    You are here : Home » Get Involved » MSRC Interactive » Help, Advice and Inspiration from people with MS » What Has Helped You » Products » Functional Electrical Stimulation (FES)

    Functional Electrical Stimulation (FES)

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    Anne Barrett
    Functional Electrical StimulationAnne Barrett was having problems getting her right foot off the ground, but the Odstock Foot Stimulator gave her a kick start.

    When I found out about Functional Electrical Stimulation (FES) I couldn’t believe that something so simple could make such a difference. Why wasn’t it advertised in every G.P’s surgery?

    The FES device, known as the Odstock Dropped Foot Stimulator, stimulates the muscles which lift the foot, doing the job of the nerve.

    I duly got my GP to refer me to Salisbury District Hospital. Amazingly, he knew nothing about it, and I had to get him loads of info from the web. The first appointment measured general leg strength, It is at this hurdle that some people fall-the leg cannot be too weak, nor too highly toned.

    At the second appointment some weeks later, I was fitted with the device. I have one electrode stimulating the nerve under the knee at the front (called the peroneal nerve). A second electrode is placed over the top of the fibula bone (the bone on the outside of the lower leg). A current flows between them. The electrodes are thin, silver, circular sticky pads which need a lot of adjustments to get the position just right.

    FES attached to Anne's feetFES on Anne's leg

    The pulses are controlled by a foot switch, on an inner sole, in your shoes. So it’s important your shoes are flat and give a lot of support. Only small amounts of pressure needs to be taken off the switch to make it work. You raise your foot, the pulse kicks in and you lower your foot, the pulse goes until the next time. Once you’ve got the hang of it, it takes an awful lot of energy out of the walking process.

    Clipped to your belt or waistband is a little black box (easily camouflaged with a jumper). This has a dial marked1-10- which sets the level of electrical pulses. Depending on how you feel, you can either turn the dial right down or off, or use the ‘pause’ button. I have set it between 2 and 3.

    FES Control Box

    It feels like pins and needles or a very mild electric shock. If you’ve ever used a Slendertone or similar machine, it’s a bit like that. If you turn up the power too high, it can hurt. Too low, and it won’t work.

    Be warned!
    Don’t try and walk too much at first. I wasn’t used to walking any more and it took me two days too recover.

    You don’t really notice this contraption unless you wear short skirts. But with trousers it is near enough invisible. There’s a wire coming out of your shoe, but it disappears up the back of your trouser leg. It takes less than a minute to put on, and about 10 seconds to take off at night.

    Several weeks on, I’m finding the FES invaluable, not least because it forces me to use my right side.

    There is absolutely no doubt that this device can really be of benefit to anyone who ahs a dropped foot and it’s an invaluable way of giving the body a ‘kick start’.

    What is it?
    Functional electrical stimulation produces contractions in paralysed muscles by means of electrical stimulation.

    What is the device used in MS?
    It’s called the Odstock Dropped Foot Stimulator (ODFS).

    What does it do?
    It’s a neuromuscular stimulator that corrects dropped or dragging foot. It can be used on one leg or both.

    How does it work?
    Self-adhesive electrodes are applied to the skin, attached to a control box. The electrical stimulation makes you lift your foot. It does this by causing a nerve impulse in the common peroneal nerve, which is situated below the knee. This impulse then travels along the nerve, causing the muscles that lift the foot to contract.

    This is timed to the patient’s own walking rate, using a small pressure pad (footswitch) placed inside the shoe under the heel. When the weight is taken off the footswitch, the stimulation is turned on, causing the foot to lift as the leg is swung forward.

    When the heel strikes the ground, the stimulation is switched off. This makes walking safer because you are less likely to trip. Also there is less effort involved and you can walk faster. The electrical stimulation can also have an effect on spastic muscles causing them to relax.

    What does it feel like?
    Electrical stimulation significantly improves both walking speed and efficiency. When using the FES device, walking speed increased by 20% and 12% less energy was used in walking.

    Perhaps surprisingly, the FES device not only maintained its effectiveness but actually increased walking speed by 10% even when it wasn’t being used. This happened in 16 out of 52 people. Also, 21% experienced less energy expenditure during walking when they were not using the device.

    However, in many patients, walking does not change when they were not using the device.

    Out of 139 patients, only 16 have stopped using it after one year- a compliance rate of 88%.

    Does it encourage new nerve pathways?
    Not with everyone. Some people with MS do seem to learn to walk better without the device. But more research is needed to understand this better.

    How long has it been used?
    The original idea was developed in the 1960’s, but the technique has only become widely used in the UK following the development of ODFS between 1988 and 1996. The longest any MS patient had been using the Odstock Foot Stimulator is about 6 years.

    Are there similar machines which work on other parts of the body?
    Yes. Some use surface electrodes, some are implanted. They are used to help with other things, standing, bladder control, knee extension, hand movement and walking. None of these techniques have been used in MS yet. There are also cosmetic machines available for home or salon use which work on the following muscle groups: tummy, thigh, buttocks, calves.

    Where can you get it?
    The main places are Salisbury District Hospital where the device was developed and City Hospital Birmingham. These centres have large outpatient services. Many other hospitals and MS Centres all over the UK have been trained to use ODFS but most only treat people in their own area. Take a look at the Salisbury District Hospital FES website to see the full list.

    How do you get referred?
    You need a referral letter from your GP or hospital consultant. Salisbury District Hospital can take referrals from NHS patients all over the UK. Birmingham Hospital only takes people from the Midlands.

    Clinical Procedure
    You are first assessed at a clinic. You must be able to go from sitting to standing unaided and be able to walk at least 10 metres with aids.

    If it is thought the device will be suitable, you are asked to return for set up of the device at a later date. This is done over two consecutive days. On the first day you are taught how to use the device. On the second your ability to use it properly is checked, and some measurements made to monitor your progress.

    It’s very important that you understand how to use the device correctly. A lot of time is spent on explanations and training.

    You are followed up at 6 weeks, 3 months, 6 months and then yearly for as long as the device is used. If people experience problems, extra appointments can be arranged and the telephone advise id always available.

    How long does it take to get used to it?
    Most people get used to it in a few days, although it takes about three months to get the full benefit. Muscular fatigue can be a problem to begin with but this improves with use. It’s important to build up the time you use it over about one month.

    How much do you use it?
    On average, about 60% use it all the time. If people have some voluntary movement, they are encouraged to practice walking without the stimulator so they do not become too dependent on it. Some people only require it when they are tired or when they go for longer walks.

    How much does it cost?
    The cost to the NHS is approx £1000 in the first year and about £200 a year afterwards. This includes equipment, treatment, admin, spares etc.

    Referrals to Salisbury should be:

    Professor Ian Swain,
    Department of Medical Physics and Biomedical Engineering.
    Salisbury District Hospital,
    Salisbury, Wiltshire SP2 8BJ
    Tel. 01722-429065
    Email: [email protected]

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