What is Functional Electrical Stimulation (FES)?
FES has been used widely in rehabilitation for therapy, function restoration and maintenance of vital function in muscle weakness and/or paralysis. FES uses small electrical impulses to activate muscles by exciting the nerves leading to the muscles.
Two self adhesive patches (electrodes) are usually placed on the skin close to the nerve supplying the muscle and over the centre of the muscle. Leads connect the electrodes to a stimulator that produces the impulses.
How FES can help walking
The most common problem treated by FES is called dropped foot. This is an inability to lift the foot and toes when swinging the leg during walking, causing the toes to catch or the foot to drag on the ground. Dropped foot is caused by weakness of the muscles that lift the foot and excessive tightness (spasticity) in the muscles of the calf.
Stimulation is given to the muscles at the front of the leg. The simplest stimulator is the Odstock Dropped Foot Stimulator (ODFS). It activates the muscles that lift the foot during walking. A switch worn in the shoe triggers the stimulation and the electrical signals reach the muscles through electrodes stuck to the skin on the side of the leg, just below the knee.
The stimulator is about the size of a pack of cards and can be worn at the waist on a belt or in a pocket. Leads connect the stimulator to the switch in the shoe and to the electrodes on the leg. A small battery operates the stimulator.
Electrical stimulation can help people to walk faster, with less effort and with more confidence. Stimulators are being continually developed with computer technology allowing them to be more finely controlled and more muscle groups can be stimulated to produce a more natural walking pattern.
How stimulation can be used to improve arm and hand function
This is much more varied and complicated. Stimulation may be given as an exercise to strengthen weak muscles or relax tight ones. This sort of stimulation is often used as part of physiotherapy. People who benefit from this usually have some movement of the arm and hand. FES is used to improve on this in order to make the hand and arm more useful.
Who is the Service for?
People who have difficulty moving due to damage to their brain or spinal cord can benefit from FES. The majority of people who use FES have had a stroke, suffer from Multiple Sclerosis (MS) or have had an incomplete spinal cord injury (T12 or above).
It can sometimes be used with children who have cerebral palsy and people who have had a head injury. To be effective it is important that the nerve fibres between the spinal cord and the muscles are not damaged. The impulses need to travel along the nerves to reach the muscles.
Referral Process
Referrals are received from Healthcare Professionals and are screened. The patient is invited for an assessment to decide whether FES is a suitable treatment for them.
What we do at an assessment?
An assessment takes about an hour. If patients do not respond to FES then they will be discharged from the FES clinic. If FES can help this is reported to the referring Doctor. Appointments are then made for the patient to attend the clinic to start treatment with mutually agreed goals.
What happens after the assessment?
An appointment is arranged for the fitting of the appropriate stimulator and setting up of a treatment programme. Outcome measures are recorded for future comparison. Further appointments are made so that progress can be measured and adjustments made to the stimulator or exercise programme.
Some patients use stimulation independently everyday – others use it as part of their physiotherapy treatment. Some patients continue to use FES for many years, others only for a period of a few months. Treatment continues for as long as it is appropriate for the patient
Relevant web pages
www.salisburyfes.com
www.odstockmedical.com
www.ifess.org
Fact Sheets
