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Functional Electrical Stimulation (FES)

FES

What is Functional Electrical Stimulation?

FES uses small electrical impulses to activate muscles by exciting nerves leading to muscles. FES is used widely in rehabilitation for therapy, function restoration and maintenance of vital function in muscle weakness and/or partialparalysis.

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 the inability to lift the foot and toes when walking, causing them to drag on the ground. It 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 which 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 the size of a pack of cards which is operated by a small battery and can be worn at the waist on a belt, in a pocket or on a knee strap. Leads connect the stimulator to the switch and electrodes.

Electrical stimulation can help people walk safer, 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 used as part of physiotherapy. People who benefit from this usually have some movement of the arm and hand. FES is used to try and improve on making 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, have multiple sclerosis (MS) or have had an incomplete spinal cord injury.

It can 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.

Are there any risks or side effects?

Stimulation causes a tingling “pins and needles” sensation on the skin, although most people do not find it uncomfortable, a few do and for this reason do not use it. At times, even though patients are carefully assessed, we find that treatment has not helped them or they are unable to use the stimulator effectively. In these cases, stimulation will be stopped.

Occasionally, patients find that electrodes irritate their skin. Using hypoallergenic electrodes or change the type of stimulation used can solve the problem. Very rarely we have found that stimulation increases the muscle tightness (spasticity) and in these cases treatment will be stopped.

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.

It can 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.

What we do at an assessment?

An assessment takes about an hour. If patients do not respond to FES they will be discharged. If FES can help, it 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 the 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.odstockmedical.com
www.salisburyfes.com 
www.ifess.org 

Additional information and referral form:

Please click this link to download the Functional Electrical Stimulation referral form

Click this link to download the Pathway of care and inclusion criteria

Click this link to download the Functional Electrical Stimulation referral form

Contact Us

Functional electrical stimulation 

Christine Singleton
Clinical specialist (FES)
Tel: 0121 466 3232

christine.singleton@bhamcommunity.nhs.uk