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Clinical
FES (Functional Electrical Stimulation) Service ,
Odstock Medical, National Clinical FES Centre |
|
| FES Patient information leaflet | |
| Referral criteria and treatment protocol Guidelines for referring clinicians | |
| FES is a means of producing contractions in muscles, paralysed due to central nervous system lesions, by means of electrical stimulation. Applications are found in stroke, spinal cord injury, head injury, cerebral palsy and multiple sclerosis. The electrical stimulation is applied either by skin surface electrodes or by implanted electrodes. The National Clinical FES Centre has a number of projects developing its own techniques or assessing devices produced elsewhere. Some of the developments have progressed from research to clinical service. Clinical services are provided by Odstock Medical at the National Clinical FES Centre. | |
| The Clinical FES service was began in 1995 after the randomised controlled trial of the Odstock Dropped Foot Stimulator (ODFS) was completed. The trial results together with case series data from subjects who had multiple sclerosis and spinal cord injury were presented to the South and West Regional Health Authority Development and Evaluation Committee. After examining this and evidence from other groups, the committee recommended the ODFS for use in the UK's National Health Service for patients with upper motor neurone lesions. Later, in the year 2000 the ODFS was recommended by the Royal College of Physicians in their publication "National clinical guidelines on stroke". See Completed Research Projects. | |
While the clinical FES service began with the correction of dropped foot, as our research experience grew, further developments were added to the treatments offered. The staff who provide the clinical treatments all work part time in the clinic and part time in FES research. This ensures that they are up to date with new techniques and helps keep their research clinically focused. The same staff also teach the FES courses run by the department. |
|
| Odstock Medical treats about 40 patients each week of which 4 will be new patients beginning treatment and the rest will be follow up appointments. The clinic receives referrals from all over the UK and beyond. To date (April 2006) over 2100 people have received treatment of which 54% had had a stroke, 25% MS, 8% spinal cord injury and 13% other neurological conditions. | |
| The Treatments | |
| Correction of Dropped Foot | |
| Using the ODFS as part of Physiotherapy | |
| Hand, arm and shoulder | |
| STIMuSTEP implanted dropped foot stimulator | |
| Who can use FES? Contraindication and precautions. | |
| Standard Treatment
pattern
Patients are first seen at an assessment clinic. Subjects are suitable for treatment if they have a dropped foot due to an upper motor neurone lesion and are able to walk at least a few metres with appropriate aids or assistance. The following are contraindications; fixed contractures of the ankle, poorly controlled epilepsy and poor skin condition in the area of the electrodes. The effect of the stimulation is not known in pregnancy and pacemaker users are assessed by a cardiologist to ensure the ODFS doses not interfere with the pacemaker. The stimulator is tried and if gait can be improved, the patient is recommended for treatment. The ODFS is fitted over two clinic sessions on consecutive days. On the first day the user is taught how to apply the device while on the second day their ability to do so is assessed and further training given if necessary. Use of the stimulator is increased gradually over 2 to 3 weeks until it can be used all day. Follow up is made at 6 weeks, 18 weeks, 45 weeks and 72 weeks from first use and then yearly for as long as the device is used. If users experience problems they are encouraged to contact the clinic so advice can be given, equipment repaired or extra clinic sessions arranged if necessary. In the case of more complex movement problems where more than one muscle
group are stimulated, treatment is often started with a single channel
ODFS and the second channel introduced at the 6 or 18 week follow up
assessment once the user has become accustomed to FES. If upper and
lower limb FES are both required, it is also normal to delay introduction
of the upper limb FES. Funding can be available through the NHS but this is not always possible. Some areas have funding for a limited number of patients a year, others will not fund all types of treatment. Some areas treat each patient as an individual case. If NHS funding is not possible, self funding is possible. Treatment is charged at a set rate per session and this charge covers all equipment, electrodes and treatment. Please contact us for more details enquiries@odstockmedical.com. |
|
| How to be referred for treatment. If you think you might benefit from the clinical treatment offered or would like to be involved in one of our research projects, you must first be referred to us by your GP or hospital Consultant. Referrals can be made to Prof. Ian Swain, Odstock Medical, Salisbury District Hospital, Salisbury, Wiltshire, SP2 8BJ. If you would like more information, you can write to us at the above address, phone us on 01722 429065 or email us at enquiries@odstockmedical.com |
|
| For other centres providing clinical FES go to our Clinics page | |
| How to get to Salisbury District Hospital | |