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In Touch Article May 2015

Thu 30th Apr, 2015

New evidence for the use of technology to improve walking in Multiple Sclerosis and Stroke

The Department of Clinical Science and Engineering at Salisbury District Hospital has published the largest case series to date of people who have Multiple Sclerosis (pwMS) and use Functional Electrical Stimulation (FES) to assist walking1.  It is estimated that around 30% of pwMS walk with some degree of disability.  The most common impairment is dropped foot, consisting of difficulty in lifting the foot as it is brought forward and ankle instability when weight is returned to the foot.  FES is used to stimulate the common peroneal nerve by placing self-adhesive skin electrodes over the head of fibula and tibialis anterior.  Stimulation causes dorsiflexion and eversion and when timed to walking using a footswitch in the shoe significantly improves the safety, speed and efficiency of walking.  The technology was pioneered in Salisbury following research funding from the Department of Health.

The new study follows 187 pwMS over the first 20 weeks of FES use.  89% continued to use FES at the end of the study.  The main outcome measure was walking speed over 10m from which the functional walking category was calculated (household only, most limited community, least limited community, or community walker).  Overall there was an increase in walking speed of 0.11ms-1 (SD 0.16) at 20 weeks when using FES and 73% of pwMS achieved a clinically meaningful increase.  54% of pwMS in the lower functional walking categories improved their walking ability by one or more category.  The study concluded that FES is a well-accepted intervention that enables clinically meaningful changes in walking speed, leading to a preserved or an increased functional walking category and hence greater participation in activities of daily living and improved quality of life.

The Study adds to the evidence presented in the group’s long term audit study published last year that followed 126 FES users who had stroke, MS or other upper motor-neuron lesions over 10 years2.  The study demonstrated that average FES use was 5 years and was cost effective within the terms used by NICE.

Salisbury District Hospital provides a clinical FES service and is able to take referrals from GPs.  For referral criteria and clinical pathway please visit: http://www.odstockmedical.com/knowledgebase/introduction-fes-odfs-and-clinical-pathways-upper-and-lower-limb-fes

  1. Street TD, Taylor PN, Swain ID.  The Effectiveness of Functional Electrical Stimulation on Walking Speed, Functional Walking Category and Clinically Meaningful Changes for People with Multiple Sclerosis. Archives of Physical Medicine.  Volume 96, Issue 4, April 2015, Pages 667–672 http://www.archives-pmr.org/article/S0003-9993(14)01281-7/abstract
  2. Taylor P, Humphreys L, and Swain I, The long-term cost-effectiveness of the use of functional Electrical stimulation for the correction of dropped foot Due to upper motor neuron lesion.  J Rehabil Med 2013; 45: 154–160 http://www.medicaljournals.se/jrm/content/download.php?doi=10.2340/16501977-1090

 

Paul Taylor

p.taylor@salisburyfes.com