Functional Electrical Stimulation Service

 

FES stimulates nerves using small electrical impulses to activate muscles.

 

It is used widely in rehabilitation and maintenance of function where there is muscle weakness or tightness.

 

Two adhesive patches (electrodes) are placed on the skin - one close to the nerve supplying the muscle and one over the centre of the muscle.

 

Leads connect the electrodes to a stimulator that produces the impulses.

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 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. The electrical signals reach the muscle through electrodes.

 

The stimulator is the size of a pack of cards and is operated by a small battery. It can be worn at the waist on a belt, in a pocket or on a knee strap.

 

Electrical stimulation can help people walk safer, faster, with less effort and with more confidence.

 

This is much more varied and complicated.

 

Stimulation is given as an exercise to strengthen weak muscles or relax tight ones.

 

This sort of stimulation is used as part of physiotherapy.

 

People who have difficulty moving due to damage to their brain or spinal cord can benefit from FES - both adults and children.

 

Patients who use FES may have: Multiple Sclerosis (MS), Cerebral Palsy (CP), Stroke, incomplete spinal cord injury, brain injury or other neurological conditions.

 

FES is not effective with complete peripheral nerve damage. To be effective, the nerve fibres between the spinal cord and muscles need to be intact.

 

The impulses need to travel along the nerves to reach the muscles.

Stimulation causes a tingling 'pins and needles' sensation on the skin. While most people find it comfortable, a few cannot tolerate the sensation and therefore 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 changing 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.

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.

FES referral form - adults

FES referral form - children

 

FES CANNOT BE USED WHERE THERE IS A PACEMAKER OR DEFIBRILLATOR IN PLACE OR WITH UNCONTROLLED EPILEPSY.

 

An assessment takes about an hour. If patients do not respond to FES, they will be discharged.

 

If FES can help, an appointment will be booked to issue a FES machine and teach the patient how to use it. 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.

• FES skincare 2018 v.1.docx [docx] 56KB
• FES pathway of care and inclusion criteria updated Oct 2020.doc [doc] 2MB
• FES electrode care 2018 v.1.docx [docx] 108KB

 

Relevant Web Pages

• Odstock Medical (OML)
• International Functional Electrical Stimulation Society (IFESS)
• Different Strokes - charity helping younger stroke survivors
• Stroke Association
• Multiple Sclerosis Trust