Alan’s physiotherapist is trained in the application of an alternative orthotic device for managing his dropped foot, Functional Electrical Stimulation (FES). She feels that this device may benefit Alan so she discusses it in detail with him, provides written information and gives him time to consider if he wishes to try it.
An FES Device
Watch the video below to see a stroke patient who presents with a dropped foot walking. Then watch the same gentleman walking but this time using an FES device to correct his dropped foot.
Duration: 1 minute 1 second (no audio)
The FES Device shown is Odstock Dropped Foot Stimulator (ODFS) from Odstock Medical Limited Salisbury. Other and newer FES devices are available .
Definition:
FES is a means of producing contractions in muscles paralysed due to central nervous system lesions (eg stroke) by means of electrical stimulation to the peripheral nerve (the nerves that are out with the brain and spinal cord). This stimulation is used to produce a functional movement e.g. lifting the affected foot during the swing phase of walking. Stimulation can be applied via surface-applied or implanted electrodes.
Impact of FES:
FES potentially has a therapeutic effect. This being the effect seen when the stimulator is switched off. By its mode of action, namely stimulating muscle, FES may encourage motor recovery.
Similarly to an AFO it also has an orthotic effect that being the effect seen while the stimulator is switched on.
Contraindications:
Exposed orthopaedic metal work on the lower limb; tumour in the area of stimulation; uncontrolled epilepsy; lower motor neurone conditions (conditions that have caused damage to the peripheral nerve)
Cautions:
Marked spasticity, poor skin condition; marked oedema (swelling); pregnancy; pacemakers; fixed ankle contracture
Rationale:
Alan meets the inclusion criteria for FES. Additionally, as Alan has some motor activity at his ankle it is considered that FES may help the motor recovery of his ankle and forefoot muscles. Following his discussion with the physiotherapist Alan is keen to try it and is therefore set up and provided with FES.
References:
Image labels:
Electrode pads – directly delivers the electrical stimulation to the muscles
FES stimulator box
Foot switch – a pressure sensitive switch worn inside the shoe which triggers the stimulator box on and off
Leads – connect the electrodes and foot switch to the stimulator box
Video labels:
00:00 – 00:04 – Patient with a dropped foot prior to set-up with Functional Electrical Stimulation
00:39 – 00:44 – Set-up with FES to correct the dropped foot
00:51 – 00:55 – Patient with FES
Page last reviewed: 22 Apr 2021
