MS Lobby: do you have access to a Walking clinic and FES? #ClinicSpeak #MSBlog #MSResearch
"I did my first clinic yesterday after returning from sabbatical. It felt good doing what I was trained to do; helping MSers live their lives in the best way possible. In clinic yesterday I saw three patients who I will be referring for an assessment for functional electrical stimulation, or FES, to help with a foot drop. All these patients were at high risk of falls due to their foot dragging and catching whilst walking; in fact all three of these patients had recently had falls. In addition, to the risk of falls the energy costs of a dragging foot are not insignificant; it takes energy to lift a heavy leg higher than it needs to be lifted to walk. The study below shows this elegantly in MSers with slower walking speeds. Other benefits of FES are not only safer and more energy efficient walking, but faster walking; you simply get from point A to B quicker. The big problem we face in the UK is that access to walking clinics and FES is patchy. I am aware that in certain areas of the country the local CCGs (clinical commissioning groups) simply won't pay for FES despite it being a relatively cheap intervention and one that works. When it comes to FES the NHS post-code lottery is alive and kicking; 'kicking MSers in the teeth'."
"I am currently chairing a lobby group to try and widen access to early early effective treatments and to drive adoption of treat-2-target of NEDA. Maybe we should set-up a petition to widen access to walking clinics for MSers and to allow access to FES?"
Epub: Miller et al. The impact of walking speed on the effects of functional electrical stimulation for foot drop in people with multiple sclerosis. Disabil Rehabil Assist Technol. 2015 Mar 31:1-6.
PURPOSE: Functional electrical stimulation (FES) is effective in assisting MSers with gait. Previous studies have investigated the effects of FES in MSers with slow self-selected walking speeds (SSWS). This study reports on the effect of the Odstock Dropped Foot Stimulator (ODFS) on the speed and oxygen (O2) cost of gait in MSers walking at a range of SSWS.
METHODS: Twenty MSers (mean age 50.4 ± 7.3 years) currently using FES walked at their SSWS for 5 min with and without FES. O2 cost of gait was measured using a gas analysis system, and gait speed was calculated. Data were analysed for all participants, and comparisons were made between those with a SSWS < and >0.8 m/s (walking speed required for community ambulation).
RESULTS: Significant improvements in the speed and O2 cost of gait were seen using FES in the group with SSWS <0.8 m/s (n = 11, p = 0.005). When participants' SSWS >0.8 m/s, no difference in gait speed was noted, and a significant increase in O2 cost of gait using FES (n = 9, p = 0.004) was noted.
CONCLUSION: FES has a different effect on the speed and O2 cost of gait dependent on the SSWS of MSers. This requires further investigation. Implications for Rehabilitation Functional electrical stimulation (FES) used for foot drop is effective in improving the speed and oxygen cost of walking in MSers walking at SSWS <0.8 m/s. FES does not seem to have a beneficial effect on the speed and oxygen cost of walking in pwMS walking at SSWS >0.8 m/s. Further research is needed to understand the possible mechanisms involved so that FES for foot drop can be efficiently prescribed.