Friday, 3 April 2015

ClinicSpeak: FES, foot drop and reduced energy expenditure

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.

5 comments:

  1. Do MSers burn more calories than non MSers because of their greater expenditure of energy when doing things? Do MSers need to eat more the way athletes do?

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  2. FES, totally changed my life. I have gone from a frequent faller, over 3 times a week to someone who rarely falls over. I used to use a MuSmate, a mechanical device to lift the foot. Using an FES my balance is better, I fall over less than once every two weeks and walking is easier. FES has made a huge improvement to my life.

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  3. It worked well for me, although I always had to pay (£200 every visit, which covered a 90 minute appointment and all the kit). I had researched it myself - my GP had never heard of FES. It helped with the foot drop but it couldn't prevent the musculo-skeletal damage to the knee which was the product of years of hyperextension/abnormal gait. After eight years or so, the physio at the FES clinic recommended a switch to a Fellauer Dynamic Walk orthotic. (It was either this or knee surgery). The hospital's orthotic dept had never heard of it: fortunately, the orthotist had trained with my physio at the FES centre so was persuaded by her. The DW is carbon steel, light as a feather and supports the back of the calf, so it encourages correct knee alignment and movement. With it, I can walk faster and for far longer. Conclusion: my experience mirrors what your post says. Access to treatment is inadequate overall; expertise of medical professionals is uneven - and if I hadn't done the groundwork myself, where would I be now? Scary stuff.

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  4. Prof G,

    Welcome back. It´s good to have the captain back at the helm. While the cat´s away, the mice will play..... Don´t been too hard on your long tailed colleagues. You pay peanuts, you get..mice.

    Have you come back with any big ideas / projects?

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  5. Probably quite far off being available but you might find these links on a prototype exoskeleton device to increase walking efficiency interesting:
    http://www.digitaltrends.com/cool-tech/leg-mounted-exoskeleton/?utm_source=facebook&utm_medium=socialm&utm_campaign=cooltech
    http://www.nature.com/nature/journal/vaop/ncurrent/full/nature14288.html

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