Tell us who you are
Sarah: I’m Sarah Joiner, I am the vice chair of the MS Trust and I have been involved since 2007 because I used to be the Patron from 2007 to 2012 and doing a great range of different activities with the Trust.
Christine: My name is Christine Singleton, I’m a clinical specialist physiotherapist and I first got involved with the Trust in 1996 as part of my clinical work as I was dealing with neurological patients and I wanted to know what the MS Trust was doing. I was so impressed with their work that I have been working with them ever since!
What is FES?
Christine: FES is using electrical stimulation to augment, to add to your own neurological problem and depending on the condition that you have, and in this case we are dealing with multiple sclerosis, there is a pathway problem, you are not getting the messages to tell the foot to lift up. And electrical stimulation adds to that by going straight to the muscles and giving electrical stimulation to those muscles that lift the foot up and then we do it in a way functionally so that with a use of a foot switch it does it as the patient is walking. So it adds and provides safe walking which is really important.
Who can use FES?
Christine: Neurological patients, there are a few exceptions, so anyone that has a dropped foot that doesn't have the contraindications and you would be have to be screened for the contraindications for that. But not only is it useful for neurological patients but electrical stimulations per se can be used for muscular skeletal problems as well.
How would you wear FES?
Sarah: The basic principle are the two electrodes that stimulate your femoral nerve. The actual position of them, don't worry about that, you will be shown by your physiotherapist, because it may be slightly different for every person. Then there is a long lead that goes in to it. Red to the front connector and Black to the back. This lead runs all the way up to your battery pack which is this device here. And it has a 9 volt battery in it, which is either rechargeable or the standard ones that you can buy and that activates your lead on this side. Then there is a second lead, I wear a wireless set up so my second lead is like that and this goes in my shoe and that has a little wireless pack that goes with it which is this and that sends a signal to this box.
But more importantly you need to be able to cover up your electrodes because otherwise they peel off. What I find most useful for me is that you take a pop sock in your own skin tone and cut off the bottom bit and then you just make bit of a cut at the top because you don't want to cut off your blood supply in your leg either. Then you slip it on and you run it right up to where those electrodes are. Make sure your leads are all nice and flat and level under there and there we are, you are ready to go!
Christine: Some people use Tubigrip to do exactly the same thing, to cover the electrodes or indeed another tip is to use an old pair of socks, particularly for the men. An old pair of socks, they cut off the foot part of that and then they’ve got a colour coded own tubigrip that they can use to cover their electrodes.
Sarah: If you wanted to wear your skinny jeans, what I have found works absolutely brilliantly, you still need to have these covered up but you move your pop sock down quite a bit, make sure again you are not cutting off your blood supply get your ordinary sock that you might be wearing under your jeans anyway and get it so that the sock covers the pop sock by a good inch and then it means you really can get into your skinny jeans and it works. If you’re not wanting to wear your sock because you wanted to wear some pretty flat pumps with your electrics in, you just pull the sock off from underneath the trousers.
Christine: And the reason for having the Tubigrip on under skinny jeans like this, or even normal trousers, is that these are sticky pads and they can stick to the jeans and move and roll up. And it is important that they stay on the leg otherwise it won't work. They have to remain in the position that you need to have them to stimulate your nerve.
Then you just connect it to the stimulator, which is the battery pack, and then test that the position of your foot is correct by the stimulation that you are getting and then put your shoes on and off you go!
Has FES made a difference to your life?
Sarah: Boosted my confidence enormously because I now feel confident to walk outside, because we all know how treacherous the pavements are in the UK or anywhere else in the world, the confidence has really been tremendous but I am now walking distance, so I am developing stamina. I can see why people get into those tracker devices I go "Oh I did 5000 steps today!" Or “I did 3000 steps today, so I say to myself I need to do a bit more walking tomorrow”. So it is actually giving me exercise and it means for the first time in 30 years I’ve been walking in my local park. I’ve been in there lots of time before in my wheelchair scooter but it is so nice to be able to be walking. It is also holding me more upright my centre of gravity has moved back. It really has been hugely beneficial.
Christine: Has it dropped any maybe back pain that you had, from the way you were walking before?
Sarah: It has some ways but in one other way it has given me more of a twinge but that is because my back is readjusting and I am getting used to the readjustment. But no it has really definitely readjusted my hips.
Christine: And what about the effort of you lifting up your foot? Has that changed?
Sarah: It is much easier, and people say to me that I look as I am walking with ease, rather than struggling and that is quite interesting, other people’s perceptions about it.
Christine: Also other people’s confidence in actually allowing you to go or to be around you while you are doing your walking as well because they know that you are safe.
Sarah: That's right!
How do you get referred for FES?
Christine: Electrical stimulation or the dropped foot stimulator is provided by a professional so a clinician, physiotherapist or in the case of Odstock Medical they have clinical engineers down there as well as the physiotherapist that provides the service. So you need to ask for a referral, you either do that through your GP or your consultant or even your MS nurse. Occasionally people can self-refer particularly if they want to do it privately, and Odstock Medical does it privately as well, many of the other clinicians around the country do private service as well. The referral then has to go to the centre where you will be seen, so depending on where you are in the country, there are certain centres in the country, Odstock Medical have a franchise in different places, or there is like my service in the Midlands which is completely NHS and separate from Odstock Medical. There are other services like my own in the country. We would then find out what funding was required and that can often be a stumbling block, depending on what your commissioners are prepared to fund. Again that depends, sometimes you have to apply for funding directly to the commissioner and in other cases like myself in the service that I run we have a blanket funding so we can see patients no matter where they are, certainly within the West Midlands, because we cover the whole of the West Midlands.
Then it’s a question of having an assessment because not everybody is suitable for electrical stimulation. So the assessment would be your screening. At assessment, which is normally about an hour’s treatment, you find out whether electrical stimulation is suitable for you and if it is going to make a difference. Then if it is, there is the process of teaching you to apply it and giving you the support as time goes on. Because it is a technical piece of equipment it needs to be monitored all the time, mainly because of the technology, but also people change and it is important to make adjustments with the stimulator. You need the support of a clinician all the time. For some of my patients I have been seeing them for 15-16 years now continually on an annual basis.
Sarah: That is good news for me!
Christine: Because essentially the patients or the people with the condition are treating yourself and the only time between appointments that you need to contact us is if something has gone wrong, if you have changed in any way or if you want any advice or further consumables that is really the only reason.
Can FES make a difference for people with dropped foot?
Christine: I’d love a penny for every time, and it happens every single day, that I am told I have made a difference to people’s lives and such a positive difference, and then not just to their lives but their immediate families’ lives as well. Because you get situations, the classic would be where a mother of children would stay at home while the husband - father takes the children out, whereas now she goes out with them. So it is that inclusion which is so important, because they feel confident in going out as Sarah has said about walking outside and that’s so important. Every single day I get told what a wonderful job this is and what a wonderful product this is and it makes my life so much easier. You get rewarded everyday with comments like that.
Sarah: It is great to have something that isn't more medicine to take
Christine: Yes absolutely, and you can do it yourself!
Sarah: And it is keeping you fit, the whole effect around it is really quite wonderful!
Christine: It is your choice whether you put it on or not, so you are totally in charge of your own treatment which is really lovely, to have that power!