Treatment Options

At OML, we have a range of treatments to help with you with walking.

Our flexible and holistic approach allows us to treat a broad range of problems and provide the right solutions as neurological conditions change.

Drop foot

The most common application of FES is for the correction of drop foot.

Drop foot, which is sometimes called foot drop or dropped foot, is a muscular weakness or paralysis which makes it difficult to lift the foot whilst walking. Toes may catch the ground, making it hard to walk and it can lead to falls.

FES is used to lift the foot whilst walking. Self-adhesive skin electrodes are placed over a nerve, called the common peroneal nerve. Small electrical impulses applied to the electrodes cause nerve impulses that pass down the nerve to the muscle causing it to contract.

Stimulation is timed by a pressure sensitive foot switch placed under the heel. Stimulation starts after the heel is lifted from the ground and continues till just after weight returns to the heel, lowering the foot to the ground in a controlled manner.

Our FES device is called Odstock Dropped Foot Stimulator (ODFS®) Pace. Find out more here or click here to see how to receive this treatment

Walking is made safer, faster and more efficient.

What are the effects of using FES for drop foot?

The main effects of using FES are increased foot-lift (called dorsiflexion) and foot turning out (called eversion).

This leads to:

Improved ground clearance

• Reduced tripping and falls
• Reduced compensatory activity
• Reduced effort of walking
• Reduced spasticity
• Increased walking speed

Heel strike with eversion

• Improved loading response
• Greater stability in stance

Greater range of mobility

Greater safety, confidence and independence while walking

Greater social interaction and improved quality of life 

Do you have more complex walking problems?

Odstock Two-Channel Stimulator (O2CHS)

This stimulator is controlled by a two-channel footswitch which assists drop foot and other gait problems, following an upper motor neurone lesion. It has the same functions as the ODFS® Pace but has additional features to control the interaction of two channels. This gives the device great flexibility.

The table below shows the commonly used combinations of muscles that can be stimulated with an O2CHS. In many cases a second muscle group is added to compliment drop foot correction.

If there are three or more muscle groups required, the O2CHS can be synchronised with a second O2CHS or an ODFS® Pace.

The timing of muscle activation can be adjusted so that a contraction can occur as weight is transferred on or off a footswitch or set to occur at other times in the gait cycle by adding a delay following a footswitch transition.

The device is used as an orthotic aid, replacing conventional splinting and also as a training device assisting gait re-education.

Strengthening muscles with electrical stimulation

Electrical stimulation can be a useful form of exercise when you are lacking voluntary controlled movement to make effective contractions. Repetitive graded contractions can also have beneficial exercise effects.

The main effects are:

• Increase in muscle bulk. This can help to avoid pressure sores and improve your overall appearance.
• Increase in muscle strength. If you have muscles that are partially paralysed, exercise can lead to more effective function.
• Reduction in spasticity. Regular electrical stimulation exercise can lead to a reduction in muscle tone, resulting in improved range of motion.
• Improved fatigue resistance. From regular exercise, you can improve the length of time muscle contractions can be maintained for.
• Re-education of movement. We have found in some cases; exercising muscles can lead to improved voluntary control and you have a greater awareness of the effected limb.

The typical applications of muscle exercise are:

• Muscle strengthening before walking following stroke, Multiple Sclerosis or spinal cord injury.

• Exercising the lower limb muscle groups, following paraplegia or tetraplegia, can improve body image, control spasticity and prevent pressure sores.

• Improve upper limb function. For more information, see the Arm Function section.

• Control of spasticity in late stage Multiple Sclerosis.
• Treatment of contracture in stroke, head injury and Cerebral Palsy often used in conjunction with botulinum toxin and/or splinting.

Please click here to find out more about our exercise stimulator – the Microstim 2v2

As well as this, the ODFS® Pace and ODFS® Pace XL has an exercise mode, which is ideal for muscle training prior to walking.

OML also offer Physiotherapy led exercise approach for those with Parkinson’s Disease in Hoehn and Yahr stages 1 to 4 (Salisbury Clinic only) – https://odstockmedical.com/patients/patients-classes/

Functional Electrical Stimulation (FES) for the upper limb

FES treatment is provided for upper limb neurological problems resulting from stroke, brain injury, spinal cord injury or cerebral palsy.  There a three main categories of upper limb treatment:

Subluxation of the shoulder

Shoulder subluxation is a condition where the ligaments around the shoulder stretch causing the humerus bone of the arm to drop from the shoulder socket.

Shoulder subluxation is frequently painful and the range of shoulder movement and function are reduced. It is a common condition following stroke but can also result from other neurological conditions.

The Microstim 2v2 device has been specifically designed to be used to exercise the muscles around the shoulder.  By providing overlapping stimulation from two separate channels, the first channel can be used to stimulate muscles that lift the humerus into the socket while the second channel takes over to maintain it in that position.  Our clinical experience is that electrical stimulation is very effective at reducing the pain associated with shoulder subluxation and where there is some voluntary movement, it can result in an overall improvement in arm function

• The main aim is to reduce pain associated with shoulder subluxation
• The three compartments of the deltoid muscle plus the supraspinatus muscle are stimulated causing the humerus to elevate into the glenoid -humeral socket
• The treatment may need to be continued long-term to maintain reduction of pain

FES Exercise to improve hand and arm function

Stroke, Cerebral Palsy and Head Injury

Where there is some functional movement the treatment aim is to improve the hand and arm function.

• Patients should have some functional ability, typically being able to produce a grip but may not be able to release, or reduced ability to extend the elbow
• Main treatment aim is to increase the strength of the extensor muscles while reducing the spasticity in the flexor muscles
• Repetition of exercises may lead to neuroplastic changes (learning) resulting in improved function
• Patients may be asked to practice practical tasks while exercising with electrical stimulation.  By combining voluntary activity with exercise there may be a greater training effect, leading to movements being relearned.

FES Exercise to improve hand and arm function

Spinal cord injury

The treatment aim is to strengthen existing voluntary movements to maximise functional ability.

• Patients should have some functional ability, typically a weak tenodesis grasp in C6 tetraplegia or general weakness in incomplete C5/6/7 tetraplegia
• The main treatment aim is to increase the strength and therefore function of the affected muscles
• Specific aims can be improvement of tenodesis grip, strengthening of elbow or wrist extension or retraining of muscles used for tendon transfer surgery.

Non functional group

In most cases, if there is little voluntary function, it is unlikely that there can be significant improvement in function after using electrical stimulation.  However, electrical stimulation can still have beneficial effects.

• FES can be used to relieve spasticity with the aim of loosening an over tight grip or elbow flexion
• The main treatment aim is to reduce pain associated with spasticity, increase range of motion to assist with hygiene by enabling better washing or assist other activities of daily living such as dressing

Clinical Procedure for Upper limb FES

The referral and assessment process is the same as for lower limb applications.

In most cases upper limb treatment is limited to a 6 month period.  In that time the patient will be seen for five, 1 hour appointments.  At the first appointment an electrical stimulation exercise programme for the patient to perform at home will be devised. Where appropriate, additional physiotherapy exercises may also be given.  Follow up is provided at 2, 8, 16 and 24 weeks.  At each session, the exercises are reviewed and progressed.  Where appropriate, functional measures will be made to record progress.

In some cases it is beneficial to continue treatment over a longer period.  This is reviewed at the week 24 appointment and a recommendation made to the referring clinician.

Microstim 2V2 Kit

Clinic referral criteria

Assisted cough and blood pressure control in high level tetraplegia

It is common for people with tetraplegia with spinal lesions at C3/4 level to lose the ability to make an effective cough. Stimulation of the abdominal muscles can be used to augment expiration.  The increased abdominal pressure produced lifts the diaphragm so compressing the lungs and increasing expiration.  To be effective, the user must have control over expiration so the stimulation can be synchronised with voluntary effort.

Electrical stimulation of the abdominal muscles has also been shown to increase blood pressure, a useful effect for people with high level tetraplegia who are affected by postural hypotension.  This is the effect where blood pressure is reduced when sitting upright and is often worse after eating.  Electrical stimulation causes a short-term increase in blood pressure that can significantly improve ability to cope with an upright posture and reduce light-headedness and fainting.

In both applications, OML’s O2CHSII device is used.  For each individual, a specific means to control the device is required.  This can be through environmental control systems or custom-designed switches.

Important: Because there is a risk of autonomic dysreflexia in this patient group in response to electrical stimulation, it is essential that there is appropriate medical supervision when applying this technique.

For more information click here.

Facial paralysis / Bell’s Palsy

Loss of voluntary movement can occur following Bell’s Palsy or nerve injury.  Electrical stimulation exercises can be used to strengthen and re-educate the movements of these muscles, restoring facial expression. OML’s Microstim 2v2 device is used in for this application. Typically a 6 month protocol of daily home based exercise is used with follow up at 2, 8, 16 and 24 weeks.

Constipation/ Irritable Bowel Syndrome (IBS)

It can alleviate constipation/irritable bowel syndrome (IBS) for those with neurological conditions of brain and spinal cord.

Individual applications of FES

The team at the National Clinical FES Centre are able to take referrals for other applications of FES requiring individual solutions for individuals with specific neurological conditions. Please contact the centre for more information.