Research Evidence
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New evidence for the cost effectiveness of FES
Two recent papers on the cost effectiveness of ODFS Pace. Linda Renfrew’s paper reports on a randomised controlled trial that was funded by the MS Society and took place in Scotland. Flora Jukes study is a case series of patients receiving ... -
STEPS Study – FES User Day 8.12.2017
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Comparison of AFO and FES for correction of dropped foot
Comparison of AFO and FES for correction of dropped foot. -
STEPS Participant Information
The STEPS Study STEPS is an RfPB funded study to investigate the use of FES to improve the mobility of people who have Parkinson’s Disease. The 25 month study begins May 2016 and is taking place in Salisbury District Hospital and ... -
In Touch Article May 2015
New evidence for the use of technology to improve walking in Multiple Sclerosis and Stroke The Department of Clinical Science and Engineering at Salisbury District Hospital has published the largest case series to date of people who have Multiple Sclerosis (... -
Functional Electrical Stimulation to Elicit the Flexor Withdrawal Response in Gait
Kelly Robinson, from Burwood Spinal Unit in Christchurch New Zealand, presents a poster on the use of functional electrical stimulation to elicit the flexor withdrawal response to create or assist swing phase of gait in people with spinal cord injury. Click here to read ... -
Study summary – Use of FES and AFO’s with peristent foot drop in MS
This provides information on the study being planned in Scotland looking at the use of FES and AFO’s in individuals with persistent footdrop due to MS. -
Study flyer – use of FES and AFO’s with persistent foot drop in MS
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The practical clinical use of Functional Electrical stimulation in the treatment of people with multiple sclerosis (Journal abstract)
Data from a large audit study completed at OML on the use of FES in individuals with MS was presented at the RIMS Annual Conference in Brighton on 6th and 7th June 2014. The findings show ... -
A comparison of external and implanted FES for the correction of dropped foot in MS
This presentation gave an overview of the process involved in the impanted FES system STIMuSTEP and provided audit data on its use in MS. This was presented at the FES User Day in Sheffield on 26th June 2014 -
Large Scale Clinical Audit of Functional Walking Category and Associated Clinically Meaningful Changes for People with MS and Stroke
This presentation delivered the findings from a large audit looking at the effectiveness of lower limb FES on walking speed and walking category in those with Stroke and MS. This was presented at the FES User Day in Sheffield on the 26th June 2014. -
The effect of functional electrical stimulation and exercise on the quality of gait of people with secondary progressive MS (Conference abstract)
Abstract of a study examining the effect of FES for the correction of drop foot and hip instability, in combination with physiotherapy core stability exercises, on the gait of people who have MS. This study was presented at 3rd ... -
New FES publications Dec 2011
There have been two new journal articles published -
The Kinematic Effects of Common Peroneal Functional Electrical Stimulation (FES) in Chronic Stroke (CVA) and Multiple Sclerosis (MS) using a 3-D Model of the Shoe
Measurements of foot inversion/eversion during gait are of particular interest in people using common peroneal Functional Electrical Stimulation (FES). The aim of this project was to characterise gait kinematics with and without FES in 3... -
Electrocutaneous feedback system for patients with loss of sensation in their feet
This project looked at developing a feedback system for patients with sensory loss in their feet as a result of peripheral neuropathy. The development involved designing shoe insoles with tactile sensory which can detect and transmit contact and movement information to areas of ... -
Feasibility of combining physiotherapy and electrical stimulation to improve gait in patients less than 6 months post stroke
This feasability study examined the combination of physiotherapy with FES in sub-acute stroke patients (less than 6-months post-CVA). Group A received physiotherapy only and group B received physiotherapy and FES treatment. This study demonstrated the feasibility of integrating FES into physiotherapy. FES ... -
Shefstim: A clinical trial of automated FES setup for drop foot using the Shefstim electrode array stimulator
While FES is an effective technique of correcting foot-drop for patients with upper motor neuron lesions, a significant minority of FES patients have difficulties finding sites for electrodes which provide an acceptable foot movement. A potential solution to this issue is the use ... -
The cost-effectiveness of the ODFS and STIMuSTEP
This article revisits the original cost-effectiveness that was done for the DEC report and brings in other factors such as reduction of falls. The same analysis is also applied to the STIMuSTEP. The QALY analysis shows that the ODFS and STIMuSTEP (implanted ... -
Neuroprosthesis for footdrop compared with an ankle-foot orthosis: effects on postural control during walking (Journal abstract)
A comparison of FES with AFO splints in 15 people who had had a stroke. After 8 weeks of use, there was an improvement in gait symmetry indicating that balance was improved more by FES than the AFO. This ... -
Gait in individuals with chronic hemiparesis: one-year follow-up of the effects of a neuroprosthesis that ameliorates foot drop (Journal abstract)
A 1 year follow up of 16 people who had a stroke and used FES to assist their walking. Improvements in walking speed were seen both with and without the device. The full article is published in Journal of Neurologic Physical ... -
Spatiotemporal and kinematic effect of peroneal nerve stimulation versus an ankle-foot orthosis in patients with multiple sclerosis: a case series (Journal abstract)
A comparison between ODFS use, AFO use and no intervention for 4 participants with MS. Participants were new to the ODFS. The study showed that ODFS users obtained greater dorsiflexion at heel strike. Other gait parameters were more variable. ... -
Can alternatives to the forceplate be used for accurate detection of key gait events? (Conference abstract)
This study demonstrated that the footswitch system used by the ODFS and O2CHSII was extremely accurate when compared to kinematic measures taken using gait analysis. -
Using the Odstock Dropped Foot Stimulator: Users and Partner’s Perspectives (Conference abstract)
This qualitative study examined the opinions of users of the ODFS and their partners. The study indicated a significant impact on the life of ODFS users and carers. -
Recent findings regarding the efficacy of functional electrical stimulation in patients with chronic hemiplegia and multiple sclerosis: a narrative literature review (Journal abstract)
A review of research into the use of FES for correction of drop foot in MS patients. This literature review identifies that there are a number of benefits from FES in MS patients including gait parameters and acceptance of the device ... -
Long term therapeutic and orthotic effects of a foot drop stimulator on walking performance in progressive and nonprogressive neurological disorders (Journal abstract)
This paper presents case series data for FES users who had progressive (mostly MS) and none progressive (stroke and SCI) conditions resulting in drop foot. The study showed that both groups responded well with the device but the training effect seen in MS ... -
A literature review of the current use of electrical stimulation for lower limb treatment of children with cerebral palsy (Journal summary)
An abstract of a review paper on the application of ES in CP to asist walking and standing. Includes a useful reference list. The full article is published in Physiotherapy Ireland, 21(1): 25-28, 2000. -
A randomized trial to investigate the effects of functional electrical stimulation and therapeutic exercise on walking performance for people with multiple sclerosis (Journal abstract)
This abstract summarises the randomised trial of the ODFS in people who had secondary progressive MS. The control group received physiotherapy exercises. This quantatative study showed significant increases in walking speed and distance walked in 3 minutes when FES was ... -
User experiences, preferences and choices relating to functional electrical stimulation and ankle foot orthoses for foot-drop after stroke (Journal abstract)
This study reports a series of structured interviews with users of the ODFS who had a drop foot due to a CVA. It compares their preference for using the ODFS or AFO. In this qualitative research nearly all participants preferred ... -
Functional Electrical Stimulation in Hereditary Spastic Paraparesis (Conference publication)
This study measured the change in ankle stiffness and strength and their effects on foot clearance in people with FSP/HSP. The effect of FESon walking speed; efficiency and kinematics and its’ perceived effectiveness was explored. -
Dropped Foot Stimulator: From the first idea to a patient satisfactory device (Conference publication)
This conference paper summarises the development of FES in Salisbury. It describes the early research that supported the start of a clinical service leading to the NICE guidelines published for the approval of FES in walking. This was the key note lecture ... -
An investigation of the effect of functional electrical stimulation to assist the gait of children with cerebral palsy (Conference abstract)
This study looked at the use of electrical stimulation for ambulatory children with cerebral palsy. There is limited research of FES in paediatric patients but this paper investigates the use of FES in either the dorsiflexors (to correct toe walking) or plantarflexors (... -
Assessing FES-assisted walking in cerebral palsy children using a visual gait analysis scale (Conference publication)
This conference publication describes the use of the Edinburgh Visual Gait Analysis Interval Testing Scale as an outcome measure to assess gait in cerbral palsy patients who use FES. -
Non-repetitive Stimulation of the Common Peroneal Nerve (Conference Abstract)
This article describes the use of stimulation doublets to produce as stronger muscle contraction. This was used to modulate the stimulation envelope to mimic the natural activity pattern of the tibialis anterior muscle. -
A comparison of electrical stimulation and the conventional ankle foot orthosis in the correction of a dropped foot following stroke (Conference publication)
This study compared the effect of using FES for dropped foot and push off with an AFO in sub acute stroke (less than 6 months post-CVA). Both groups significantly improved their walking ability but no significant difference was found between groups. &... -
Retrospective study of patients using Functional Electrical Stimulation for drop foot correction and increased hip stability (Conference publication)
This audit examined the effect of using FES for hip extension and drop foot correction in stroke and MS patients in Salisbury. The audit identified that patients who used a two channel FES stimulator found that the technique was ... -
Is efficiency of gait improved in stroke patients using a dropped foot stimulator? (Conference publication)
In this study a reduced spring like model of walking was used to demonstrate the effect of FES on gait efficiency. The acceleration profile of the centre of force trajectory (COF) was considered as a good quality estimator of the spring system. FES ... -
The Orthotic Effect of Functional Electrical Stimulation on the Improvement of Walking in Stroke Patients with a Dropped Foot: A Systematic Review (Journal abstract)
This review article (published in 2004) looks at the evidence available for FES correction of dropped foot in stroke patients. Outcome measures of walking speed and effort (Physiological Cost Index) are included. The full article is published in Artif ... -
Does prior use of an Ankle Foot Orthosis (AFO) effect the response to use of the Odstock Dropped Foot Stimulator in chronic stroke patients? (Conference abstract)
This study indicated that both groups (those who had used AFOs prior to FES and those who had not used an AFO before using FES) responded well to FES. The non AFO users may have shown more long term ... -
The Effects of the Odstock Drop Foot Stimulator on Perceived Quality of Life for People With Stroke and Multiple Sclerosis (Journal abstract)
This study demonstrated that both MS and CVA patients who use the ODFS demonstrated an increase in quality of life measured using PIADS (psychological impact of assistive devices). While there was an overall increase in walking speed when FES was used, there was ... -
Impact on activities of daily living using a functional electrical stimulation device to improve dropped foot in people with multiple sclerosis, measured by the Canadian Occupational Performance Measure (Journal abstract)
This randomised controlled trial with people with secondary progressive MS demonstrated that use of FES improved activities of daily living (as measured by the COPM) and gave a reduction in the number of falls. No significant changes were seen in the ... -
The effect of combined use of Botulinum Toxin Type A and Functional Electrical Stimulation in the treatment of spastic drop foot after stroke: A preliminary investigation (Journal abstract)
This study looked at the effect of combining the use of the ODFS® with Botulinum Toxin to reduce the spasticity in the calf in 21 stroke patients. A significant improvement in walking speed was seen. The full article is ... -
Does the Canadian Occupational Performance Measure determine if the Odstock drop foot stimulator improves activities of daily living for people with Multiple Sclerosis? (Conference abstract)
A preliminary report of an RCT comparing FES and physiotherapy in MS patients. This publication particularly focuses on the affect on activities of daily living. -
Improvement in hand function and sensation in chronic stroke patients following electrical stimulation exercises: A pilot study
This study demonstrated the effect of exercising wrist and finger extensors in people who have had a stroke using the Microstim 2 exercise stimulator. An increase in hand function was demonstrated using the Jebsen Taylor hand function test. Also an improvement in hand ... -
Is transcutaneous peroneal stimulation beneficial to patients with chronic stroke using an ankle-foot orthosis? A within-subjects study of patients’ satisfaction, walking speed and physical activity level (Journal abstract)
A study comparing FES and AFO splints with 26 people who had a stroke. While no differences in walking performance were measured participants preferred walking with FES stating that it improved the stability of the effected side in weight bearing. Both devices had ... -
Therapeutic Effect of an Implantable Peroneal Nerve Stimulator in Subjects With Chronic Stroke and Footdrop: A Randomized Controlled Trial (Journal abstract)
This RCT compared the implantable drop foot stimulator (STIMuSTEP) to normal walking device (AFO, walking aid etc) in CVA patients. The outcomes included root mean square of tibialis anterior and peronei muscles as well as walking speed. There was no improvement ... -
The efficacy of Functional Electrical Stimulation in improving walking ability for people with Multiple Sclerosis (Conference publication)
A summary of the early clinical experience of using the ODFS and O2CHSII with people with MS in Salisbury. Analysis of this patient group showed improvement in orthotic effect whilst using FES and a reduction in effort (measured by the ... -
Relation between abnormal patterns of muscle activation and response to common peroneal nerve stimulation in hemiplegia (Journal abstract)
This paper examined the effects of different presentations of spasticity on the response to the ODFS during gait. FES was more beneficial to those who demonstrated a higher level of spasticity, this is thought to be due to reciprical inhibition. ... -
Optimising two channel stimulation to improve walking following stroke (Conference publication)
This study looked at the effect of combining dropped foot correction with hamstring stimulation or calf stimulation using a two-channel stimulator in CVA patients. Both set-ups resulted in improvements in walking speed and PCI. -
Neuroprosthetic effect of peroneal nerve stimulation in multiple sclerosis: a preliminary study (Journal abstract)
This preliminary study looked at using FES in MS patients during gait related tasks. The full article is published in Arch Phys Med Rehabil. 2009 Feb;90(2):362-5. -
How long do people use the ODFS for? (Conference abstract)
This audit looked at all ODFS users who started using the device in 1999 or 2004. The study shows that the average time the ODFS was used for was about 5 years. 26% of ODFS users were still using the device in 2010. The ODFS is ... -
Restoration of gait and motor recovery by functional electrical stimulation therapy in persons with stroke (Journal abstract)
This study investigated the use of electrical stimulation in sub-acute stroke patients. Both the control and FES group received conventional therapy. Improvements in walking speed and other gait parameters were shown in the FES group. The full article&... -
Clinical Use of the Odstock Dropped Foot Stimulator. Its Effect on the Speed and Effort of Walking (Journal abstract)
This paper was the the first to show a statistically significant training effect from the use of FES for the correction of dropped foot in people who have had a stroke. The paper describes the results from 151 people with stroke, MS or SCI ... -
Patients’ Perceptions of the Odstock Dropped Foot Stimulator (ODFS) (Journal abstract)
This qualitative study looked at patients’ perceptions of using FES. A questionnaire was sent out to current and old patients asking them why they used FES and any reasons for discontinuing. The full article is published in ... -
Different muscle activation patterns, identified during walking, in people with spastic drop foot (Conference abstract)
This paper describes how spasticity in the calf muscles can be exhibited in different ways in stroke patients. FES can be used in the presence of multiple presentations of spasticity. -
The effect of common peroneal nerve stimulation on quadriceps spasticity in hemiplegia (Journal abstract)
This paper describes results from the original randomised controlled trial (RCT) in stroke patients that showed the FES users received a reduction in quadriceps spasticity that was not seen in the control group. The full article is ... -
Therapeutic effects of Functional Electrical Stimulation in the upper limb of children with Cerebral Palsy (Conference abstract)
This study used electrical stimulation exercises to strengthen wrist extensors in children who had cerebral palsy. Improvements in wrist extension range of motion were found after 6 weeks of intervention and the improvement was maintained 6 weeks after stimulation stopped. -
An investigation into the relationship between types of muscle dysfunction and response to common peroneal nerve stimulation (Conference abstract)
This paper describes how drop foot can be due to paralysis in the dorsiflexor group, over activity in the calf muscles due to spasticity or inappropriate timing of muscle activity. -
Analysis used in determining a measure for spasticity in the calf muscles in stroke patients (Conference publication)
This paper describes the method used to analyse the EMG activity from the calf and dorsiflexor muscle groups and how it was used to define the different types of dysfunction that resulted in dropped foot. -
Clinical results of a preliminary investigation into the use of two channel stimulation to improve the quality of walking of patients with established hemiplegia (Conference abstract)
The Compustim 2B was a predecessor to the O2CHS FES device. This paper describes initial experience of its use to stimulate common peroneal nerve with either hamstrings, calf or triceps muscles and bilateral drop foot. Use of the device produced significant ... -
The effects of common peroneal stimulation on the effort and speed of walking. A randomised controlled trial with chronic hemiplegic patients (Journal abstract)
This article summarises the original randomised control trial (RCT) in stroke patients for the ODFS. This study was the first RCT of any FES device and showed significant improvements in walking speed and reduction in PCI (effort) when the ODFS was used.&... -
Provision of a clinical service for the correction of dropped foot (Conference publication)
A detailed narrative of how the FES service at Odstock, Salisbury started. -
Limb Blood Flow, Cardiac Output and Quadriceps Muscle bulk Following Spinal Cord Injury And The Effect Of Training For The Odstock Functional Electrical Stimulation Standing System (Journal abstract)
This paper describes the effect of training the quadriceps muscles using electrical stimulation in preparation for the Odstock Standing System. The study shows the course of muscle atrophy and reduced peripheral circulation following SCI and shows that muscle thickness and limb blood flow ...
Case Studies
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Lumbar Decompression Surgery: Correction of Foot Drop
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Effect of Drop Foot Stimulation On Proximal Kinematics
This presentation looked at two case studies whereby the proximal effects of drop foot stimulation had been analysed in a gait lab. This was presented at the FES User Day in Sheffield on the 26th June 2014. -
Dystonia Case Study- using two-channel FES to correct biomechanical changes
Case study of a lady with Dystonia affecting lower limb biomechanics and gait. The article describes initial problems and the improvement achieved with 2-channel drop foot stimulation. This patient made a signifficant improvement in her mobility as a result of FES.
Clinical Guidelines
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NICE Guidelines: Long Term Rehabilitation After Stroke
NICE have published a summary of their recommendations for stroke rehabilitation which incorporate guidelines for electrical stimulation(ES) for both upper limb and lower limb. While stating the ES for the upper limb is not routinely used for all patients, recommendations are given ... -
How to access FES (MS Society publication)
This is an excellent publication by the MS society that provides good background information and lots of practical advice that can be useful for any patient who is trying to get funding for FES treatment. Although this publication was produced for the benefit ... -
ODFSIII set up flow diagram part 2
A step by step guide to setting up the ODFSIII and solving clinical problems Part 2 covers adjusting the device for walking.
Clinical Advice
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Neurophysiology applied to FES set-up
A presentation that discusses the different paramaters on the ODFS Pace in relation to there effects on individuals gait and neurophysiology. This presentation is aimed at helping you to clinically reason the changes you make to the parameters on the device. -
New ODFS Pace Software v1.4
An introduction to new ODFS Pace software v1.4 and its key features. -
FES of Muscles around the Pelvis and Hip
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How to set up a dropped foot stimulator
FES Userday April 2017 Tips and tricks on using teh ODFS Pace. -
Trouble shooting workshop questions and answers
FES Userday April 2017 A questionnaire was sent out in advance of the meeting asking for questions that attendees would like to ask. -
Using a double footswitch with an ODFS® Pace/Pace XL
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Making FES more versatile (Newsletter article)
This article provides information on how FES can be versatile in terms of how it is worn. This can be of great benefit to individuals as often they are concerned about how FES will work with different items of clothing. -
Tips and Tricks – How to reduce toe clawing with FES
A quick tip on how FES can be used to reduce toe clawing both when walking and putting on shoes. -
A Little Bit about Batteries
A review of the types of batteries available, their characteristics and performance in relation to OML stimulators. -
ODFS Pace crib sheet for finetune and exercise menu software version 1.3
This crib sheet helps you to navigate through the finetune and exercise menus of the ODFS Pace software version 1.3. Please note in the software version 1.3 there are seperate parameters for the exercise mode which weren’t available on earlier software versions. -
“Tips and Tricks: Footswitch Connections”
This article offers solutions for managing the problem of accidental footswitch disconnection, during the use of drop foot stimulation. -
Skin irritation information sheet (Clinician)
Advice for clinicians in preventing and managing skin irritation associated with electrical stimulation. -
Skin Irritation Audit 2011
Summary of the findings of the Skin irritation audit, conducted at National Clinical FES Centre Salisbury in 2011. -
“Tips and Tricks: belt clip, velcro strap & velcro dots”
Description of attachment of ODFS® Pace to belt clip and use of leg strap. Use of velcro dots to attach footswitch in shoe. -
FES and mental capacity
A person’s potential to use FES, from the point of view of their mental capacity should be a distinct consideration when setting up FES. In Sheffield, we have had several occasions where the issue of mental capacity has not been clear-cut. ... -
Referral Criteria and contraindications for FES
This article describes the referral criteria and contraindications for people wishing to receive FES treatment at OML. -
ODFSIII set up flow diagram part 1
ODFS III Set up flow diagram. Part 1 A step by step guide setting up the ODFS III and solving clinical problems Part 1 covers placing the ... -
Salisbury FES service- iFESs FES Workshop Korea 2009
A summary of a workshop given at the 2009 IFESS meeting in Korea. The talk gave a practical description of the clinical FES treatments provided in Salisbury including FES in gait (ODFS III, two-channel, STIMuSTEP) and upper limb rehabilitation (including the REaCH stimultor). -
ODFS Pace setup flow diagram part 1
A step by step guide to the clinical setup of the ODFS pace for the correction of drop foot. Part 1 goes through placing the electrodes and solutions for clinical problems you may encounter. -
ODFS Pace Clinical Setup Flow Diagram part 2
A step by step guid to the clinical setup of the ODFS Pace Part 2 describes how to use the device in walking and ofers solutions for clinical problems you may encounter -
Using Frequency in the ODFS® Pace
This newsletter article describes the affect of changing frequency when treating FES patients. The older stimulator, the ODFS ® III had a fixed frequency, however the ODFS® Pace has the ability to vary the frequency from 20-60Hz. The clinical ... -
Multipurpose Two Channel Stimulator For Gait Correction
A description of the two-channel FES stimulator (O2CHSII) device. This report describes how a two channel stimulator works and some common algorithms for FES use in different muscle groups.