Research Evidence
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Ultrasound Guided Shoulder Rehabilitaion Programme in People with Stroke
An informative presentation on the use of ultra sound to help infom the rehabilitation programme for shoulder problems post stroke. -
The FES-UPP project
FES Userday April 2017 The FES-UPP project is developing a new FES system that uses multi-channel FES to enable mass practice of functional tasks. -
Comparison of AFO and FES for correction of dropped foot
Comparison of AFO and FES for correction of dropped foot. -
A home based trial of the Sheffstim electrode array stimulator with automated set-up to assist foot-drop
This presentation provided information on the Sheffstim device and its use unsupervised use in the home environment. It also looked at its effectiveness at correcting drop foot compared to other FES devices available on the market. This was presented at the FES ... -
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. -
FES User Day Abstracts February 22nd 2013
Abstracts presented at the FES User Day Friday 22nd February 2013 -
FES User Day Summary February 22nd 2013
A Summary of the Day’s Proceedings by Trainee Clinical Scientist Aggie Dimunge. -
The long-term cost-effectiveness of the use of functional electrical stimulation (Journal abstract)
This abstract is an audit of all FES users with drop foot who began using the ODFS in 1999. The results show how long people can benefit from FES and how much it costs. The study suggests that previous estimates of cost ... -
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... -
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 ... -
Accelerometer-Triggered electrical stimulation for reach and grasp in chronic stroke patients: A pilot study (Journal abstract)
This paper describes the pilot study for the REAcH stimulator. 15 people who had chronic stroke used a two channel stimulator for hand opening and elbow extension triggered by movement of the arm. There was a significant improvement in hand function over the 12 ... -
The REAcH Project Participant Information
The Re-education of arm and Hand function (REAcH) study aims to investigate accelerometer-controlled electrical stimulation of the upper limb in stroke patients. This patient information document describes who was eligable to participate and what to expect from study. -
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 ... -
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 pilot study to investigate the effects of electrical stimulation on recovery of hand function and sensation in subacute stroke patients (Journal abstract)
This pilot study compared cyclical electrical stimulation of the forearm and elbow extensors to passive stretching. It looked at the affect of these interventions on hand function and sensation in CVA patients. The full article is published in Neuromodulation 2005 ... -
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 ... -
Variation in system gain when using voluntary EMG to control electrical stimulation of the same muscle (Conference paper)
This abstract describes the modulation of EMG activity in the presence of electrical stimulation. The results indicate that a period of time after the pulse before a sample of EMG can be taken that is representative of voluntary effort varies with stimulation intensity.&... -
Can treatment with upper limb electrical stimulation be justified in the severely disabled acute stroke patient? (Conference publication)
Patients with no upper limb function post-stroke were treated with electrical stimulation over their wrist extensors for eight weeks in addition to their usual therapy. These patients were compared to a similar group of patients post-stroke who had their usual therapy only. ... -
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 ... -
A pilot study to inform sample-size calculations for an investigation into the effects of Electrical Stimulation on recovery of hand sensation and function in stroke patients
A preliminary report desrcibing the sample size needed for a larger study investigating the use of FES (Microstim stimulator) in upper limb rehabilitation for CVA patients. -
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 ... -
Correction of bilateral dropped foot using the Odstock 2 Channel Stimulator (O2CHS) (Conference publication)
This study describes the clinical effect of using the O2CHSII for bilateral dropped foot correction. Statistically significant increases in walking speed and reduction of effort were recorded when FES was used in a variety of patient groups. -
The use of electrical stimulation for correction of dropped foot in subjects with upper motor neuron lesions
This article published in “Advances in clinical neuroscience and rehabilitation” gives an overview of the use of FES for the correction of drop foot. It includes early research and clinical development of the Odstock Dropped Foot Stimulator. -
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. -
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 ... -
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 ... -
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. -
Electrical stimulation exercises in the upper limb
A description of the clinical techniques used in the FES clinic for training upper limb function following stroke (CVA) and spinal cord injury (SCI). This includes pictures to help with electrode placement and desribes using the microstim exercise stimulator and the ... -
The Case for FES
A summary of the published evidence for using the ODFS. The article summarises the Randomised Controlled Trials (RCT’s), case series and economic evaluations (QALY and cost benefit) for using the ODFS for correction of drop foot. It also ... -
ODFS Reference list
A list of research references for the ODFS, STIMuSTEP and other FES dropped foot stimulators. This list is updated regularly. -
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 ... -
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.&... -
Sensory Amplification By Cutaneous Electrical Stimulation For Retraining Proprioception
This paper describes a system for retraining upper limb sensory function following stroke, specifically in the hand. In this case study, improvements were shown in both sensation and motor function. -
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. -
A clinical controlled trial of the Odstock Dropped Foot Stimulator (ODFS) for the correction of dropped foot in chronic stroke (Conference publication)
This article gives the results of the gait analysis performed as part of the original randomised control trial of the ODFS in chronic stroke. The analysis showed that people walking with the ODFS walked faster, more efficiently, took longer strides and improved the ...
Case Studies
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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. -
Skin Irritation Case Study part 1 October 2012
This is an article that shows the initial management of a patient with acute skin irritation, which developed soon after commencing an FES programme for drop foot.
Clinical Guidelines
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Upper limb video and SIGN guidelines
This article links to videos showing upper limb electrode placement around the shoulder and upper arm and also links to The Scottish Intercollegiate Guidelines Network (SIGN), document which recommends the use of electrical stimulation in stroke patients, at risk of developing shoulder subluxation. -
The DEC report: Report to the Development Evaluation Committee. Common peroneal stimulation for the correction of drop-foot
This report was presented to the South and West Regional Health Authority Development and Evaluation Committee in 1996. The report contained a QALY analysis of the ODFS using data collected in the original randomised controlled trial of stroke patients (Burridge 1997) and additional data collected ...
Clinical Advice
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Upper Limb FES positions From Birmingham Clinic April 2017 FES User Day
FES Userday 2017 A selection of upper limb electrode positions -
Upper limb tips and tricks
FES Userday April 2017 Presentation slides showing the standard treatment pathways and stimulation techniques for upper limb therapies. -
The use of electrical stimulation to aid stretching of the long finger flexors.
A useful tip on how to use electrical stimulation to aid a stretch of the long finger flexors. -
Upper limb probe stimulation
This article includes pictures and notes on how to use the probe to stimulate nerves and motor points in the forearm and the hand. -
Upper Limb Service Queen Mary’s Hospital, London
This presentation was part of the Upper Limb workshop that took place on a User Day. This presentation outlines the service provision at Queen’s Mary Hospital, the service pathway, outcome measures used and the limitations within the service. -
Swansea FES service: recent developments and outcome measures
This presentation describes the development of the FES service in Swansea. It also describes the outcome measures used, including speed and PCI over 10metres and patient surveys. The RS scan and Silicaon Coach are also introduced and may be used in gathering ... -
Referral Criteria and contraindications for FES
This article describes the referral criteria and contraindications for people wishing to receive FES treatment at OML. -
Using the ODFS as part of physiotherapy
The ODFS is not only a practical everyday mobility aid but is also a useful tool in the physio gym. This article describes how functional electrical stimulation by using the ODFS can be used in gait re-education following stroke, iSCI ... -
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). -
Full referral criteria and clinical pathway
A summary document providing all the essential information for clinicians making a referral for FES treatment. An introduction is given to FES and the main research evidence described. The referral criteria and clinical procedures are then described for both FES for walking and upper ... -
Splinting and FES in the upper limb
This article briefly discusses the use of splinting to assist upper limb electrical stimulation and covers some examples used in Salisbury. Splints were mainly used around the hand, although a small number of elbow drop-out casts were also used.