Development and provision of a clinical FES service

The authors' involvement in functional electrical stimulation (FES) began 13 years ago when they began investigation into the development of a standing system for complete paraplegics. This work was funded by the Medical Devices Agency of the Department of Health. During the course of this work the authors perceived that there were a number of incomplete paraplegics whose mobility could be improved by the provision of simple FES systems to dorsiflex the foot. At that time there did not appear to be a reliable, commercially available device in the UK. The subsequent grant further developed the stimulator, the Odstock Drop Foot Stimulator (ODFS) and established treatment protocols to improve walking function for patients with a variety of different neurological conditions such as CVA, MS and cerebral palsy as well as incomplete SCI. After the completion of the randomised controlled trial the authors obtain the approval of the South and West Development and Evaluation Committee in early 1996 which has made funding easier in certain areas. This trial showed that in the treatment group walking speed was increased by 21%, the effort involved in walking measured by the Physiological Cost index, PCI, was reduced by 25 %, that reduction in spasticity was more sustained and that patients anxiety and depression levels were reduced. All of these findings were statistically significant. The service has now been running for 5 years. The authors take referrals from both G.P.'s and Consultants and then apply to the patient's local Health Authority or to the G.P. if they are a member of a fund holding practice.