FUNCTIONAL ELECTRICAL STIMULATION (FES) FOR FOOT DROP Evidence-based Practice Workshop June 2015 Northeastern University Megan Helfrich

Table Of Contents Objectives What is FES? FES for Foot drop Pros of FES Cons of FES Indications Contraindications Precautions Reflective Note References

Objectives By the end of this presentation you should be able to: Explain to a patient how FES is beneficial for their condition Determine if a patient should be using FES Determine if a patient is/is not eligible to use FES

What is FES? FES: Is a technique used for restorative therapy Applies electrical current to excitable tissue with the aim of stimulating peripheral nerves Goal of FES: to restore tissue function that is lost and increase activities of daily living (ADLs) in patients who suffer from neurological impairments Common Neurological Impairments that use FES: Multiple Sclerosis (MS) Stroke Brain/Spinal Cord Injury

FES for Foot drop Foot Drop: the paralysis or extreme weakening of muscles involved in dorsiflexion. People who suffer from foot drop walk very distinctly, either raising their knee higher or swinging their leg to the side, to prevent their toes from dragging across the ground, or tripping Causes of Foot Drop: Typically the result of peroneal nerve damage, which is the nerve that controls the muscles, specifically the anterior tibialis, in control of one’s ability to dorsiflex his or her foot

FES for Foot Drop Past Treatment for Foot Drop: An ankle foot orthosis (AFO) was provided to reduce effects of foot drop and improve gait ability by providing a barrier to keep the foot from dropping when walking. Why FES is a more beneficial treatment: FES involuntarily activates the muscles involved in walking, preventing muscular atrophy, and trying to create or fix existing neural connections between the muscles and the peroneal nerve. This ideally works to regain better function of those muscles and reduce effects of drop foot.

FES for Foot Drop WalkAide uses functional electrical stimulation (FES) to restore typical nerve-to-muscle signals in the leg and foot, effectively lifting the foot at the appropriate time. The resulting movement is a smoother, more natural and safer stepping motion. It may allow faster walking for longer distances with less fatigue. In fact, many people who try WalkAide experience immediate and substantial improvement in their walking ability, which increases their mobility, functionality, and overall independence. A sophisticated medical device, WalkAide uses advanced tilt sensor technology to analyze the movement of your leg. This tilt sensor adjust the timing of stimulation for every step. The system sends electrical signals or stimulation to the peroneal nerve, which controls movement in your ankle and foot. These gentle electrical impulses activate the muscles to raise your foot at the appropriate time during the step cycle (in text citation and proper formatting needed). WalkAide, a FES device for foot drop, explains why FES, specifically its product, is a beneficial treatment (2015):

Pros of FES Non-invasive Restoration of voluntary muscle movements Portable Easy to use Reliable

Cons of FES Uncomfortable pins-and- needles feeling Has many contraindications Expensive Skin irritation can occur under electrodes Isn’t always effective Dependent upon if the electrical current can create connections between the muscle and nerve

Indications Increase circulation Increase healing of tissue Muscle Retraining Muscle strengthening Pain Control

Contraindications Across the Chest Arrhythmias Arterial-Venous thrombosis Cardiac Pacemaker Electronic Implants Lymph Cancer Peripheral Vascular Disease (PVD) Pregnancy –lower abdomen/lumbar region Skin Cancer Superficial Metal Unstable Fractures Uncontrolled seizures

Precautions Anesthetic Skin Cancer Cognitive Impairment Obesity Open Wounds Pregnancy Scars Seizure Precautions

Things to Remember Make sure to receive an extensive patient history to decide if the patient is eligible or not Decrease resistance for optimal current flow: To do this: Clean Skin Warm Skin Optimal Placement Increase frequency

Reflective Note Evidence-based practice is crucial for all healthcare providers. Doctors have to make sure they are up to date with the most recent technology and evidence, to treat their patients as best they can. I decided to make this PowerPoint a presentation during an evidence-based practice workshop that doctors must attend. It provides new treatment options for foot drop and explains them in a concise and professional setting. I used some medical terminology that I would not normally use if I were presenting this to a patient with the condition. It is meant for healthcare providers to understand and begin treating foot drop with this new course of action. A lot of the information that I have about foot drop, FES, and Indications/Contraindications/Precautions is information that I know from on-the-job experience.

References - Drop Foot (Foot Drop). (2006). Retrieved June 10, 2015, from FootAnkleConditionsDropFoot.asp - Functional electrical stimulation| FES powered therapy (2015). Retrieved June 10, 2015, from - Neuroprosthesis Control Group. (2014, October 7). Retrieved June 10, 2015, from control.ee.ethz.ch/~ncg/previous_projects/elecstim.php - Peckham, P. H., & Knutson, J. S. (2005). Functional electrical stimulation for neuromuscular applications*. Annu. Rev. Biomed. Eng., 7, Posterior Leaf Spring AFO. (2015). Retrieved June 16, 2015, from orthotic-product.asp?prodId=17 - THE ODFS Pace, a Functional Electrical Stimulation (FES) Device: How it helps walking. (2015). Retrieved June 10, 2015, from - WalkAide. (2015). Retrieved June 10, 2015, from orthopedic-care/walkaide/ - WalkAide & Foot Drop. (n.d.). Retrieved June 10, 2015, from patients/Pages/default.aspx