Current Research Projects

An investigation into the effect of Functional Electrical Stimulation on mobility and quality of life in people with Multiple Sclerosis.

This project is a randomised controlled trial of the use of the Odstock Dropped Foot Stimulator with people who have secondary progressive MS. The project will compare two groups of people, 25 who will use the Odstock Drooped Foot Stimulator and 25 who will receive some gait training advice. Both groups will receive equal contact time with research staff and will both undergo the same assessments.

The effect of the device will be assessed by measuring its effect on walking speed, the effort of walking (physiological cost index), walking endurance (distance walked in 3 minutes), the number of falls while walking and quality of life.

The project runs from 1st February 2003 till 30th January 2005 and is funded by a grant from the MS Trust.

Further information.

In conjunction with this project the research volunteers are being offered the opportunity to take part in an art project called Face to Face. This project aims to give a voice to people who participate in research in way not normally possible using a formal research approach. For more information please click on Face to Face.

Salisbury Contacts:

Paul Taylor p.taylor@salisburyfes.com

Geraldine Mann g.mann@salisburyfes.com

IMPULSE ISCI

(Improved Mobility through imPlanted fUnctional eLectrical Stimulation of nErves) Trial with people who have incomplete spinal cord injury

The purpose of this project is to investigate the safety and efficacy of the Finetech Implanted Dropped Foot Stimulator. This medical device is a 2 channel implanted neuromuscular stimulator intended for the correction of dropped foot following stroke. The device has been developed by the University of Twente and Roessingh Research and Development in Holland in collaboration with the UK based company, Finetech-Medical Ltd who have organised this trial.

The nerve that controls the lifting of the foot in walking is called the common peroneal nerve. At a point, just below the knee, this nerve splits into two branches, the deep branch and the superficial branch. The deep branch goes to the muscles that lift (dorsiflex) and turn inward (inversion) the foot while the superficial branch supplies the muscles that turn the foot outwards (eversion). In normal walking, a combination of these movements is required. Therefore an electrode is surgically inserted in both nerves enabling the movements to be controlled separately. The nerves are stimulated at a frequency of 30Hz, a pulse width of 300ms and at current amplitudes of up to 1mA. This causes nerve impulses to travel down the nerve to the muscle in the same way as naturally occurring nerve impulses. Power to run the stimulator is passed through the skin using radio waves from a small control box strapped to the outside of the leg. To stimulate the muscles at the correct time a foot switch (a small pressure pad placed in the shoe) is use to detect when the foot is lifted from the ground. Stimulation begins when the foot is lifted and ends when the heel is returned to the ground. Sensation from the electrical stimulation should be very slight and it is expected that users will quickly become accustomed to it. Use of the system will be automatic; the user only has to set the stimulation intensity using two control knobs. Once healing has occurred the operation site scars should be negligible. It may be possible to palpate the implant under the skin but it is not expected to be noticeable to the eye.

The five devices have been implanted in The Netherlands and five in Salisbury in stroke subjects. It is expected the device will also be applicable to people with other neurological conditions. This work is funded by Medlink. A second trial is now planed but this time with people who have a dropped foot due to incomplete spinal cord injury. This will involve spinal units in Glasgow, Stoke Mandaville and Salisbury.

The Finetech Implanted Dropped Foot Stimulator was awarded a CE mark 24th November 2004. For more information regarding the planned clinical service for stroke click STIMuSTEP implanted dropped foot stimulator

More information

Salisbury Contacts:

Paul Taylor p.taylor@salisburyfes.com

TUBA (Transceiver and inertial Unit for Biomedical Application)

This project is a development from the IMPULSE project and aims to refine the technology of the original system. New RF electronic techniques will be used to improve the transmission of power and control signals between the implant and transmitter and movement sensors will be developed to replace the foot switch. The project is funded under the European Union 5th Frame work programme and brings together partners from Finetech Medical (UK), European Technology for Business (UK) University of Salford (UK), Roessingh Research And Development (NL) And University College Cork - National University of Ireland, (NMRC - UCC) Jan 2002 - Jan 2005

NEWS

Salisbury Contacts:

Paul Taylor p.taylor@salisburyfes.com

Ingid Wilkinson i.wilkinson@salisburyfes.com

For more information regarding the planned clinical service for stroke click STIMuSTEP implanted dropped foot stimulator

Development of an EMG controled hand opening system for hemiplegia following stroke

It has been postulated that the re-education of movement in the upper limb can be improved if the electrical stimulation exercises can be performed as part of a functional task requiring greater conscious effort from the patient. Several devices have been developed which allow the subject to trigger a stimulator by shoulder movements, by a foot pedal control or from residual EMG signals from wrist extensors, there by opening their hand to grasp or release an object. This work was the subject of a Ph.D. project at Southampton University, part funded by the Wessex Rehabilitation Association (April 1997-2004)

More information

Clinical results

Salisbury Contacts:

Paul Taylor p.taylor@salisburyfes.com

OGFO Odstock Grasp Function Orthosis

This project is to develop an implanted device to assist hand opening following stroke. It is common to loose the ability to open the hand while still retaining the ability to grasp. The same 2 channel implant used in the IMPULSE project (Finetech Implanted Dropped Foot Stimulator) will be used to activate the nerves that control wrist, finger and thumb extension. The device will be controlled using the EMG techniques developed in the above project. The initial project will develop the hardware and software for the device. Further funding will be obtained to pilot the clinical use of the device. The project is funded by EPSRC and will run from August 2002 to March 2004.

More information

Salisbury Contacts:

Rod Lane rodlane@salisburyfes.com

Paul Taylor p.taylor@salisburyfes.com

A pilot study to investigate a programme of electrical stimulation to the buttock (gluteal) muscles of spinal cord injures persons for the reduction of seating pressures

Pressure sores are a common complication following spinal cord injury. It is generally believed that they are coursed by high seating interface pressures leading to an occlusion of blood circulation in the tissue immediately under sacrum and pelvic bones. When the blood flow is restricted, the tissue is starved of oxygen and dies. It has been shown by other clinical trials that it is possible to increase the muscle bulk and local blood circulation in the muscles of the thigh using electrical stimulation exercises. The aim of this study is to use the same techniques to increase the bulk of the buttock muscles and investigate if this might lead to a reduction in seating pressures. This is possible because the increased padding the muscles may produce may cushion the areas underneath the pelvis and sacral bones. In this project volunteers who have a spinal cord injury will be given electrical stimulation exercises for a period of 6 months and their seating pressures will be monitored.

Contact: Carol McFadden cmf@salisburyfes.com

Parkinson's Disease Research Study

The department of Medical Physics & Biomedical Engineering has been awarded a grant from the Parkinson's Disease society to investigate the use of FES to improve walking in PD. The study is 1 year in duration (Feb 03 - Feb 04) and will have 10 participants. There is a 4-week pre and post treatment period. The treatment period, when the FES device is issued, is 8 weeks.

Method

The Odstock Dropped Foot Stimulator (ODFS) will be used to stimulate dorsiflexors within the swing phase of gait, as we currently do with stoke and MS patients. The device is triggered by a foot-switch and stimulation is applied via surface electrodes. The ODFS will be used to provide a sensory cue along with a foot-lift. By doing this, it is hoped that people with PD will have a larger and more regulated stride length, along with improved heel strike. We will also be looking at 'freezing', which can occur at the start of a walk, whilst walking and when turning. Falls will also be monitored throughout the trial. Walking speed, distance, stride length, Physiological Cost Index (PCI) are some of the parameters being recorded.

Cueing

Many studies have been carried out looking at the effect of cueing on people with PD. They show positive results and people will be familiar with techniques such as visual cueing, such as placing strips on their carpet at home to regulate stride length, and auditory cueing such as rhythmical music or by using metronomes. As described, the ODFS will provide a sensory cue, and may have advantages over the above because it will adapt to the user's walking speed and can be used anywhere.

Results

The study is incomplete and we have had some difficulty recruiting. We are currently half way through the trial and have not done full statistical analysis. For the several participants of the trial there does seem to be a benefit and all people finishing the trial have chosen to keep the device to assist their mobility. A case study will be presented at this years FES User Day - 5th December 2003.

Contacts:

Stacey Finn s.finn@salisburyfes.com

Geraldine Mann g.mann@salisburyfes.com

academic

Healthy AIMS (Ambient Intelligent Micro-Systems for Health)

European Union 6th Framework Programme Integrated Project

The Healthy AIMS project is an integrated project involving 27 partners from industry, academic and health care in 9 countries, with the intention of developing microsystems technology in the field of medical implants. The technology is aimed at a wide range of applications but with similar requirements, enabling the exploitation of common core components and techniques. In this way costs can be reduced for any one application and the speed of development increased. The project was originated from the NEXUS Association Medical Application Group. This is a trade association that aims to promote the development of microsystem technology by encouraging interaction between its menders. The project application process was lead by Diana Hodgins of European Technology for Business (ETB) who has now taken on the role of project co-ordinator.

The project will develop applications in the following areas:

These devices all have common requirements in the following areas

Salisbury has been asked to take the lead in developing and testing FES applications.

More information

Salisbury Contacts:

Rod Lane rodlane@salisburyfes.com

Paul Taylor p.taylor@salisburyfes.com


Who can use FES? Contraindications and precautions.

How to be referred for treatment.

If you would like to be involved in one of our research projects, you must first be referred to us by your GP or hospital Consultant. Referrals can be made to Prof. Ian Swain, Department of Medical Physics and Biomedical Engineering, Salisbury District Hospital, Salisbury, Wiltshire, SP2 8BJ. If you would like more information, you can write to us at the above address, phone us on 01722 429065 or email us at enquiries@salisburyfes.com

For other centres providing clinical FES go to our Clinics page

How to get to Salisbury District Hospital

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News Letters For more information on FES, check the back issues of our news letters.

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