Salisbury FES Newsletter
The Millennium Edition
Setting up a clinical service
Electrode and skin care
Compustim - 10B two channel neuromuscular stimulator following stroke
Combining the use of Botulinum Toxin A and Functional Electrical Stimulation
'Long Pulse' Stimulation - stimulation of denervated muscle
World Wide FES
New phone numbers and e-mail addresses
Its a while since our last newsletter so we thought we would take this opportunity to wish you a merry Christmas and a happy New Year, nay, New Millennium.
Much has happened since last March. Jane Burridge, who last year gained her doctorate for her work on calf spasticity has recently been appointed as a senior lecturer at the University of Southampton to run their Rehabilitation MSc. Jane joined Medical Physics in 1993 to work on the original randomised controlled trial of the Odstock Dropped Foot Stimulator and did a huge amount to take what had been the sole preserve of bioengineers into clinical practice. In developing the training course she was instrumental in spreading the use of FES to other centres and now hopes to introduce it to the course in Southampton. Jane will maintain some links with Salisbury, maintaining research interests in FES and working one day a week in the department and will also help out with some of the courses. I would like to thank Jane for all her hard work over the last seven years and wish her all the best at Southampton.
Physiotherapist, Catherine Johnson joined the department earlier this year to work half of the time on the clinical service and the other half of her time on a trial of the use of Botulinin Toxin to relax calf tone with FES to correct dropped foot. More on this project later. We also welcome to the team Rune Thorsen who is a Danish Post Doctoral researcher who will spend 10 months in Salisbury. He is on an EU program to promote links between research groups. He is investigating the control of FES devices by voluntary EMG signals recorded from the same muscle that is stimulated.
This year has seen the ODFS go international. We supplied stimulators to the CREST project, an EU funded project to improve the mobility of people with incomplete spinal cord injuries which has centres in Denmark, Holland, Spain, Scotland and England. We have also supplied equipment to a research group in Zurich. Interest in FES still grows in the UK. We have held FES courses in Glasgow, Pontypool, Bath, Swansea, Birmingham and Salisbury.
Next April is the IPEM clinical FES meeting in Guildford. This is a muti-disciplinary meeting and is the main forum for discussion on the field of FES in the UK. We hope to see as many of you as possible there.
Jane Burridges new address:
School of Health Professions and Rehabilitation Science, University of Southampton, Highfield, Southampton, SO17 1BJ Tel: 023 8059 5908. Fax: 023 8059 5301 e-mail: email@example.com
1. Taylor PN, Burridge JH, Dunkerley AL , Lamb A, Wood DE, Norton JA, Swain ID. Patient's Perceptions of the Odstock Dropped Foot Stimulator (ODFS). Clin. Rehab. 1999; 13: 333-340
2. Paul Taylor, Jane Burridge, Anna Dunkerley , Duncan Wood, Jonathan Norton, Christine Singleton, Ian Swain. Clinical audit of 5 years provision of the Odstock Dropped Foot stimulator (ODFS). Artif Organs Vol.23, No. 5, May 1999
3. AH Woodcock, PN Taylor, DJ Ewins, Long Pulse Biphasic Electrical Stimulation of Denervated Muscle. Artif Organs Vol.23, No. 5, May 1999
4. Taylor PN, Burridge JH, Dunkerley AL, Wood DE, Norton JA, Singleton C and Swain ID Clinical Use of the Odstock Dropped Foot Stimulator. Its Effect on the Speed and Effort of Walking. Arch Phys Med Rehab. In Press, to be published December 1999
5. Kinsella S, OKeeffe D, Wood D, Lyons, GM. A case study of the effects of functional electrical stimulation for drop foot in a subject with hemiplegia. Physiotherapy Ireland Vol. 20 No.1: 9-13, 1999
IPEM Clinical FES Meeting
11th 12th April 2000. University of Surrey, Guildford.
This biannual meeting is organised by the Institute of Physics and Engineering in Medicine, is a multidisciplinary meeting intended to bring together all that have an interest in FES. It is the main forum for discussion of this discipline in the UK and also attracts over seas participants. There is an opportunity to present case studies and R&D in the form of aural presentations and posters. The deadline for abstracts is 16th January 2000. Please find enclosed a registration form.
We will be holding our annual user day on Saturday 16th September 2000, 10am till 4pm. The meeting is open to any one who has an interest in Salisbury FES. We invite you to present case studies or research results. Abstracts of each presentation will be published in the newsletter. The meeting is a good opportunity to share experiences and meet other clinicians working in the field. Cost £10.
Before clinicians can prescribe the ODFS or O2CHS for their patients,
they must attend a course. This is mandatory. Two courses are offered. The
introductory course gives an introduction to FES and its application in
neurorehabilitation. The course, which has a large practical content, is
intended to enable clinicians to select candidates for the ODFS and to set the
device up. Course participants can borrow the equipment used on the courses for
Newcastle Upon Tyne on February 11th and 12th At the Hunters Moor Regional Neurological Rehabilitation Centre, Hunters rd, Newcastle Upon Tyne NE2 4NR. Contact Julia MacKenzie, Physiotherapist Tel 0191 2195661 Fax 0191 2195665
Royal Shrewsbury Hospital on March 16th and 17th. 2000 Contact Jean Breakeu, Royal Shrewsbury Hospital Site North, Copthorne Rd Shrewsbury SY3 8XQ Tel 01743 261 419.
Wolfson Neurorehabilitation Centre, Copse Hill, Wimbledon, SW20 0NE. 7th and 8th of April 2000. Contact Clinical Specialist Judy Skinner 0181 725 4752
Salisbury District Hospital on 11th and 12th May 2000. Contact Paul Taylor or Geraldine Mann 01722 429065. Cost £125
Two Channel Stimulator Course
This course covers the use of the O2CHS and is intended for those who have attended the introductory course and have some experience of using the ODFS. Includes a 2 months loan of equipment. The course will be held on 25th and 26th May 2000 please contact Paul Taylor or Geraldine Mann 01722 429065. Cost £125.
This is a new course intended for clinicians who have completed the introductory course but have not had an opportunity to use FES in clinical practice and feel that they need to refresh their skills before starting to treat patients. The course will revise the basics of patient selection and the workings of the ODFS and then consist of practical sessions using the device. Includes a 2 months loan of equipment. This one day course will be held on Saturday 25th March. Contact Paul Taylor or Geraldine Mann 01722 429065 to reserve a place. Cost £50.
The ODFS and Microstim 2 are now made by a contractor but still supplied through Salisbury. There were a few teething problems with this change but these have now been ironed out. Some problems have be experienced with the level control and on / off switch which will be replaced with a more robust component in the next production batch. We have found a way of making the controls stiffer so they are less likely to be accidentally moved while in use.
Over the last few months we have introduced a new design of foot switch which is proving to be much more reliable than its predecessor, lasting on average, twice as long.
We are now able to offer a discount on bulk purchases.
Finally we have found a cheap supplier of batteries:
H-Squared Electronics Ltd, Conifer House, Old Bridge Way, Shefford, Bedfordshire, SG17 5HQ Tel: 01462 851 155, Fax: 01462 815 187
They supply Procell batteries, which are the industrial version of Duracell batteries for about £1 each when bought in bulk. They also supply Nickel metal hydride (NiMH) batteries which are the better sort of rechargeable battery and also the chargers for them.
As ever, we welcome any feedback on equipment so we can improve the device we offer. Comments to Paul Taylor or Stacy Finn.
No one has written us any letters. If you would like to contribute to the next newsletter, which will go out in the late spring, please send contributions to Paul Taylor.
Setting up a clinical service
Until April 99 it was possible to receive ECR (Extra Contractual Referral) funding to treat patients using FES. In April the funding system was changed and it is now often necessary to set up contracts with individual Health Authorities for provision of a service. Recently several different centres have asked us to provide information to help them put together business plans. Below is information we put together for a Trust that you can use as an example, recalculating the size of the service offered for your target population.
Information for a business plan
To estimate the number of cases you might expect to see a comparison can be made with the service we provide for Dorset. We have 51 patients from Dorset with whom we have had a service agreement for 3 years. In theory, everyone who requires treatment will be treated although of course there may be many GPs who have not heard of us. However, 51 cases could be considered to be the steady state at any one time from a population of 800,000. This works out at 64 cases per million population. If your area has a population of 300,000 then you would expect a steady state of about 20 patients on your books.
Our current model of treatment is five sessions in the first year. The first two are on consecutive days and are used to set the device up, educate the patient and their carer in its use and record walking speed and PCI. The following appointments are six weeks later, three months after that and then after six months. The next year the patient is followed up twice and subsequently once a year for as long as the stimulator is used. Experience has shown us that continuous follow up is needed to ensure the best is obtained from the treatment. This obviously leads to an ever-increasing number of patients to follow up although some discontinue use due to improved mobility or deteriorating health. If on average each patient is seen, say about 3 times a year, about 60 patient sessions would be required a year, each of approximately 1 to 1 1/2 hours length (although new patients require more time than follow ups and some patients may require more time for other reasons.) Additional time should be allowed for extra appointments for patients who have problems, for administration and for answering telephone enquires from patients who may need extra guidance etc.
We charge health authorities a flat rate per patient session of £190.50. 60 sessions would therefore bring in to your trust £11,430. This includes all equipment and consumables although patients provide their own batteries after the first one. Equipment remains the property of the department and must be returned when no longer required by individual patients.
The current cost of equipment is as follows:
|Microstim 2 kit||£267.75|
|4 channel exercise stimulator kit||£295.40|
|Odstock 2 Channel stimulator kit||£379.00|
Kits include all leads, batteries and electrodes etc.
|Cost||Average ODFS user|
|Foot switch||£22.40||2 per year|
|Foot switch lead||£11.20||rarely replaced|
|Electrode lead||£8.90||rarely replaced|
|Tubigrip cuff||£2.80||rarely replaced|
|Inner-soles||£2.60||1 per year|
|1.5" electrodes (pack of 4)||£6.70||6 packs a year|
The prices do not include VAT, however, VAT is not charged to NHS Trusts, as we are also part of the NHS.
Equipment is guaranteed for one year except for foot switches, which are only guaranteed for 1 month. After one year, all repairs are charged at a flat rate of £25. We aim to provide a next day repair service, however it is essential to have some spare equipment to cover breakdowns.
A service has been set up in Birmingham by Christine Singleton, Senior Physiotherapist at City Hospital, Dudley Rd., Birmingham who wrote an article about her experiences in the August 97 edition of this newsletter. Back editions of the newsletter are available on our web page www.salisburyfes.com. We may have some patients from your area and we would be pleased to pass them on to you (and their funding) to save them travelling to Salisbury. We would be happy to help in any way and would be pleased to pass on referrals we receive from your area.
Clinical Help from Salisbury
Our aim is to get you up and running as independent users of FES. However, many people do not feel confident to start using FES without further guidance. If you would like further help then it is possible for a member of the Salisbury team to attend a clinic at your centre. Normally it is necessary to charge for time and travel expenses but if you have bought a number of stimulators, the time for the first visit will be free. It is not our intention to run clinics at your hospital but enable you to get them started yourself. We are always available to offer advice over the phone.
If you have a particularly difficult patient, it might be beneficial to refer them to Salisbury. You would be able to follow the patient and gain experience.
Electrode and Skin Care
Last year we did a questionnaire survey of all the then current used of the ODFS (see reference 1 in the list of recent publications). One of the issues raised by the survey was that 22% of ODFS users had experienced skin irritation due to the electrodes at some time while using the stimulator. While many had overcome this problem and received benefit from using the device, we were concerned to take steps to reduce this problem.
The main reason for skin allergy is often poor hygiene. We now advise users to wash the skin with warm water before placing the electrodes. This also has the benefit of moistening the skin, which reduces its resistance to the flow of electric current, leading to lower levels of stimulation being used to achieve the desired movement. If skin creams have been used, this will remove them from the electrode area, again improving the conduction of the current. We also ask the user to lightly wash over the surface of the electrode with warm water to remove any debris or dead skin that may be picked up by the gel. This also has a second advantage as it rehydrates the gel, making the electrode stickier and it will stay in place better.
Pals 1 ½ " electrodes, if used daily for common peroneal stimulation, will generally last for one month. After this time they should be replaced. As electrodes age, the gel may become less homogeneous which will lead to different current concentrations over its area. Inevitably it will pick up dirt, which is not removed by washing and will generally not stick to the skin as it did previously.
Often, some users who have a lot of hair in the electrode area are tempted to shave the skin in order to make the electrodes stick more effectively. When the skin is shaved, often the razor causes many small scratches, which can encourage an allergic reaction to the gel. Never use a razor. If hairs are a problem they should be trimmed using scissors. Any other skin problem such as a cut, spot or graze could also cause problems so again the electrode should not be placed over that area until the skin is completely healed.
Finally, some users have been known to leave the electrodes on overnight (usually because they have problems locating the correct electrode position and dont want to lose it once it is found) and this has led to skin problems. It is important that the skin has some time each day to recover so electrodes must always be removed at night.
Following the above rules, skin problems have become less of a problem. However some problems still occur. If a skin rash appears, it is important that electrodes are not placed over that area again until the skin is completely healed. If the skin problem is only under one electrode, it is possible that the reaction is due to electrochemical effects. The normal output from the stimulator is asymmetrically bi-phasic meaning that while the current flows both in the positive and negative directions, the amplitude of the positive flow is greater but for a shorter duration than the negative flow. This can lead to ionic flow within the skin and chemical imbalance. The ODFS III stimulator has an alternative output of a symmetrical bi-phasic current in which the polarity of every other pulse is reversed, eliminating the ionic flow. This is usually effective at eliminating the skin problem. However, as both electrodes are now the same, the tricks that are often used to create greater or lesser eversion by choosing which electrode position will be the active or indifferent electrode can no longer be used.
If the skin problems reoccur or are under both electrodes, a different type of electrode can be used. A good alternative electrode is the Blue Pals electrode (5 x 5cm # 901 220) from Nidd Valley Medical Tel. 01423 799 113. When starting again after a skin problem it is important to re-emphasise the skin and electrode hygiene procedures discussed above. Patient education is paramount to successful use of the dropped foot stimulator.
A pilot trial to determine the optimum control algorithms and patient selection criteria for use with the Compustim 10B two channel neuromuscular stimulator following stroke
We have recently completed this study, which was funded by Action Research.
This work followed on from a previous study in which the Compustim 10B, a two channel microcontroller based stimulator, was developed and tested with patients following stroke. Results indicated that stimulation of the calf or hamstring muscles in addition to the common peroneal nerve, gained the most effective improvement in gait when the stimulator was used. In addition to this orthotic effect, a training or carry over effect into unstimulated walking was noted.
The objectives of the current pilot study were:
Fourteen patients were recruited all of whom had had a single stroke and had been treated with a single channel Odstock Dropped Foot Stimulator (ODFS) for at least six months prior to the study.
All subjects followed a CONTROL TREATMENT CONTROL study design in which TREATMENT was FES using a two channel stimulation with the Compustim 10B and CONTROL was single channel common peroneal nerve stimulation with the Compustim 10B. Each phase lasted twelve weeks. Each patient continued to use their ODFS for four weeks prior to the study as a baseline to establish whether their gait was continuing to improve.
Walking speed, Physiological Cost Index and Hauser Ambulation Profile were assessed at approximately four weekly intervals throughout the study. Gait analysis was performed at weeks 0, 12, 24 and 36.
During the trial two patients withdrew before using the second channel, one at week 11, for personal reasons and the other at week 4, because he found the stimulation from the Compustim 10B was not effective. Of the remaining twelve patients one died and one did not perform the final tests because of problems with the stimulator.
Patients presented with a dropped foot, corrected by common peroneal nerve stimulation, and either poor active push off or poor knee control. Three stimulation algorithms were used:
A scoring system was developed in this study, to describe patients gait. This may be a useful tool in the future to identify suitable patients and to monitor progress following treatment interventions such as FES.
Effect of using the second channel
Response to patient questionnaires
Of the eleven patients who completed the study ten chose to continue using the two channel Compustim 10B because they felt that it improved their confidence in walking and enabled them to walk faster and with less effort. Patients main criticism of the stimulator was that it was too bulky to wear comfortably.
Were the objectives of the study achieved?
Clinical Trial to compare electrical stimulation and the conventional ankle foot orthosis in the correction of dropped foot following stroke
We have been fortunate in securing a further grant for two years from Action Research to conduct this randomised control trial. This will again use the Compustim 10b stimulator, which is being made smaller and more manageable for patients to wear. The trial is being conducted because despite there being much published literature concerning the benefits of ankle foot orthoses (AFO) and of Functional Electrical Stimulation (FES) in improving hemiplegic gait, there is none comparing the two methods of treatment. Although we may feel that FES is a better treatment it is difficult to convince doctors to refer patients if there is no published research comparing the two methods, especially when there are always cost considerations.
Seventy-five patients will be recruited from centres in Salisbury, Bournemouth and Christchurch and Bath. We may well have to involve more centres in order to recruit enough subjects. We are looking at earlier stages of rehabilitation so that patients will have had a single stroke six months or less prior to the start of intervention and have been discharged from inpatient hospital care. Suitable patients will have a dropped foot and an inability to achieve an effective push off at terminal stance. They will be randomised into three groups:
Patients will continue on the trial for six months and outcome measures taken at monthly intervals.
These will include:
We hope to start recruiting patients for this trial in January.
Pilot study to investigate the combined use of Botulinum Toxin A and Functional Electrical Stimulation with Physiotherapy for spastic dropped foot in stroke
This study has been funded by IPSEN who produce Dysport, one of the commercially available forms of Botulinum Neurotoxin A (BoNTA). The aim is to investigate the combined effect of BoNTA and Functional Electrical Stimulation (FES) in the treatment of spastic dropped foot in stroke. BoNTA is injected into a spastic calf the medial and lateral heads of gastrocnemius and tibialis posterior as required - weakening the overactive muscles. FES is applied to the common peroneal nerve to reinforce dorsiflexion and eversion using the Odstock Dropped Foot Stimulator (ODFS III).
The study hypothesis is that whilst FES applied to the common peroneal nerve is able to reduce calf tone in many patients, through reciprocal inhibition, this is not always so. The use of the neurotoxin inhibits over activity in the calf and may reduce its braking effect on the agonists. This provides an opportunity for greater active ankle dorsiflexion and forefoot eversion, and may be further reinforced by the use of FES. It is hoped that the combined therapy will facilitate the re-education of a more normal walking pattern and improve function in stroke patients.
The participants have all had a single stroke of vascular origin within one year of starting the trial. They also have a premature activation of their calf muscles, identified by surface electromyography (EMG), at the beginning of the stance phase of the gait cycle. They must be medically stable and without serious psychological problems. Medical consent and informed consent from patients is obtained.
Patients are recruited from Salisbury District Hospital, Royal Bournemouth Hospital and Christchurch Hospital. 32 participants are required.
The study period for each patient is 16 weeks. This includes a 4-week baseline assessment period where data is collected before patients are randomly allocated into either the control or the treatment group. Both groups continue rehabilitation, including Physiotherapy 3 times per week as an in-patient, or twice weekly for outpatients. The Physiotherapy treatment activity is recorded in a simple table, where priority given to a specific treatment, such as gait-re-education is noted. Treatment session length and any additional comments are also written down.
The treatment group receives, in addition, the BoNTA and FES immediately following the baseline period. BoNTA is injected under EMG guidance. FES is set up following the standard procedure, usually 3 days after receiving the BoNTA. The patient typically builds up to using the ODFS III for most of the day; it may also be used during Physiotherapy sessions.
A battery of measures is used to assess all participants. Those used include walking speed, Physiological Cost Index to measure effort, the Rivermead Motor Assessment Scale, Modified Ashworth of the lower limbs. Clonus and the patients reflexes are also recorded. The Barthel Index is also used, along with the SF 36 Health Survey and a semi-structured interview.
EMG is recorded with a portable system where patients are able to walk on the ground fairly freely. Surface electrodes are used over the motor point of tibialis anterior and the lateral head of gastrocnemius. A small receiver is carried in a waist-high pack that connects to a computer. The software package called LabVIEW is used to present the data measured. From this the premature calf activation index, tibialis anterior activity index, and the push-off index are calculated.
The main problem to date has been a slower than anticipated recruitment rate of patients fulfilling the selection criteria. To address this problem and to ensure that the study is completed with sufficient numbers, we are hoping to extend our geographical area for recruiting participants.
The study is progressing well with very good commitment shown by the patients and the staff involved. Useful and interesting data are being gathered for analysis. This study may progress on to a larger trial if the results gathered during this phase suggest positive benefit to patients.
Long Pulse Stimulation - stimulation of denervated muscle
Functional Electrical Stimulation (FES) produces contractions in paralysed muscle by applying short pulses of electricity to the nerve supply of muscles. The pulse of electricity causes the membrane of the nerve to depolarise. This results in a nerve impulse being propagated to the muscle, causing the muscle to contract in a very similar way as it would have been had the nerve impulse resulted from natural processes. This technique has been found to be very effective when the nerve damage is confined to above the T12 level.
However, below T12 the spinal cord changes, dividing into many peripheral nerves which continue to travel down the spinal canal, exiting at different spinal levels between L1 and S3. If the spinal cord is damaged at these levels, the nerves are also damaged. Because a nerve fibre is a single cell with the cell nucleus at the top end, where it meets the spinal cord, the distal end of the nerve that is damaged also dies. It is therefore not possible to produce a contraction by stimulating the nerve. Muscle wastes away reducing the cushioning effect around bones and also reducing the blood supply to the area.
Nevertheless it is possible to produce a contraction in such muscles by exciting the muscle fibre directly, although this requires a much greater amount of charge in each pulse of stimulation. FES applications typically use pulses of around 300 millionths of a second long, whereas it can take a pulse of up to one thousand times longer to excite a muscle directly. Hence the term long pulse stimulation. Long pulse stimulation brings new problems such as this large amount of charge having electrochemical effects on the skin, and causing skin damage. Fortunately this can be avoided by following every pulse of charge by an equal and opposite pulse. This results in a net current flow of zero and so reduces the build up of certain ions at the skin/electrode interface which can irritate the skin.
Dr David Ewins and Alan Woodcock of the University of Surrey have designed a long pulse stimulator and an initial trial of the device in Salisbury, funded by INSPIRE, has recently been completed. The trial had five subjects, three of whom had complete paraplegia, two who had incomplete nerve damage in the arm and leg. It was found that it was not possible to produce a continuous contraction with long pulses, as only a series of individual twitches was generated. However it was found that as the muscle was trained, the amount of charge required to produce a contraction reduced. It was therefore possible to use shorter pulses and place them closer together, producing a fused contraction. This raises the possibility of producing functional movement but so far the contraction strengths have been quite weak. Indications of improved blood flow were seen using a technique known as thermography. This showed that skin temperature was increased, even when the stimulator had not been used that day suggesting that the amount of blood flow in that area had increased.
While the trial results were encouraging the training effect seen was not as great as had been hoped. The physiological measurements made regularly throughout the trial did not reach a plateau suggesting that further improvements could have been expected had the treatment period been longer. It took several weeks of the trial period simply to reduce the pulse length sufficiently to produce fused contractions. This reduced the time frame for exercise when it was thought that the main benefit to be had from these exercises would occur.
We are therefore starting a second trial in January 2000, with a considerably increased time for training and exercise. This should maximise the benefit evident from using long pulse stimulation. Five patients with lower limb denervation as a consequence of spinal cord injury will be recruited. The aim of the investigation is to quantify therapeutic benefits of the stimulation in terms of muscle bulk, resting limb blood flow and skin temperature. Changes in muscle excitability will also be studied and functional benefits of the treatment where appropriate. A further aim is to continue to develop treatment protocols for a future wider-scale clinical trial.
We would like to thank INSPIRE for funding both the original trial and the trial which is commencing January 2000.
World Wide FES
You are interested in Functional Electrical Stimulation. What can the Internet do for you? Due to saturation coverage in the media, most people are aware of the World Wide Web (WorldWide Wait!). However few people realise that as well as being a good place to buy books, it can also be a very powerful research tool.
The Internet has often been compared to a global library catalogue, with the books online; this is not a bad analogy. While in the old days it could take many hours of searching library shelves, now at the click of a mouse, you can go online to one of the major search engines (www.google.com; www.infoseek.com etc) and search for any topic you want instantly. Incidentally there is software available (http://www.ferretsoft.com/netferret/index.html) that sits on your PC desktop. You simply enter your search criteria to the package and then go off to the Internet and contacts all the leading search engines, automatically enters your search and downloads all the matching "hits" to your machine. You literally get the power of 20 or so different search engines and hence a far more thorough search. Similarly if you are interested purely in academic journals / articles, there is a multitude of web sites that allow you to search and immediately download the adobe pdf file of the journal / article document (www.sciencedirect.com; edina.ed.ac.uk; www.theses.com; http://www.ncbi.nlm.nih.gov/pubmed/).
Most good web sites have a standard structure and are clearly navigable. They contain information on products, current research, general information, links to other sites and contact details. I have designed and developed (with Gerard Lyons) the Centre for Biomedical Electronics, University of Limerick web site. Like many of our peers, it was felt that a web presence would be beneficial to the group. On our site (www.ul.ie/~cbe) you can find out background information on the group and its objectives. There is a section on the web site outlining the projects which we are currently involved in, as well as a list of all our publications. Finally no web site would be complete without a set of web links, to other related web sites. We have links to some of our partners web sites, which may or may not be of interest to the Internet reader.
If you "surf" to the Cleveland FES web site (http://fescenter.case.edu/) you are greeted with the following message: " This page is provided as a community resource on activities of the Cleveland FES Center and on broad topics in Functional Electrical Stimulation to increase health and independence for persons with disabilities." As it is a well-maintained site and excellent resource, it is a good place to start your FES information search from. Another good site is Salisbury District Hospital, England (http://www.salisburyfes.com)
Another important development with the advent of the Internet is the proliferation of email. This allows users to send almost instant text (and multimedia) messages to anywhere in the world. This can be done at a fraction of the time and monetary costs of the traditional postal system ("Snail mail"!). This too is a powerful tool for the dissemination of information. Mailing lists can be set up, with anything from two to two thousand people on the list. So when a mail is sent out, it is copied to everyone on the list. There are hundreds of these mailing lists on the Internet covering a wide range of topics. There is even a few for FES, once of which is based at (http://fourier.bme.med.ualberta.ca/~fes/fes.html). When there is a question, announcement (call for papers, grants, job opportunities etc) or any kind of relevant information, the information can be passed quickly and directly to the people who are interested in the area. (i.e. the people who have subscribed to the mailing list).
There is a wealth of information out there, Happy Surfing!
Derek OKeeffe is currently a Ph.D. student and Irish Health Board research fellow at the Centre for Biomedical Electronics, University of Limerick. Email: firstname.lastname@example.org.
Salisburys Web Page
These days, if youre not on the web, you dont exist so in a bid to join the 20th century before it became the 21st we set up a web page to advertise ourselves to the world. The page contains an introduction to FES, describes clinical services offered and the current R&D projects. We also advertise course, list publications and post back issues of this newsletter. Increasingly, patients are finding out about new treatments on the web and we have had several referrals that have resulted from patients going to their GPs after seeing our web page.
We would like our web page to help you. Firstly, if your institution has a web page then we would like to set up a link to that page so browsers can easily go from page to page. Please return the favour and set up a link to our page. Secondly, if you would like to advertise your service we would be pleased to post you details on the page (you do not have to have an e-mail address). Finally, if you are running a course or holding a meeting, we would be pleased to advertise it in the meeting section of the page.
Were nearly famous
The BBC Radio 4 program Testbeds on Jan 20th 2000 at 9pm will have a feature on FES in Salisbury.
Department of Medical Physics and Biomedical Engineering, Salisbury District Hospital, Salisbury, Wiltshire, SP2 8BJ Tel: 01722 429065 Fax 01722 425263
|Ian Swainemail@example.com||01722 429117|
|Paul Taylorfirstname.lastname@example.org||01722 429060|
|Geraldine Mannemail@example.com||01722 336262 Ex4868|
|Catherine Johnsonfirstname.lastname@example.org||01722 336262 Ex4868|
|Duncan Woodemail@example.com||01722 429121|
|Philip Wrightfirstname.lastname@example.org||01722 336262 Ex4868|
|Stacey Finnemail@example.com||01722 429118|
|Rune Thorsenfirstname.lastname@example.org||01722 429119|