Text from a poster to be presented at 13th European Congress of Physical & Rehabilitation Medicine Briton 28-31 May 2002
Using the Odstock Dropped Foot Stimulator: Users and Partners Perspectives.
L. Malone, *C. Ellis-Hill, I. Swain
Department of Medical Physics and Biomedical Engineering, Salisbury District Hospital, United Kingdom. Email: firstname.lastname@example.org *University of Southampton, United Kingdom. Email: C.H.Ellis-Hill@soton.ac.uk
The Odstock Dropped Foot Stimulator (ODFS) is a single channel neuromuscular stimulator providing peroneal stimulation to correct dropped foot. Previous studies are quantitative in nature. There is no research exploring peoples use of the device from their own perspective. By using a qualitative design, this study explored the experiences of people using the device and their partners views. The participants reported that the ODFS had changed their lives. The ODFS users were more socially confident with the device, as it reduced the risk of tripping and/ or falling. Partners felt more confident leaving the ODFS user alone at home. The main problems reported included electrode positioning and finding suitable clothes to wear with the device. Overall, the participants wished that more people were aware of the device and that access to it was made easier.
The Odstock Dropped Foot Stimulator was designed at the Department of Medical Physics at Salisbury District Hospital in 1988 to correct dropped foot. This is a common problem experienced by people with an upper motor neurone lesion, where somebody is unable to lift their toes clear of the ground when walking. The ODFS is a single channel portable device providing electrical stimulation to the common peroneal nerve, to elicit ankle dorsiflexion and eversion. A clinical service was established at the Department of Medical Physics and Biomedical Engineering in 1996, following submission of research findings to the United Kingdom South West Region Development and Evaluation Commitee. Previous studies published on the use of devices to correct dropped foot have focused on the effects on walking ability using standardised measures, such as walking speed and effort involved . Questionnaires [2,3] designed examining the use of devices at home report potential benefits as well as problems associated with its use. There are no studies exploring peoples use of the device from their own perspective. Subsequently the aims of the study were a) To explore the personal experiences of people using the ODFS and the meaning that the device holds in their lives, b) To explore partners views of the device and the meaning that the device holds in their lives.
Ethical approval for the study was obtained from Salisbury Local Research Ethics Committee. Professor Swain, as the guardian of the database held at the Department of Medical Physics and Biomedical Engineering, identified patients using the ODFS between 6-24 months, living within 50 miles of Salisbury. Professor Swain obtained written consent from the doctors who referred the patients to the department, to invite the patients to take part in the study. Twelve people out of seventeen contacted the researcher agreeing to participate. Separate narrative interviews were conducted with ten of the ODFS users (length of use, median = 8 months, range 6-19 months) and five partners in their own homes. In addition, two couples chose to be interviewed together. People were asked to tell their story of their life before and after ODFS use. Data on demographics, ODFS use, social and work activity (using the Frenchay Activities Index)  was collected to aid comparison with previous quantitative studies and describe the participant group. The interviews were tape-recorded and transcribed verbatim. Each transcript was read and re-read to identify issues important to each participant. Similarities and differences were compared across all the interviews. A small number of transcripts were read by a second researcher and the interpretations compared.
The age of the participants ranged from 41-73 years with a mean of 54.7 years. Interviewed were eight men and four women using the ODFS. The main diagnosis was multiple sclerosis and the second stroke. Other neurological conditions included spinal cord damage and cerebral palsy. Out of 45 on the Frenchay Activities Index, the participants using the ODFS scored from 13-41, with a median of 30. This indicated that overall the participants appeared to be managing at a fairly high level of independence 
All the participants reported that the ODFS had changed their lives. Although this is just a small piece of equipment, the benefits reported were wide ranging. People described it as being an integral part of their lives, so much so that one participant using the stimulator stated "I often think to myself when Im walking home, what if I was mugged. In all that time to get it, two years. What if I were mugged. You know, that would be awful." The benefits described appeared to be linked back to peoples mobility.
Prior to using the ODFS all the participants reported tripping and falling. As one lady said "I was falling over at least once a day and I mean really really bad, sort of smashing up face kind, of wreaking glasses and bruises like youve never seen. I described it as if someone was picking me up "The participants reported spending time in and out of hospital. They described losing confidence with their walking. They had to concentrate all the time, looking at their feet. Overall they became more and more tired, which impacted on other areas of their lives.
With the ODFS, participants described feeling more socially confident with the device as it reduced the risk of tripping and falling. They were able to walk faster and for longer distance. Participants described feeling that their walking was more normal and required less effort, as they did not have to concentrate so much on their walking. Five participants using the ODFS spoke of not needing to use their walking stick any longer. As one gentleman described after a period of using the ODFS, "I dropped the walking stick, which forced me to walk more upright, almost like a neolithic man coming up and the suns come out ever since." There appeared to, be a knock on effect in performing activities of daily living. Opportunities for work, social and leisure activities increased. Partners reported feeling more confident to leave the ODFS user on their own at home.
The main problems experienced with its use included, initial difficulty finding the correct electrode positions As one person stated "It was a nightmare to begin with. I nearly binned it. "However, this was resolved by all but two participants. In addition, all the women and their partners and several of the men, described difficulties finding suitable clothes, as they all wanted the device to be kept hidden from the sight of others. All the women felt that it was difficult to wear a skirt or dress with the device although most found ways of keeping it discrete. The participants felt that the stimulator box could be made more compact, and some felt that an implanted device would be advantageous. Problems with unreliable equipment, namely the foot switch, was experienced by two of the participants using the ODFS. Overall however, the participants reported that the benefits far outweighed any difficulties reported. As one lady stated "After my glasses it is the first thing I put on in the morning and the last thing I take off at night. "Even though the researcher was not actively involved in the treatment of the patients, the researcher was a member of the Department of Medical Physics and Biomedical Engineering. Ideally the study should have been conducted through an independent organisation.
This limited study has shown that the ODFS had far reaching effects on participant s lives. Throughout the NHS although it is recognised by the Royal College of Physicians of England as a suitable treatment for people following stroke, some areas of the United Kingdom are able to refer people with a wide range of neurological conditions. Some just people with stroke, whereas others are unable to refer in significant numbers. The participants who took part in this study were generally pleased with the ODFS as well as the service received, and all expressed a wish that it was more widely available. As one gentleman summarised "It has been absolutely outstanding. It has really changed my life completely. The world looks complete again because you can touch it, you can taste it all. Because you can walk better you can do more things. You find things are available to you, you thought the door had been closed on. You obviously cant see these things, nobody can, but it doesnt just stop with being able to put one foot in front of benefits to society are far reaching and it should be marketed that way. It could change peoples lives. They could be more useful members of society rather than sitting indoors lone, not wanting to go out, because they are afraid to walk."
This study was conducted as the final part of a Masters Degree in Rehabilitation and Research at the University of Southampton. The work was funded partly by a grant from the Department of Health; the Department of Medical Physics and Biomedical Engineering, Salisbury District Hospital; and Southampton. The researcher would like to thank her supervisor Dr Caroline Ellis-Hill, at the University of Southampton; the team at the Department of Medical Physics, at Salisbury District Hospital; and especially the participants themselves.
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