Informal Debate Forum
At this years FES User day we had an open forum debate to discuss any problems or issues relating to FES. This type of forum can smoothly glide along with topics being eagerly debated. Solutions to common or uncommon problems freely flowing around the room or a deathly silence can ensue leaving the facilitator with clammy hands, a flushed face and with a desire to be anywhere other than the forum floor.
So firstly before I report on the topics debated, I would like to thank all those that contributed and made my task of facilitator unbelievably enjoyable. Also I’d like to thank Catherine who scribed during the session, which enabled this feedback to be given. I have only included a few of the topics as a memory jogger to the session.
The session was opened with a discussion on the treatment of acute strokes.
An opening statement was made that time commitment, and human resources appeared to dictate what program of stimulation the user was given: once or twice a day etc. and for how long.
The question being, did others around the room feel this to be the case in their hospital and secondly was there any evidence to suggest optimal dosages?
There was a general agreement that time commitment and human resources did to a large extent drive the program of stimulation given, especially if the recipient required supervision, during stimulation.
Summary the reasons that clinicians felt influenced both treatment time and frequency of treatment:
No known research evidence is available that compares different stimulation programs suggesting optimal programs, for different patients.
So if anyone reading this has an interest in research! Well who knows?
The next issue that was brought up for discussion was Epilepsy.
The outcome of this discussion regarding Epilepsy was that a request was made that if any patients with epilepsy experience any adverse effects, that the clinicians report the incident to Salisbury. Salisbury will then inform the Medical Devices Agency.
THE PRECAUTIONS REMAIN THE SAME: FES SHOULD NOT BE USED ON PATIENTS WITH UNCONTROLLED EPILEPSY.
Remaining on clinical issues ‘Tolerating the sensation’ of FES was discussed.
Tips were given on how to increase a patient’s sensory tolerance to FES.
Patients find blue pal electrodes are more comfortable (Increasingly we are using 50 x 50 mm blue pals electrode as a first choice in Salisbury. As we buy them in bigger and bigger quantities, the price is now nearly the same as the 1.5mm round pals)
Initially a patient, who is very sensitive, may have FES introduced at sub- clinical levels until the patient is happier and tolerating the sensation before raising the level achieving a motor output.
Using the Microstim 2 exercise stimulator prior to introducing a functional stimulator. This stimulator has a very slow rising ramp, which can be more comfortable than the shorter ramp used in the ODFS. At Salisbury a person may be set up with a Microstim 2 initially, delaying the ODFS set up until their next appointment, 6 weeks later.
Allowing the patient to take control with of the progression of the intensity has been found to be a successful method of improving sensory tolerance. This often works well with kids.
What do you think?
A web chat forum could be set up on our web site to assist the transfer of knowledge between clinicians, open to FES clinical users only. Novel solutions to problems maybe gathered or innovative usage of FES again can be promoted or discussed.
Do send back your thoughts, as we are not likely to put in the work needed to create a chat forum if only one person is excited by the idea.
Thank you for you time.
See you next year
Carol McFadden