Development of clinical guidelines for service provision of functional electrical stimulation to support walking: mixed method exploration of stakeholder views.

BACKGROUND: Over the past 20 years Functional Electrical Stimulation (FES) has grown in clinical use to support walking in people with lower limb weakness or paralysis due to upper motor neuron lesions. Despite growing consensus regarding its benefits, provision across the UK and internationally is variable. This study aimed to explore stakeholder views relating to the value of a clinical guideline focusing on service provision of FES to support walking, how people might use it and what should be included. METHODS: A mixed methods exploration sought the views of key stakeholders. A pragmatic online survey (n = 223) focusing on the study aim was developed and distributed to the email distribution list of the UK Association for Chartered Physiotherapists Interested in Neurology (ACPIN). In parallel, a qualitative service evaluation and patient public involvement consultation was conducted. Two group, and seven individual interviews were conducted with: FES-users (n = 6), their family and carers (n = 3), physiotherapists (n = 4), service providers/developers (n = 2), researchers (n = 1) and distributors of FES (n = 1). Descriptive analysis of quantitative data and framework analysis of qualitative data were conducted. RESULTS: Support for clinical guideline development was clear in the qualitative interviews and the survey results. Survey respondents most strongly endorsed possible uses of the clinical guideline as ensuring best practice and supporting people seeking access to a FES service. Data analysis and synthesis provided clear areas for inclusion in the clinical guidelines, including current research evidence and consensus relating to who is most likely to benefit and optimal service provision as well as pathways to access this. Specific areas for further investigation were summarised for inclusion in the first stage of a Delphi consensus study. CONCLUSIONS: Key stakeholders believe in the value of a clinical guideline that focuses on the different stages of service provision for FES to support walking. A Delphi consensus study is being planned based on the findings.

Does acupuncture help patients with spasticity? A narrative review.

Spasticity is a motor disorder encountered after upper motor neuron lesions. It adversely affects quality of life in most patients and causes long-term burden of care and has significant financial implications. The effect of conventional therapies for spasticity including physical therapy, surgery, and pharmacotherapy are not always satisfying because of the short-term effects or side effects in some patients. Acupuncture is a part of traditional medicine originating from China. It has been used to resolve functional recovery problems after central nervous system injury for many years in Asian countries and is increasingly popular in western countries. Some researches suggest that acupuncture has therapeutic potential to help improve limb movement function and decrease the severity of spasticity. This review synthesizes studies involving stroke, brain injury, spinal cord injury, cerebral palsy, and multiple sclerosis to give an overall picture of the effect and potential mechanisms of acupuncture on spasticity occurring after upper motor neuron lesions. Moderate-quality evidence suggests that electroacupuncture combined with conventional routine care (pharmacological/rehabilitation) could reduce spasticity and improve motor function and activities in daily living after stroke. However, there is not enough evidence to conclude that acupuncture (including electroacupuncture) could reduce spasticity with other central nervous system diseases.

The Effect of an Interphase Interval on Electrically Induced Dorsiflexion Force and Fatigue in Subjects With an Upper Motor Neuron Lesion.

The study objective was to investigate the effects of an interphase interval (IPI) interposed between the two phases of a biphasic symmetric pulse, on electrically induced contraction (EIC) forces and fatigue during stimulation of the ankle dorsiflexors in individuals with an upper motor neuron lesion (UMNL). The dorsiflexor muscles of 20 subjects with UMNL routinely using functional electrical stimulation to correct a foot drop during ambulation, were electrically stimulated with biphasic pulses (250 µs phase duration and 35 Hz pulse frequency) using nine IPI durations (ranging from 0 to 400 µs). The induced muscle force and fatigue were measured. A significant positive correlation was found between IPI duration and induced muscle force. Introducing a 250 µs IPI significantly decreased rate of muscle fatigue compared to stimulation with no IPI (P < 0.05). Thus, the introduction of an IPI may reduce the current intensity required to achieve a specific force during functional electrical stimulation in individuals with UMNL. Reduction in muscle fatigue may shorten the conditioning period necessary for first time users of functional electrical stimulation.