Lorna Tasker, Clinical Scientist. Thomas Habgood, Neuro physiotherapist

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1 Lorna Tasker, Clinical Scientist Thomas Habgood, Neuro physiotherapist Swansea FES service, Rehabilitation Engineering Unit, Medical Physics & Clinical Engineering, Morriston Hospital, Swansea

2 Overview of service Share experiences of a developing service What we have learnt so far... Early work on outcome measures, seeking any feedback!

3 Dr David Abankwa Rehabilitation Medicine Consultant Lorna Tasker Clinical Scientist, FES Lead Thomas Habgood Neuro-physiotherapist Ann Davies FES Administrator

4 Accept referrals from 3 Health Boards: Abertawe Bro Morgannwg University Hwyel Dda (Powys-depending on location) <1,000,000 population

5 2006-service began as a pilot Funding was applied on an individual basis for each patient... end 2010 business case for secondment of physiotherapist (3 days/month) Service became funded for ABMU patients (lower limb) Continue to apply for funding for other Health Boards

6 61 current users 60% MS patients Referrals received- 1-2 per month 1 FES clinic day per week ~6 patients/week Waiting time = 3 months

7 Initial assessment Rehab Consultant & FES practitioner Trial of FES unit Fitting -1 day --- under review 6 week review 3 month review 6 month review 6 monthly/annual review

8 105 patients have been assessed for FES since patients were considered not suitable at the initial assessment 34% not suitable referral rate Reasons identified: Unable to elicit response, patient can not tolerate Inappropriate referrals Lack of education- criteria awareness

9 Referrals letters received from Physiotherapists, Consultants and GPs Telephone calls and s enquiring about the service and referral criteria Introduce referral form reduce the number of inappropriate referrals impact on resources and the waiting list

10 Form to include: Service information Referral criteria Identify non compliance to criteria from answers Aid the screening of referrals Identify any contraindications before initial assessment Seek more information Arrange appropriate healthcare professional present at appt Consultation with Healthcare professionals/current referrers Keep it to 1 page!

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12 Introduced in August too early to assess effectiveness Target not-suitable rate <20%, National FES centre s statistic The referral form will also be made available on the internet/intranet and will be in an editable format-send referrals electronically Awareness session for physios arranged for next week

13 Routinely use 10 metres walking tests: PCI and speed Used to report to health boards for funding Simple measures with limitations Cardiff FES service, Holly Jenkins, has investigated these measures and others - Total Heart Beat Index (THBI) 2 measurement systems that require further investigation (1) Silicon Coach, a 2D video-footage analysis software (2) RS foot scan, a dynamic foot pressure measurement system. Ascertain their value in FES Determine where they fit into service- routine/research Driver for use is mainly to increase /enhance knowledge of gait and effect of FES inhouse As well as these objective measures, more subjective measures have been collected using a...

14 30 respondents to postal questionnaire 67% use FES 4-7 days a week 83% agree that FES has made a positive difference to their life. 77% -Use FES more than 6 hours a day 66% agree that they get less tired when walking 87% agree that they are less likely to trip when using FES Outcome of survey:- Improve on patient resources- e.g. Information leaflets Plan to implement a new system for ordering consumables

15 2D visual gait analysis software Software & camera ~ 1200 Parameters: Ground clearance angle Stride length Walking speed To be investigated: Angle of lean?/line of sight?/circumduction angle?

16 Pros: Decide FES suitability provides evidence if required. Monitor patient progress over time Transparent view is an effective comparison Sync footage of with/without FES Good for patient feedback/gait re-education Low cost Cons/limitations: Camera position needs to be permanent- plan to purchase two camera system to allow dual capture- frontal and saggital planes Poor Image quality- implications on identifying gait landmarks Only 2D Relatively crude measurements- we have a high speed camera (1200fps)- yet to be investigated Need to be consistent on gait landmark identification for stride length/speed calculations

17 High sampling-300hz High resolution sensors < 5000 Parameters being investigated: Vertical force change over time during stance COP trace Stance time Foot axis angle Contact area %

18 No FES With FES

19 No FES With FES

20 No FES With FES No FES Stance time= 1920ms With FES Stance time = 1580ms ~ 22% decrease Normal walking = 800ms

21 No FES No FES Useful to quantify adjustment to electrodes and/or internal parameters? With FES

22 Pros Immediate visual feedback for clinician/patient Relatively low cost Portable Use of shoes (Cf. Barefoot) Cons/limitations Influence of shoewear targeting - need to embed mat to avoid this Sufficient run up Collaborate with podiatrist? More suited for research environment

23 Insight into the operation of small scale service Areas of development Review implementation of referral form in Feb 12 Outcome measures remain proactive Silicon coach- to increase our evidence base on routine basis, monitor patient progress (permanent set-up of cameras) RS scan- explore for more research-based activities Re-run patient survey next year

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25 No FES With FES