by Heuga Center CEO Brian Hutchinson, PT, MSCS 
There has been an increase in the public's awareness of functional electrical stimulation (FES) and its use in people living with MS. FES as an ambulatory aid, has been used for many years by rehabilitation professionals. Research however, is limited. There are new devices available that provide an exciting opportunity, but also need to be approached in a thoughtful way through discussions with your treatment team.
FES, to assist in ambulation, is most commonly used to help with “Foot Drop”, secondary to a decrease or loss of nerve signals to the muscles that dorsiflex or lift the foot. Electronic stimulation is generally applied through surface electrodes, to stimulate the peripheral nerve. This has the ability to be successful in people diagnosed with multiple sclerosis because FES bypasses the central nervous system signal and provides direct stimulation to generate a muscle contraction.
A critical first step is to determine if you are an appropriate candidate for FES. It is important to recognize that there are other reasons that a person may ‘drag their foot’ and these could be confused with a foot drop secondary to neurological weakness. Things such as tightness and loss of range of motion at the ankle as well as hip weakness can be some reasons.
One needs to consider other medical conditions. Individuals who have a pacemaker, suffer from seizures or have peripheral nervous system conditions are not good candidates for FES. It is important to discuss any conditions with your physician to see if FES may be contraindicated for you.
These FES systems are designed to help individuals with stepping and walking. Therefore, using them for other activities, such as driving, is not appropriate.
Finally, cost can be an issue with FES systems. While insurance reimbursement varies considerably, it is rare with a diagnosis of multiple sclerosis, that the FES system will be covered.
FES, as a tool to improve ambulation, holds tremendous promise for individuals who experience foot drop due to neurological weakness of the lower leg muscles. However, these devices do have limitations. Careful assessment to identify appropriate candidates, as well as, proper training and follow-up, are critical for optimal success. In addition, it is important to conduct further research in this area to better understanding the expected outcomes and benefits and provide rationale for reimbursement.
