Out on a Stim: The Pros and Cons of FES Devices (Part 1)

First in a series.

For a minute or two, I felt like I was in a time machine.

It was late March, and I was test driving (perhaps test walking) the WalkAide System, a functional electronic stimulation (FES) device designed, according to their website, “to improve walking ability of people living with foot drop.” Functional electronic stimulation, for the uninitiated, “applies small electrical pulses to paralyzed muscles to restore or improve their function.”

For foot-droppers like me, those pulses emanate from the FES device then travel along the peroneal nerve, which runs along the outside of legs and provides movement and sensation to the lower legs, feet, and toes. That stimulation and its results don’t work for everyone with MS, and the jury is still out (and has been out for a while) regarding the device’s long-term efficacy.

Still, on that day in March, the FES worked really well for me. Really well.

I’ve had foot drop for more than 10 years, and for a few months before FES, I’d used my walker to will myself around the block to try stemming muscle atrophy. Though I had used an AFO before, I no longer had the leg strength to stride through my gait properly while wearing it, and walking for any length of time had become very hard.

I pulled on my old running jacket and sweats, grabbed my cane, stepped out into our driveway, strapped the FES device onto my right calf, and then timidly turned it on. The pulse the device generates is triggered only by foot movement, and as I stood still, preparing to be pulsed, it did … nothing. Then I forced my foot to move and, sans cane, walked up my driveway.

By the end of the driveway, I was feeling good. I set the stopwatch app on my phone and walked around the block. With no walker, no cane, no assistive device or leaning against a telephone pole or fence. Nothing. Something between euphoria and delirium overtook me when I returned home and saw that I had made the trip in barely over five minutes. And while it didn’t burst the moment’s bubble, I noticed that I struggled to climb the two steps to my front door at the end of the walk.

Getting fitted for the device was pretty simple. First, I met with an orthotist at Hanger Clinic, who watched me walk and studied how my foot worked (or didn’t). Then he strapped the FES “cuff” around my right calf, just below my knee. Inside the cuff were two electrodes that HAD to be placed properly to make the correct contact against my leg and the peroneal nerve to work right. After that, the orthotist tweaked the device’s settings, reattached it to my leg, and then watched me walk again before handing me two packets of new electrodes and turning me loose.

I did lots of things with the device. I walked on the treadmill with it, played pool with it, walked all the way around the mall without resting, went to a crowded party and had drinks with it — everything that I could think of to test it. When I got the placement right, it improved my walking immensely, and again, it felt like I had turned back time by at least a few years. When I didn’t get the placement right, it was an “almost” improvement that helped me walk a little bit better yet still left me fearing that I would catch my toe before accidentally hitting the dirt.

About a year ago, I tried a similar device from Bioness, WalkAide’s main competitor in the U.S. At the time, they only offered an FES that was a foot-drop device with an electrode under the heel of the insole in the user’s shoe. The pulses travel up through the heel of the foot before stimulating the foot muscles, much as the WalkAide does. While the Bioness unit did work for me, I found its pulse “delivery system” disquieting.

Since then Bioness has released a new model, the L300 Go, which doesn’t require a heel piece. The investment for this kind of device is high enough that I feel compelled to try the new product before making any decision about them. I am scheduled to demo it on June 12. I’ll share more after that!

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