Tuesday, 31 July 2018

AGM 2018: Functional Electrical Stimulation - Jon Graham

The final presentation at the AGM was an ad-hoc presentation by Jon Graham of Physiofunction (https://www.physiofunction.co.uk/).

Jon described that Functional Electrical Stimulation (or FES for short) was part of a rehabilitation triad that they use at physiofunction. The three elements of the triad are Physiotherapy, Exercise and Technology.

Where there is a muscle imbalance the FES system stimulates the nerve, this fires the muscle and causes it to move. The FES systems are usually positioned so that they lift the foot up when stimulated, often making it lift quicker than it would without the FES. The level of stimulation can be varied over time, as patterns in your gait change, and so that you prevent system over-loads.

The main centres for FES in the UK are Birmingham and Salisbury, and two of the main equipment manufacturers are Bioness (https://www.bioness.com/Home.php) and DM Orthotics, or DMO (https://www.dmorthotics.com/). Jon noted that traditionally FES is provided by a unit which straps round your leg, the technology is moving on and it is becoming incorporated into a sock or membrane. You can get whole body systems, such as the Mollii suit (http://www.remotion.co.uk/) which instead of having a few pads like the strap-on system can have between 45 and 50 pads.

There are four routes to getting FES on the NHS. Some regions have a commissioning service. You may be able to register as an "exceptional case". You may be able to regard FES as a mobility aid and get this through the back to work scheme, or you can go through a private channel.

NICE note that FES can be used to help footdrop of central neurological origin (https://www.nice.org.uk/guidance/ipg278) - which would include HSP.

FES can be used to help build muscles by use with FES Cycling, where the FES system helps you to pedal a stationary bike, and the pedalling helps build your muscles up again.

Jon concluded by mentioning the National Footdrop Society (https://www.nationalfootdropsociety.com/)

Sunday, 29 July 2018

AGM 2018: An overview of Occupational Therapy - Fiona Shea

The second presentation of the AGM was Fiona Shea, who is an occupational therapist. She gave an overview of occupational therapy.

Essentially an occupational therapist helps people achieve their aim. This might be by resolving physical issues, by looking at the person and the environment they live in, by looking at rehabilitation or posture. The practice is both generalised and specialised. Fiona noted that the physical issues that she resolved are not always physical issues, often she helps those with mental illness.

Occupational therapy works in a simple four stage process. The first stage is to assess the situation. The second stage is intervention planning, followed by the third stage of putting the intervention(s) in place. The final stage is to evaluate the intervention. The evaluation may show a need to re-assess and re-plan interventions, or if the intervention has been successful the patient would be discharged.

The assessment stage looks at the person and identifies what they are having issues with. Fiona described a model which is used by occupational therapists to show the inter-relation between the person, their occupation and their environment. I describe this model at the end of this post.

When interventions are being planned the can sometimes be small, and other times they can be longer term objectives, built up at an appropriate speed. The goal of the intervention must be smart (specific, measurable, achievable, relevant, and time-bound.) If the patient has accepted their condition/situation then this can make intervention planning easier.

Once the intervention has been planned, if it involves behaviour change then it is up to the patient to put this into place. If the person is not bothered by the issue then the goal has not been set right.

The evaluation stage becomes assessing if the goals have been met. If not, a re-assessment or re-setting of the goal may be in order. If the goal has been met then there is a need to look to the future to consider what may happen going forward before being discharged. 

CMOP-E Model
The CMOP-E model has been developed by the Canadian Association of Occupational Therapists (https://www.caot.ca/) and is called the Canadian Model of Occupational Performance and Engagement.

It is worth noting that occupation in occupational therapy doesn't mean your job or profession, it refers to humans as "occupational beings" - i.e. they live by undertaking a series of goal directed activities.  The picture below shows the model. The triangle is the person, with their spirituality at the centre - it is their driving force. The main factors considered for the person are the Physical (doing things), Cognitive (thinking about things) and Affective (emotions about things). The triangle sits on a circle representing the occupation, split into self care (dressing, eating, sleeping etc.), productivity (things done to help yourself or others) and leisure (things done for enjoyment etc.). Finally, the person and their occupation are in an environment. The four key factors in the environment are the physical environment (how accessible/near things are), the institutional environment (covering things like doctors/hospitals, employers, benefits etc.), the cultural environment (for example a persons customs and behaviours) and the social environment (friends, family, social groups etc.)

Each of these items are inter-related, and the OT has the task of identifying interventions to help restore the balance between these different elements. I found these links quite useful: