We have provided 2 additional functional electrical stimulation devices for the Rugby Early Supported Discharge (ESD) Team.
The first machines, donated in 2018, brought a new service to Rugby which helped with the rehabilitation of patients who had suffered a stroke and were used to strengthen muscles, reduce tightness and help lift the foot when a person is walking.
When Willy Goldschmidt, Chairman of the Friends of St Cross, heard that the service had been very successful and that there is often a waiting list to try the machines he proposed that the Friends should consider donating a further two more advanced machines. The Trustees were most impressed to hear that during the pandemic the team has continued to teach patients how to self-manage the devices by video calling them to get help the electrodes in the right place and agreed to the proposed purchase!
Katherine Thomas – Neurological Physiotherapist. ESD Rugby and Neurological Outpatients Rugby St Cross Hospital explained “Patients suffering from a large range of different neurological conditions, including stroke, brain injury, cerebral palsy and spinal cord injury, are offered a one month trial of a machine. On average one patient a month has found using the machines beneficial and has been referred to the West Midlands rehabilitation service in Birmingham to have a machine permanently set up for them. There is currently a one year waiting list for the trial service in Birmingham so being able to offer a trial service for Rugby residents is a great benefit to all concerned – even those who find that the device does not work well for them. This saves then waiting for over a year to be seen in Birmingham for the same outcome.”
The Friends have also donated some upper limb exercise equipment which will be used as part of the GRASP programme to improve upper limb function in stroke patients. In addition, two weighing scales will allow the team to accurately work out a patients MUST score, to see if they are having adequate nutritional intake or require intervention or referral. The scales can also be used for standing balance rehabilitation.
Photo: Katherine Thomas is pictured with the upper limb equipment and the two weighing scales.
In the following paragraphs Katherine has provided two case studies which demonstrate the benefits gained by use of the Functional Electrical Stimulator devices as well as information about the GRASP programme and the importance of the MUST Score. T
Case study 1:- One Rugby resident who gained substantial benefit from using the machines is a 61 year old gentleman who suffered a stroke in May 2018. This left him with weakness and tightness on the left side of his body and he was unable to walk or drive. The weakness and tightness caused significant shoulder pain. The micro stimulator machine was used around the shoulder and the left ankle with good effect. His shoulder pain significantly improved and movement in the left ankle increased. The Functional Electrical Stimulator device was tried in an outpatient clinic and found to improve his walking pattern and speed. This resulted in a referral to the service in Birmingham where he was set up with a long term stimulator. He is now achieving his goal; walking for more than 20 minutes outside and he was referred to the driving assessment centre to look at the possibility of returning to driving.
Case study 2:- Maureen, one of the first patients of the service, was referred back to neurological outpatients at Rugby St Cross for more physiotherapy input. Her left arm had shown improvements with reduced swelling in the hand and some increase in movement. Maureen only originally tried the Functional Electrical Stimulator as that was all that was available at the time. This can be more complicated to use so she is currently waiting to try the new micro stimulator that the Friends have donated on her left hand.
GRASP stands for Graded Repetitive Arm Supplementary programme. This is a well researched programme where the person does one hour of exercises from the programme every day. The benefits found include increased range of movement and strength in the weaker arm, improved ability to use the weaker arm in daily activities, decreased pain in the weaker arm and improved life satisfaction.
MUST stands for Malnutrition Universal Screening Tool this is a five-step screening tool to identify adults, who are malnourished, at risk of malnutrition (undernutrition), or obese. It also includes management guidelines which can be used to develop a care plan. It is for use in hospitals, community and other care settings and can be used by all care workers. The team in ESD use the MUST to identify if a person has lost weight during their hospital stay and is at risk of malnutrition. If the score a '0' we have no concerns. If they score a '1'there is a small level of risk and we give out information on diet and monitor to make sure they are putting on weight. If there is score of '2' or above there is a larger risk so we give out advice and refer the patient to a dietician.