Generation of a motor response to facilitate FES assisted gait in stroke patients may, at times, require clinician “perseverance”. In applying FES for gait -consideration of factors influencing the stimulation response is necessary. Presence of adipose tissue, adjustment of stimulation parameters & electrode positioning all play a part in individual patient motor responses to stimulation.

Stimulation parameters needing adjustment include pulse waveform, frequency and intensity of stimulation. Relocating and actively probing with the cathode (negative “active”) electrode is also important to identify the optimum stimulation site on the common peroneal nerve. Fibular head vs popliteal fossa electrode placement will also influence the response.

Use asymmetric waveform for a polarity effect, increase hertz to 50-60 pulses/sec and increase the intensity (milliamps) within the patient’s comfort level until a response is seen. Intensity may need to be increased up to 70 mAmps if adipose tissue is present. (Adipose tissue tends to impede current conduction).

An awareness of patient, therapist & equipment related factors in assessment with FES is key to successful intervention and an optimum rehabilitation outcome for the patient.