The question turns up in epilepsy forums in several forms, and since we began distributing an ear-worn vagus nerve stimulator (tVNS E) it has started to reach us too. Someone has been told about the implant. The phrase they hear is "an operation", and they would rather not have one. They have found a device that clips into the ear, and they want to know whether it does the same job without the surgery.

Behind that question sit two different operations. One removes or disconnects the part of the brain where seizures start. The other fits a stimulator under the skin of the chest, with a wire to the vagus nerve in the neck. The short answer is that the ear device has not formally been compared with either of them. No trial has asked whether it is as good as either operation, so nobody can tell you absolutely that it is. What follows explains what each route offers, why the comparison is harder than it looks, and who the ear device might reasonably be for.

The tVNS is a certified medical device which means for certain conditions, including epilepsy there is some evidence that benefit can arise from it's use. This article examines this in some detail.

Many people have a motorised passive-active bike at home. They use it for a year or two, usually a MOTOmed or a THERA-Trainer, and they use it most days. Their legs go round. The question is whether their legs are getting anything from it beyond going round, and whether the electrical stimulation they saw on the bike in the spinal unit gym could ever come home.

Passive cycling does beneficial things, and adding synchronised electrical stimulation provides a measurable step on top. And the part that has changed recently is that the stimulator no longer has to arrive bolted to a new bike. For many years, we worked with the RehaMove system, which integrated an 8-channel stimulator with a version of the MOTOmed bike. We were always aware that the total cost of the system meant that many people could not adopt it. And as the stimulator needed to communicate directly by cable with the bike, we were restricted to one or two models of MOTOmed. Why should they give up the bike that they were already using and replace it with one that happened to support FES cycling?

Things have changed now with the arrival of Stim2Go. The bike you already own, whatever the make, is the awkward part of an FES cycling system, and you already have it. Let's see whether adding Stim2Go would be worth it.

Over roughly 250 years, therapeutic electrical stimulation has jumped to a new level perhaps seven times, and each jump was made possible by a new technological development. It might have been a way of handling current, storing it, generating it, shaping it, measuring it, timing it, or using it to tune the nervous system rather than drive it, and finally today triggering it from the person's own movement or intention. These are the stages I allude to in the title.

The first stimulator I worked with, as a PhD student in the late 1970s, filled a good part of a laboratory bench and needed someone who understood it standing beside it. The Stim2Go electrical stimulation device I carry to homes or clinics now is the size of my hand. It can be strapped to a client's thigh, senses when they start to move, and is set up from an app on my phone. Both deliver a pulse of current to a nerve. Almost everything else about them has changed.

You might expect the guidance on pressure ulcer prevention to have plenty to say about protecting the heels of larger patients, but that is not the case. In this article I want to show where the guidance goes quiet, what the research evidence really says about body size and heel ulcer risk (it is not what most people assume), and how I suggest thinking about the problem instead: as a question of equipment fit rather than a question of risk scores.

A note on language before we start. Following the Obesity UK "Language Matters" guidance, I use person-first phrasing for people, and I keep the word "bariatric" for equipment, pathways and products, where it remains the standard term. In manual handling circles, "plus-size" is the preferred word for the person, and I follow that convention here.

If you have a nerve injury, whether at the spine or further out in a limb, at some point, someone may send you for a nerve conduction study. You will lie on a couch while a neurophysiologist delivers small electrical pulses to your skin and, a little later, puts a fine needle into one or two muscles. A few weeks after that, a report lands with your consultant. It is dense, full of numbers and abbreviations, and it is written for one clinician to read to another. Almost nobody explains it to the person whose nerve it describes. Just this morning, I read a note from a client who said, "I had a nerve conduction test, which indicated severe injury to the nerves." You might wonder, like me, what severe means, and what do I do about it?

Creatine monohydrate is the most studied supplement in sport, with a safety record few products can match. From time to time, someone living with a spinal cord injury, or a therapist working with neurological clients, asks me about it: if it builds muscle and improves performance in athletes, would it help someone rebuilding strength after a neurological injury? It is an interesting question.

This article works through what the research shows, its limitations, and what that means in practice. The short version is that the evidence in healthy and older adults is strong, the evidence in neurological rehabilitation is thin and mixed.

One point before we begin. Creatine is a food supplement, not a medicine, and nothing here is individual medical advice. If you have kidney problems, take other medication, or have a complex medical picture, speak to your doctor or a dietitian before starting anything. With that said, let us look at the evidence.