There are two very important questions we have in mind when offering technology to an individual with a disability. The first question is "will this be safe" and the second is, "will this be deliver a useful goal for this person". Every stimulator I have supplied comes with a list of reasons not to use it. These are called contraindications and every medical device will list these. Some are "absolute" and present a barrier to the products use in all situations and others are "relative" because there is a potential risk, but a clinician may feel that the benefit of use outweighs that risk in some situations.

Many, many electrical stimulation devices will list epilepsy as a contraindication. How is it possible that certain forms of electrical stimulation can possibly be helpful in epilepsy?

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.

There is a thread on an American nurses' forum with a four-word title: "To mepilex or not?" The nurse who started it described an arrangement many wards will recognise. Once a patient's risk score crossed a threshold, foam dressings went onto the sacrum and both heels more or less automatically, and nobody had ever explained when a dressing earns its place and when turning would do. One reply answered in four words of its own: "No dressing prevents pressure."

The thread is American, but the question is not. I've spent more than thirty years supplying devices that float the heel, so you might expect me to side with that reply. I don't, entirely. A dressing and a floating heel do different jobs, and the formal evidence for each is thinner than either camp tends to admit.

Put plainly we can say that a dressing changes the surface. Offloading changes the load.

We first started to work with FES cycling around 17 or 18 years ago now. We were told that many people with MS would be our clients. Actually that hasn't been the case, largely because the cost of most FES cycling systems were unaffordable. We couldn't help them. As we've started to work with the Stim2Go, we've found many more of our clients now have MS. They've been able to use the Stim2go for FES cycling and much more.

Most people with MS who own a motorised passive-active bike did not start out with one. They started with an ordinary exercise bike, and at some point it stopped being usable. They could no longer get on the upright one. The standard bike became unusable because they could not generate enough momentum. Their feet would not stay on the pedals, or a heel kept catching the frame, or tone made the whole thing impossible. A MOTOmed or a THERA-Trainer, with a motor that moves the legs when they will not move on their own, was the answer to that problem, and for many people, it has been a good one.

The question this article answers is whether the electrical stimulation you may have seen on a bike in a rehabilitation gym can be added to the bike you already have at home, and whether it is worth it. The Stim2Go, a very flexible yet powerful stimulator, is not tied to any bike. Let's look at what the evidence supports.

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.

Stim2Go from Pajunk is proving a very popular system for electrical stimulation due to its flexibility. In addition to supporting FES Cycling, it boasts many novel applications and the ability to create custom applications. Amongst its programs, there have been a number of transcutaneous spinal cord stimulation (tSCS) applications. Up until now, these were typically utilised to target severe spasms or pain.

We're getting to grips with some new cervical tSCS programs and two combined cervical-lumbar tSCS programs. These place one electrode on the neck and another on the lower back, and run both in the same 20-minute session. It is in beta testing, available under European and UK medical device rules only, and not cleared in the United States. I want to walk through the idea behind this configuration and what the human evidence shows.