The Functional Assessment and Restoration (FAR) service
Past, present and future

The FAR Service began in February 2004 as a new hospital initiative under the lead of Dr Angela Gall, Consultant in Rehabilitation Medicine in the Spinal Cord Injury Centre. It evolved directly from the research carried out at the National Centre for Neuro-Spinal Research, directed by Professor Michael Craggs and exists to provide a channel for translating clinical research into improved management for spinal cord injured patients. The FAR Service team is multi-disciplinary consisting of clinicians, nurses and clinical scientists.

The aim of the FAR Service is to ensure that spinal cord injured patients have access to the latest technology for restoring lost function. It provides extensive counselling, assessment and follow up for a wide range of technologies and implants to restore and improve lost function. The principle area is pelvic dysfunction, where by use of implanted neuroprostheses (SARS and SPAIRS) can control bladder, bowel and sexual function to improve patient management.

The current services offered by the FAR Service include the following:

Neuroprosthetic implants for bladder, bowel and sexual function

• Finetech-Brindley Sacral Anterior Root Stimulator Implant (SARS) and SPAIRS (Sacral Posterior and Anterior Root Stimulator) Implant
• Counselling, assessment and follow up of patients with an implant or interested in implants

Neuromodulation through pudendal afferents

• Assessment and optimisation of neuromodulation for control of bladder over-activity and bowel compliance.
• Assessment and optimisation of neuromodulation for control of lower limb spasm

Intrathecal Baclofen (ITB) Pump Clinic

• Counselling of patients interested in ITB therapy for spasticity following spinal cord injury and other neurological dysfunctions
• Maintenance of database of patients with an ITB Pump, management of pump refills and replacements
• Two-weekly ITB Pump Refill Clinic to refill pumps with new drug and re-programming drug dose delivery
• Technical support and programming of pumps during implantation in theatre

Neurophysiological assessments

• Complex neuro-physiological assessments of pelvic autonomic functions, to enable the neurosurgical teams to evaluate neurological outcome pre and post intervention
• Intra-operative monitoring of neurophysiological pelvic function during implantation of neuroprostheses and other neurosurgical procedures
• Fertility and ejaculation
• Nurse-led service to provide counselling and instruction of use of the Ferticare Vibrator for reflex ejaculation in spinal cord patients
• Electro-ejaculation for patients who cannot achieve ejaculation through vibro-stimulation

The FAR Service continues to work in close collaboration with the National Centre for Neuro-Spinal Research through its research into new developments for restoration of function following spinal cord injury. This includes links with other academic institutions such as the Institute for Neurology and the Implanted Devices Group, UCL. The close relationship the FAR Service has with academic and clinical research centres facilitates the translation of future research developments into better management for patients with spinal cord injury.

The FAR Service also provides teaching both internally and externally on various degree courses at both undergraduate and post-graduate level.

Referrals:
Referrals are accepted from GP's and internal and external Consultants

Consultant Rehabilitation Physician:
Dr Angela Gall

Consultant Clinical Scientist:
Professor Michael Craggs

Clinical Scientist:
Dr Sarah Knight

Research Nurse:
Sister Judith Susser

Key contact:
Tel: 020 8954 2300 ext 5605
Fax: 020 8909 5343