Scott Midavaine, OTRSwedish Medical Center

Discuss how use of technology combined with functional tasks can improve outcomes

Benefits of Neuroprosthesis over traditional FES systems

Efforts to limit the severity of the initial injury to minimize loss of function

Efforts to reorganize the brain to restore and compensate for function already lost or compromised

Collateral Sprouting

Neuroplasticity changes in neural

pathways and synapses to adapt to changes in behavior, environment and neural processes, as well as changes resulting from injury.[1]

Use of Feedback Systems Sensation

Proprioception

Good- Compensation Assistive devices Use of normally working extremity

Better- Repetition PROM AAROM AROM

Best- Functional Use

Neuroplasticity and repair depends on the performance of functional tasks and not just use of extremity.

Adjacent brain areas adopted the function of damaged brain areas that receive a full rehabilitation program

Use of low level electrical currents to stimulate and facilitate increased mvmts in muscles.

Usually focused on single muscles or muscle groups.

Normally used in repetition type exercises

Need to place 2-4 electrodes consistently in right place to be effective.

A Neuroprosthetic and rehabilitation system.

Uses water moistened electrode pads Uses electrical currents to stimulate

muscle contraction Electrical stimulation also excites sensory

and proprioceptive receptors to utilize feedback systems

Is a neuroprosthetic to be utilized during functional activities

5 electrodes vs 2-4 electrodes includes 1 Thenar electrode to facilitate lateral

pinch After being fitted, the panels (electrodes)

remain in place to decrease time needed to find most effective placement.

Enables patient to utilize hand functionally with stimulation and having prosthetic in place.

Videohttp://youtu.be/Px6CJUfZOhQ

Stroke Brain Injury Spinal Cord Injury Multiple Sclerosis Parkinson’s Disease Brain Tumor

RepetitionsPersonal- programable (spasticity reduction)Exercise- repeated flexion and extensionOpen Exercise- repeated extensions and relaxationsGrasp Exercise- repeated flexions and relaxationsFunctional UseOpen- Opening and maintaining an extended positionGrasp- Grasping and releasing objects in a palmar graspKey- Gripping and releasing objects between thumb and the lateral border of the index finger

Stimulation intensity should be set at the lowest level possible to get the desired results Fatigue

FES stimulates type II muscle fibers instead of normal fatigue resistant type I fibers.

Mimic true muscle contraction Minimize pain=increased compliance

Should decrease intensity as grip/pinch improves

Edema management Spasticity reduction Functional use Blood circulation Improved sensation Increased attention to neglected

extremity

Research Study by Ring et al. studied Effectiveness of Neuroprosthetic in improving hand function in stoke victims with moderate to severe UE paresis.

6-week Study Assessments

Modified Ashworth Scale Box & Blocks Test Jebsen-Taylor hand test (simulated eating and

lifting light/heavy objects)

Procedures Both groups had traditional therapy

3 days/wk for 3 hrs/day Occupational Therapy

ADL retraining Bobath Neuromuscular re-education

PT and SLP Neuroprosthetic Group

In addition to traditional therapy Started at 10 min 2x/day progressing to 50 min

3x/day

Results Spasticity

Control Group 9% improvement (2 or less)

Neuroprosthesis Group 64% improvement (2 or less)

Active Movement Control Group

No statistical significance Neuroprosthetic Group

Shld flex increased 28 degrees Wrist ext increased 17 degrees Wrist flex increased 21 degrees

Results Functional Movement

Control Group Box & Blocks Test

2% improvement Jebsen-Taylor Object placement

9-16% improvment Neuroprosthetic Group

Box & Blocks Test 50% improvement

Jebsen-Taylor Object placement 36-39% improvment

Pain and Edema Control Group

Out of 5 patients with pain 1 reported improvement

No change in edema Neuroprosthesis Group

100% decrease in pain reported 100% improvement in edema

Adopt “Best Uses” in Neuro-Rehabilitation Use Feedback Systems appropriately to

direct Neuroplasticity Use available technology that can be

used in conjunction with Functional Use Address multiple issues simultaneously