Scott Midavaine, OTR Swedish 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 AAROMAROM  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.

Video

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

Repetitions  Personal- programable (spasticity reduction)  Exercise- repeated flexion and extension  Open Exercise- repeated extensions and relaxations  Grasp Exercise- repeated flexions and relaxations Functional Use  Open- Opening and maintaining an extended position  Grasp- Grasping and releasing objects in a palmar grasp  Key- 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