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Published byShannon Burke Modified over 9 years ago
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Scott Midavaine, OTR Swedish Medical Center
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Discuss how use of technology combined with functional tasks can improve outcomes Benefits of Neuroprosthesis over traditional FES systems
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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
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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]
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Use of Feedback Systems Sensation Proprioception
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Good- Compensation Assistive devices Use of normally working extremity Better- Repetition PROM AAROMAROM Best- Functional Use
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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
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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.
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A Neuroprosthetic and rehabilitation system.
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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
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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.
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Video http://youtu.be/Px6CJUfZOhQ
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Stroke Brain Injury Spinal Cord Injury Multiple Sclerosis Parkinson’s Disease Brain Tumor
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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
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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
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Edema management Spasticity reduction Functional use Blood circulation Improved sensation Increased attention to neglected extremity
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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)
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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
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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
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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
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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
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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
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