Working 2 Walk

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Morning in the Ballroom Part 3

Posted by katewillette on April 14, 2008

Next is technlogy from Bioness designed to deal with the problem of foot drop. It’s apparently a stimulator that goes off and on during the gait cycle, intended for use to provide ankle dorsiflexion.  The potential user must have an intact peripheral nervous system.

The thing consists of a cuff with an e-stim unit.  It looks like a little knee brace–not an afo, but just a cuff like you might wear if you had a knee injury.  Theres a small control unit that turns it on and off and regulates the intensity; it also has modes for walking and for doing pt.  Theres’a gait sensor that actually allows for adaptation to the environment, including edema and spasticity.

The electrodes go on the leg in 2 places, one on the side of the knee and one in front that activates the tibialis muscle.

She’s got a video of the sensor detecting pressure on the heel and sending a message up to the cuff to tell it when the stim should be on or off.  It knows how much tone the leg is having, and it goes into sleep mode when you’re not walking.  It knows when you’re on grass or gravel or pavement.  The control unit is wireless.

Oh good, a demo —

A man walks up with one of these cuffs attached to his leg, his pants rolled up so we can see it.  His name is Duane Morrow and he’s an incomplete quad who broke his neck playing rugby in England.  he had no feeling below his chest and no movement below his chest.  He’s sort of a poster child for pushing the edge with aggressive re-hab; at one point he got the baclofen implant we talked about earlier this morning, because he had a stomach issue that left him with ridiculous spasticity. . . this got him back into therapy.  He was at the Shepherd Center and when he had met all his goals there he challenged them to do a program like Extreme Therapy.  that’s what the Shepherd Center has going on now.

He’s got 5 kids born in 3 states in 2 countries . . . he says, “the last thing I wanted to be was a burden to my wife.”

Aetna covered the Bioness unit after 6 months because he was able to go back and get them to see that it had actually served a medical purpose and made him better.

Question: Compare this to your usual orthotic.

The biggest difference for me was the knowledge that I was going to have to wear that afo forever.  So I went and got a fancy carbon super light one . . . but this is not supposed to have to be used forever . . . it’s a neuro-rehab tool as well as an aide to prevent foot drop.

Studies show that it works much better than an orthotic.  It costs $5,900, but the company works with clients to set up trials and payment plans if necessary.

Question: How much muscle strength do you need?  You can be 0 out of 5 w/the dorsiflexor and this will still work.

(I’m personally excited by this because it sounds perfectly designed for a certain walking quad I know. :))

Argghh, two more speakers!  This is such interesting stuff–I want time to process it but that ain’t gonna happen.  Next up is a woman named to tell us about the latest in FES cycling.  Her machine is the RT300, and Josh Basile is going to get up on the stage and use it while she talks

So, she says, sometimes she asks people with SCI what they do for therapy? The usual answeris, stretch.  What do you do beneath the level of your injury?  The usual answer is, silence — and that’s what this presentation is about.

We all know it.  Exercise is good for you, and FES is one way to get it.  It’s stimulation to the peripheral nerves that allows your muscles to get a workout.  It relaxes spasms, slows disuse atroophy, increases blood circulation, and increases range of motion.  It can also keep you in the world.

They have 2 systems, one for arms and one for legs, which must be done separately.  You do this from your own chair, meaning no transfers.  It’s connected to the internet and knows your settings.  It also adjusts them for your needs.  It combines the motor and the stimulation and adjusts constantly to your performance.

Sometimes she hears from people who still get fatigued after 10 minutes even tho’ they’ve been doing it for 2 years.  The leg electrodes go to the quads, hams, and glutes.  On the arms, you put them on biceps, triceps, and shoulde — or you can put ’em on deltoids and wrist.

Josh is up front doing this right now without leaving his power chair.

The goal is 1 hour of active therapy 3 x per week.  There’s a warm up, an active transition, an active portion, a passive portion (if needed) and a cooldown.

The internet connectivity component keeps the company in touch with you. . . it knows how much you use the machine and how often and what you do with each session.  (They will call you if they see that you’re not using it.

Reimbursement for this equipment was over 36% in 2006.  Why not higher? Because medicare national coverage decision 160.12 is a barrier.  One of our asks of the legislators tomorrow will be to have insurance companies and medicare/medicaid pay for this kind of equipment.

Josh  (determined2heal.org)  has been cranking away on the stim-bike  for a while now . . . he became an outpaitent at Kennedy Kreiger in 2005, and he got one of these machines then.  He cycles 4 days a week, and reports that it has increased his muscle mass a LOT, and that his range of motion is much better. “I like looking down and seeing my legs pumping.”  He’s kind of puffing and huffing, tells us it’s a good workout, and that’s obvious.

A woman in the audience says that her daughter (C3) has been able  over time to be able to use this machine without her vent.  She’s also stayed healthy and has not been back in the hospital since her injury.

(A short break while I go to find that rugby player whose walking issues are so like my husband’s, and then it’s back to speakers.)

Dr. Cristina Sadowsky of Kennedy Krieger:  “Medically Living with Chronic Spinal Cord Injury”

She’s got an outline up that names all the health issues people with sci face.  It’s grim, okay.  Basically all the body functions are compromised and all the systems are in jeopardy.  Pulmonary, cardio, metabolism, skin, musculo/skeletal, gastro-intestinal, genital/urinary . . . yikes.  The worst enemy is pneumonia — although 25 years ago it was genito-urinary issues.  UTI doesn’t kill injured people nearly as often as it once did.

She’s going through the wretched statistics about how dangerous it is to have sci compared to the AB population.  On the screen is a slide completely filled with text and numbers, all of which add up to tell the story: there is a very good reason to make use of the technologies we’ve been hearing about all morning.

Advice: Get lipid profiles done every year if you’re over age 20.  Eat nuts, olive oil, shellfish, salmon and limited carbs from cereal, potatoes, white bread, and snack foods. Quit smoking. Not more than 1-2 drinks per day. Take niacin. Find a way to get regular aerobic exercise.

I haven’t written down much of a summary here . . . not because the information isn’t important but because so much of it is very well known to this community.  People with SCI have every reason to look after their health — many more reasons than AB people.  The therapies we heard about yesterday are not going to be ready next week, and the therapies we heard about this morning are ready RIGHT NOW.  If you’re reading this, you already know what to do without hearing a litany of the dangers.

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One Response to “Morning in the Ballroom Part 3”

  1. Jennifer said

    Lots of demos today. Here are some links for resources and the demonstrators:
    Bioness
    Restorative Therapies
    Medtronic
    Control Bionics
    Andara OFS from Cyberkinetics
    Resource to learn about Neurotechnology at Neurotech Network
    Thank you for inviting everyone to present!

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