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Electrotherapy retrains muscles, gets patients moving
Monday June 11, 2012
Pia Stampe, PT, works with a child using the MyoTrac Infiniti NeuroPD.

(Photo courtesy of Pia Stampe, PT)


Newer electrotherapy products are helping patients who have traumatic brain injury, spinal cord injury or stroke take steps to prevent muscle atrophy, improve health and, in some cases, walk again.

Many of these products, such as the RT600 FES Step and Stand from Restorative Therapies, use functional electrical stimulation to help the patientís muscles fire at the appropriate times. Candy Tefertiller, PT, DPT, ATP, NCS, director of physical therapy at Craig Hospital, said e-stim helps prevent the secondary effects of immobility, such as atrophy, while teaching a patientís muscles when to turn on or off. The Englewood, Colo., facility, which specializes in treating TBI and SCI, uses an RT600 as part of its FES program, Tefertiller said. One hope is through many repetitions, the patientís muscles relearn when to fire, and they are able to transition to over-ground walking, she said.

"Early on, when [patients] are very weak and impaired, being able to use the harness allows us to take as much weight off of them as we need to," Tefertiller said. "So they are able to manage their body a little bit better until they are able to get stronger."

Tefertiller said the RT600 also benefits people who have no movement below the level of their injury by allowing them to get cardiovascular training and work on weight bearing. "Iíve had a lot of patients talk about how it gives them better sensation about where their feet are and where their lower legs are specifically," she said. "So if they do a session on the RT600 and then they walk over ground afterward, they feel like they have a better overall awareness of where their lower legs are."

RT600 FES Step and Stand
(Photo courtesy of Restorative Therapies)
Bioness Inc. has improved on its L300 Foot Drop System, which uses e-stim to help people with foot drop improve their gait, balance and confidence, according to Keith McBride, vice president of global marketing for the company. Customarily, people who are coping with foot drop because of a stroke, TBI, SCI, multiple sclerosis or even cerebral palsy, would use a brace or an ankle-foot orthosis, McBride said, but using e-stim to get the appropriate muscles firing gives the person a more natural gait. Most recently, Bioness released the L300 Plus System, which adds a thigh cuff to provide more stability to the knee while aiding recovery for the hamstring and quadricep muscles, he said.

"It is the first system that actually stimulates the muscles of the thigh while people are walking," McBride said. The devices are wireless, have a single control unit and are activated by a sensor in the personís shoe.

Bioness also last year released quick-fit electrodes for the L300 and L300 Plus, which are an alternative to traditional hydrogel electrodes.

McBride said the company markets its FES products to PTs, OTs and other rehab specialists. "Everything we know about trying to get meaningful change in these patients is about long-term, repetition, high-dose use and that usually needs to be done in the community," McBride said. "So our technology is equally as user-friendly for a person to take it home and use it as a long-term solution."

The devices capture data on the personís gait, which the PT can assess during the patientís visits, he said. The L300 System costs about $6,000, and the Plus thigh cuff can be added for about $4,500. The entire L300 Plus system is about $10,500. McBride said the VA often covers the devices for veterans, and there is discretionary Medicare coverage for the L300 for people with SCI.

The MyoTrac Infiniti NeuroPD combines EMG biofeedback and neuromuscular e-stim in a compact unit designed to help children and adults who have neurological impairment caused by strokes, cerebral palsy or brachial plexus injury. Pia Stampe, PT, DPT, said patients often are drawn into using the MyoTrac Infiniti NeuroPD because of its similarity to a computer or video game. "In general, both children and adults are engaged in it; itís like a computer game or play. They get immediate feedback on whether they are using the correct muscles," said Stampe, owner of Rochester, N.Y.-based Advanced Muscle Stimulators.

"The machine will read how much muscle activity the patient is able to produce, and it will add a little bit of stim to help complete the movement," she said. According to Stampe, the closed-loop learning system helps a patient learn to activate his or her muscles again. The biofeedback-triggered NMES is well-tolerated by pediatric populations because it requires less current than if the machine did all the work.

The device costs $1,675. Stampe said many patients will purchase one to use at home, and after about 45 minutes of online training, they can use the machine. •

Bonnie Benton is a member of the editorial staff.

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Monday June 11, 2012
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