Use of Technology in Upper Extremity Rehabilition: Bioness H200

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Use of Technology in Upper Extremity
RehabilitionBioness H200

• Scott Midavaine, OTR
• Swedish Medical Center

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Objectives

• Discuss how use of technology combined with
  functional tasks can improve outcomes
• Benefits of Neuroprosthesis over traditional FES
  systems

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Approaches to improving function after brain
damage

• 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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Mechanisms of Neural Repair

• 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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Neuroplasticity in Rehab

• Use of Feedback Systems
• Sensation
• Proprioception

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Good-Better-Best Uses of Neuroplasticity in
Rehabilitation

• Good- Compensation
• Assistive devices
• Use of normally working extremity
• Better- Repetition
• PROM AAROM AROM
• Best- Functional Use

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Neuroplasticity Dependent on 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

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Functional Electrical Stimulation (FES)

• 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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Bioness H200

• A Neuroprosthetic and rehabilitation system.

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Bioness H200

• 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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Neuroprosthetic vs. Conventional 2-4 lead FES

• 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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Bioness H200

• Video
• http//youtu.be/Px6CJUfZOhQ

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Patient Population

• Stroke
• Brain Injury
• Spinal Cord Injury
• Multiple Sclerosis
• Parkinsons Disease
• Brain Tumor

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Combining FES and Functional Use Therapy
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Functions on H200

• 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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Selecting Amplitude

• 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 painincreased compliance
• Should decrease intensity as grip/pinch improves

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Additional benefits and applications for use of
Bioness H200

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

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Research Study

• 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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Research Study

• 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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Research Study

• 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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Research Study

• 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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Research Study

• 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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Conclusion

• 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