By Richard C. Senelick, MD
Neurologist and Editor in Chief of HealthSouth Press
A revolution is now under way in neurorehabilitation, particularly of stroke patients. Rehabilitation is a relatively new specialty, with the primary origins of the practice only dating back to World War II. During its early stages, the rehabilitation of stroke patients was a ‘high touch’ experience, teaching the stroke survivor how to compensate for their deficits. For example, one-handed shoe tying was taught, long-handled ‘reachers’ and shoehorns were prescribed, and uncomfortable splints were applied.
in Upper Extremity Rehabilitation
Purely mechanical/non-electrical devices like the Saebo® dynamic orthosis position the wrist and fingers in extension in preparation of functional activities. It allows a patient with partial movement to perform many more repetitions of functional tasks that promote neural plasticity.
Functional electrical stimulation (FES) enables therapists to combine neuromuscular electrical stimulation (NMES) with task-specific training. FES can be delivered through a neuroprosthesis that allows a patient with limited or no movement to perform functional tasks repetitively. Noninvasive, neuroprosthesis technologies like the Bioness H200® Hand Rehabilitation System provides reproducible, synchronized electrical stimulation of the muscles of the affected arm so that the patient can perform a variety of functional tasks like self-care activities, grasping large and small objects, and stacking and lifting objects. The technology is useful in promoting motor recovery not only in patients with stroke, but also in those with traumatic brain and spinal cord injury. It has five electrodes that come in different sizes, enabling therapists to ‘custom fit’ a patient so the patient receives a consistent level of stimulation every time they use the device.
in Lower Extremity Rehabilitation
Orthotics and braces have been the mainstay for therapists and physicians in compensating for weakness in the lower extremity. However, the traditional ankle–foot orthosis (AFO) has many drawbacks. The patient is typically ‘fitted’ with an off-the-shelf AFO to use at the hospital, but then has to wait until discharge to be ‘fitted’ again with a custom AFO that can be placed inside their shoe. The patient also walks in an unnatural, stiff manner, with a fixed ankle. Another neuroprosthesis, the NESS L300® Foot Drop System, again from Bioness, is useful for individuals suffering from the effects of stroke as well as those with traumatic brain injury and multiple sclerosis. It is a single, attractive unit that wraps around the leg just below the knee and includes an electronic orthosis, a control unit and a gait sensor. The gait sensor is a lightweight pad that is placed under the patient’s heel and is connected to a small sending unit. When the patient advances their leg and pressure comes off the heel switch, a signal is sent to the stimulating electrodes, causing dorsiflexion of the ankle. As the leg swings through the gait cycle and the heel strikes the ground, heel switch contact causes stimulation to cease, and the foot returns normally to the ground. Patients quickly develop a more normal gait pattern.
Another alternative is the WalkAide® that uses a tilt sensor to control stimulation during walking. During a gait cycle, the WalkAide® stimulates the common peroneal nerve, which innervates the muscles that produce dosiflexion of the ankle and function like a brace. This device allows patients to go bare foot or wear sandals.
There Is Always More to Do
Technologies are only just beginning to scratch the surface of what can be achieved in rehabilitation. Robotics, mechanized ambulation, virtual reality and mental practice all enable the patient
to meet the criteria of task-specific therapy.
Remember the old commercial that stated, “It is not your father’s Oldsmobile?” This is not your ‘father’s rehabilitation,’ either.
To learn more about technological advances available at MidAmerica Rehabilitation Hospital, call 913 491-2400.
5701 West 110th Street
Overland Park, KS 66211