 |
Neuroprosthetics: The Next Generation of O&P Services
By Philip Muccio, CPO Neuroprosthetics are electrical stimulation
technologies that replace or assist damaged or malfunctioning
neuromuscular organ systems and attempt to restore normal body
processes, create or improve function, and/or reduce pain. These
systems are either implanted or worn externally on the
body.
In 1986 I was introduced to a fascinating technology that
clearly was way ahead of its time. I had just completed my orthotic
and prosthetic residency as I visited a research center of the
Cleveland, Ohio, Veterans Medical Center called the FES (Functional
Electrical Stimulation) Gait Lab. This is where I first heard the
word "neuroprosthetics." It was not a familiar term to me nor was
it a part of the curriculum at the University of Washington's
O&P program, but in this rather unknown, futuristic venue, the
paraplegics were not braced. Instead, to my amazement, muscles were
energized by a portable microprocessor which coordinated them to
mimic the characteristics of normal gait.
 Each paraplegic subject in this study seemed to
transcend his neurological loss. Muscles that were once atrophied
and easily fatigued were now toned, well-defined, and had
sufficient strength to power patients out of their wheelchairs and
propel them down the hallway. Seeing their renewed gait, their
improved bodies, and their health radically transformed, I quickly
signed up as a research orthotist to learn and contribute as much
as possible.
This was the beginning of a long and evolving discovery of how
electrical stimulation can augment the rehabilitation process.
After the early days in research, I went on to develop an electrode
suit that patients use to don and align surface electrodes. My
original intention was to help paraplegics use muscle stimulation
in the home rather than under the guidance of a physical therapy
center. That would help lower the cost of receiving muscle therapy
and advance the technology by reducing the complexity of setting up
as many as 18-20 electrodes on the body. It seemed to me that an
improved electrode interface would increase patient compliance and
medical outcomes.
Christopher Reeve Used System
 Christopher Reeve was among the first users of
this new system. It's what kept his muscles strong and his body in
good shape for many years. He was a vehement proponent of muscle
stimulation technology because it imparted better health, and it
prepared his body for when medical science is able to repair cord
injuries. Though Mr. Reeve's paralysis was complete, the Bioflex
Wearable Therapy System furnished improved circulation,
cardiopulmonary exercise, reduced spasticity, more range of motion
for his joints, along with added protection against undue pressure
and skin breakdown.
Muscle stimulation acts as a prosthesis by replacing aspects of
an incapacitated nervous system. In patients with upper motor
neuron damage (spinal cord injury, stroke, cerebral palsy, multiple
sclerosis, head injury), it bypasses the impaired part of the brain
or cord and stimulates the motor nerves directly. This makes the
muscles contract. The stimulator's microprocessor and controller
execute and coordinate commands to each muscle, instructing which
ones to contract and which ones to relax at any given moment. A
muscle stimulator's level of sophistication determines the
complexity of movement it imparts to the body as well as what level
of muscle force and firing sequence to emulate.
Strengthening Muscles, Reducing Spasticity
 Muscle stimulation can be used in patients with
incomplete spinal cord injury to strengthen muscles and reduce
spasticity, so that the body operates more efficiently and
effectively. For example, many persons with incomplete injuries
having voluntary control over the quadriceps can stand and walk
longer and more effectively when the quadricep muscles are
strengthened. This means less reliance on wheelchairs and orthoses
or at least minimizing their magnitude. Muscle stimulation is
advantageous because it improves the body's physiology while build-
ing muscle and reducing spasticity. In patients who ambulate and
who are looking for improved functional outcomes, this is a huge
psychological victory, because it shows patients that their bodies
are still operable and restorable.
Implementation of neuroprosthetics in stroke patients having
foot drop is another example of its utility because it restores
movement in a more physiological way. Stroke patients can be fi
tted with a sleeve that positions and holds electrodes over the
dorsifl exors and a heel switch for the shoe that triggers the
muscles at each step. The advantage is that the ankle remains free
to dorsifl ex and plantarfl ex without restriction, and spasticity
in the plantarfl exors is greatly reduced. This means more normal
walking and a minimization (often elimination) of torsional forces
by the spastic muscles causing the foot to supinate.
Reducing Pain
Another area I found electrical stimulation to be immensely
helpful is the reduction of chronic pain. While most clinicians are
familiar with TENS, few are aware that muscle stimulation can be
used as well. The difference is that muscle stimulation is a
stronger stimulus and is capable of contracting and relaxing
muscles in a cyclic manner. My clinical experience shows that
muscle stimulation is better at blocking pain than TENS. One theory
is that it reverses the vicious cycle of pain, spasm, and muscle
tightness, and that by reducing muscle tightness, you remove a
signifi cant component of the pain. I have observed both TENS and
muscle stimulation preventing pain from rising when increases in
patient activity occur. This is helping patients to be more mobile
and is helping them to return to work. It is not uncommon for pain
to be reduced 50-90 percent with these technologies.
Electrode Garment
The neuroprosthetics I create and employ in my practice
typically entail an electrode garment. The purpose of the garment
is to help align and hold electrodes in place. The material
comprising the body of the garment is a flexible spandex. The
electrodes are made of silver cloth and are highly conductive. I
make the garments in such a way that wires do not interfere with or
restrict body movement. The garment fitting is a three to five
stage process which varies, depending on the complexity of the
case. Patients doing therapy can don the garment, then remove it
after a few hours, or if being used for pain relief, it can be worn
under clothes throughout the day, sometimes even at night when the
patient sleeps. Because the garment is worn directly on the skin
and is worn for extensive periods of time, it must fit just right.
Otherwise, skin irritation and breakdown might occur.
The way in which we treat patients changes and evolves all the
time. Neuroprosthetics will certainly become more commonplace with
time. They have distinct advantages over traditional medicine and
orthotics because of the powerful ability to transform the body and
to integrate with nerve and muscle.
Technology for Orthotists, Prosthetists
Physical therapy is not the only venue for electrical
stimulation and neuroprosthetics. Orthotists and prosthetists must
assimilate the technology if we are to advance our profession. The
neuroprosthetics I employ entail extensive evaluations, fittings,
and modifications to ensure delivery of an effective and safe
medical device to my patients--the same qualifications and
standards of practice that make a successful orthotist and
prosthetist. Embracing neuroprosthetics will open up greater
possibilities for the patients we work with and ensure we are part
of this growing trend.
Philip Muccio, CPO, is owner and director of Bioflex Inc.,
Columbus, Ohio. He can be contacted at 800.552.3539; philipmuccio@earthlink.net; www.mypainmanager.com 
Table Of Contents - March 2005
|
|
