By Richard Rosenstein, D.O.
Patients surviving a stroke are often left with severe disabilities. New devices used by our Rehabilitation Medicine specialists are having positive results, even years after having a stroke.
Improving functional outcome of the upper limb in stroke patients has been an ongoing challenge to the rehabilitation specialty and it was believed that two years after a stroke, no new recovery was possible. In 2006, physiatrists at Abington Memorial Hospital initiated utilization of a device developed by an Israeli firm, Neuromuscular Electrical Stimulation Systems Ltd. (NESS), to treat the devastating effects of a stroke, namely arm weakness.
Avoiding further impairment
Complications of upper extremity weakness can include reduced functional use as well as contractures, edema, pain syndromes of the hand and shoulder, and a “psychological amputation” because of learned non-use. All of these complications may lead to further deterioration in the quality of life. The NESS H200 system was developed to treat and/or prevent these impairments and complications. It comprises a hand/forearm orthosis containing an array of electrodes connected to a portable electronic microprocessor-controlled unit.
The orthosis is designed for simple and independent positioning by the patient, thus accurately placing the electrode array on the arm. It supports the wrist at a comfortable angle for optimal activation of the hand. The neuromuscular stimulation results in an enhancement of physiologic and metabolic activity in the peripheral nerves, muscles, connective tissues and their blood supply. The NESS H200 was approved in 2001 for functional use by the FDA.
Testing NESS H200
Dr. Gad Alon, a pioneer in stroke therapy and an associate professor at the University of Maryland School of Medicine in Baltimore, was responsible for testing the NESS H200 at the university’s Kernan Center. In one of several papers, Alon and other researchers concluded in
2002 that the NESS H200 “is a safe and effective, non-invasive neuroprosthesis for improving hand functions and impairments in selected persons with chronic hemiplegia (paralysis) secondary to stroke.” Last year, in a study that included 77 patients, some of whom had had strokes more than three years earlier, Alon and other researchers reported that “five weeks of daily home training using (the NESS H200) with a task-specific stimulation program is likely to improve hand functions and upper limb impairments” from stroke.
Additional results achieved by the NESS H200 include reduced pain, decreased edema, improved blood circulation in the limb, prevention of contractures, improved skin condition, prevention of muscle atrophy and restoration of muscle bulk.
Abington Memorial Hospital physiatrists are also using a new device to address lower extremity weakness. The NESS L300TM system is a state-of-the-art functional electrical stimulation system designed to help patients with life-altering neurological disorders affecting lower extremities including disorders such as stroke, traumatic brain injury, multiple sclerosis and cerebral palsy.
The NESS L300 is a low-profile device worn on the lower leg and foot, which enables easier, more natural walking and a return to a more normal lifestyle. In addition to facilitating a more fluid gait, the NESS L300 may also stimulate muscle re-education, prevent/retard disuse atrophy, maintain or increase joint range of motion and increase blood flow.
The NESS L300 utilizes proprietary technology that not only lets patients walk more smoothly, but also more quickly. And, only the NESS L300 has a built-in sensor that recognizes the surface on which patients are walking on and adjusts accordingly. There are no bulky wires to deal with and the compact design even allows patients to wear their normal footwear. It is also easy for patients to use.
Gait and hand function of stroke survivors following training with the NESS stimulation system—a controlled, analyst-blind, prospective trial performed at the University of Maryland, Baltimore and Tel Aviv University, Israel—concluded that three months of home program combining multi-site electrical stimulation with individually tailored upper and lower limb task-specific exercises can improve selected gait and hand functions in very chronic stroke survivors.
NovaVision VRTTM Vision Restoration TherapyTM:
Vision Restoration TherapyTM (VRT) is a clinically proven, FDA-cleared medical device designed to improve the quality of life of stroke and brain injury patients by restoring some of their lost vision with in-home therapy. The therapy does not require surgery or medication of any kind.
More than 1,000 patients have been treated with VRT, and in a recent retrospective study more than 70 percent of patients who completed VRT showed measurable improvements in their vision, which enhanced their quality of life. VRT is currently being offered throughout the
U.S., in Germany and in Singapore at major institutions specializing in stroke, traumatic brain injury, vision and rehabilitation. Abington Memorial Hospital is a partner center offering VRT.
Appropriate patients complete an initial visit and our Department of Rehabilitation Medicine staff review the patient’s medical and ophthalmologic records to determine if VRT diagnostic testing is indicated. If so, the results from the tests will be used to create a customized vision therapy. Patients will receive a VRT device and first vision therapy module, usually at the hospital, and then they will take the device home to complete daily therapy sessions. Module results are sent by the patient to NovaVision for evaluation, and updates to the vision therapy are made in order to optimize the progress. After the initial six- to seven-month course of vision therapy, it may be recommended that the patient continue therapy. Patients must consistently complete daily sessions six days a week to receive optimal results. Taking an extended break from therapy reduces the effectiveness of the daily regimen.
Vision therapy results vary from patient to patient. Patients should not become discouraged if improvements do not occur in the first few months, or if improvements are gradual. Stopping the treatment after the initial phase of therapy will not cause patients to lose the sight they have gained.
For more information
To discuss the appropriateness of these devices for your patients, please call Abington Memorial Hospital’s Rehabilitation Medicine Department at 215-481-2161.