INNOVATION IN HEALTHCARE

Transcription

1 INNOVATION IN HEALTHCARE (CMAPPro) is a combination of hardware and software that objectively captures information about the interactivity of muscles and nerves while a patient is in motion.

2 A CMAPPro EVALUATION COMBINES: Isometric Functional Strength (FCE) and Pinch & Grip Strength Measurements CMAPPro utilizes proprietary, integrated isometric functional capacity evaluation sensors to measure: o Lift strength o Grip strength o Pinch strength o Muscle fatigue High Resolution Spatial Electromyography (semg) CMAPPro leverages next generation, high definition semg: o Assesses the presence and type of muscle firing o Signal to noise ratio (S/N) above 125/1 o Sampling rate of 2000Hz o Proprietary leads to collect meaningful data Range of Motion (ROM) CMAPPro employs gyroscopic sensors to detect motion and measure: o Relative motion between two points o Capabilities and limitations regarding multiple movements including flexion/extension, inversion/eversion and rotation CMAPPro POD The POD gathers data and connects all sensors, motion trackers and electrodes: o Wirelessly transmits data to a unique all-in-one computer o Rechargeable battery that lasts up to 12 hours o POD dimension: 6 (Depth) x 5 ½ (Width) x 1¼ (Height) AVAILABLE CMAPPro PROTOCOLS o CERVICAL PROTOCOL Paracervical, Upper Trapezius o THORACIC PROTOCOL Middle Trapezius, Lower Trapezius, Paraspinal T5-T8, Paraspinal T9-T12, Latissimus Dorsi, Serratus Posterior o HIP/GROIN PROTOCOL Paraspinal L5-S1, Gluteus Maximus, Iliopsoas, Rectus Abdominis, Abdominal Oblique, Gracilis, Hamstrings o LUMBOSACRAL PROTOCOL** Paraspinal L1-L3, Paraspinal L4-S1, Quadratus Lumborum, Gluteus Maximus, Rectus Abdominis, Abdominal Oblique, Hamstrings o MEDIAN NERVE PROTOCOL* (CARPAL TUNNEL) Paracervical, Upper Trapezius, Deltoids, Biceps, Triceps, Medial Epicondyle, Lateral Epicondyle, Wrist Flexor/Extensor, Thenar/Palmar Musculature o SHOULDER PROTOCOL* Scalene, Paracervical, Upper Trapezius, Pectoralis Major, Supraspinatus, Teres Major, Latissimus Dorsi, Deltoids, Biceps, Medial Epicondyle, Lateral Epicondyle o FOOT AND ANKLE PROTOCOL Tibialis Anterior, Gastrocnemius, Lateral and Medial Ankle o LOWER EXTREMITIES PROTOCOL**, Hamstrings, Tibialis Anterior, Gastrocnemius, Anterior Thigh *Median nerve protocol and shoulder protocol both include regions covered by cervical protocol **Combine lumbosacral and lower extremities protocols if referred pain or radiculitis is a concern User selects protocol on an intuitive touch screen based kiosk.

3 CONSIDERATIONS FOR CMAPPro EVALUATIONS MEDICAL CONSIDERATIONS FOR A CMAPPro EVALUATION CASE TYPE Sprains or strains of the spine or limbs Radiculopathy of upper or lower extremities Median nerve dysfunction (CTS) Fibromyalgia/Myofascial Pain/ Chronic Fatigue Syndrome Cumulative trauma disorder AME/QME/IME Patient with recurrent soft tissue claims All pre-op necks and backs WHEN TO REFER After 4 weeks without improvement Upon consideration Upon diagnosis Upon diagnosis At Symptom onset Prior to, or as part of, the independent evaluation At the onset of a new claim When surgery is considered NON-MEDICAL CONSIDERATIONS FOR A CMAPPro EVALUATION CASE TYPE Ambiguous etiology Causation analysis Claim is of uncertain nature Unexplained delayed return to work (RTW) To objectively define transitional/ modified duties WHEN TO REFER When symptoms presented do not correlate to description of injury or accident To assist in the determination of whether or not an injury is work related When presence of pathology is in doubt To determine permanent and stationary (P&S) status or maximum medical improvement (MMI) Prior to release of patient to modified duty

4 Appendix D CMAPPro PROTOCOL ICD-10 Reference Chart CERVICAL PROTOCOL (Muscles tested: Paracervical, Upper Trapezius) M Cervical spondylosis without myelopathy M53.82 Other syndromes affecting cervical region M54.2 Cervicalgia S13.4XXA Neck sprain M54.12 Brachial neuritis or radiculitis nos FOOT AND ANKLE PROTOCOL (Muscles tested: Tibialis Anterior, Gastrocnemius, Lateral & Medial Ankle) G57.50 Tarsal tunnel syndrome S93.409A Unspecified site of ankle sprain M Pain in joint involving ankle and foot S93.609A Unspecified site of foot sprain HIP/GROIN PROTOCOL (Muscles tested: Paraspinal L5-S1, Gluteus Maximus, Iliopsoas, Rectus Abdominis, Abdominal Obliques, Gracilis, Hamstrings) M Pain in joint involving pelvic region and thigh S73.109A Sprain of unspecified site of hip and thigh LOWER EXTREMITIES PROTOCOL (Muscles tested: Quadriceps, Hamstring, Tibialis Anterior, Gastrocnemius) Causalgia of lower limb M51.26 Displacement of lumbar intervertebral disc without myelopathy M23.90 Unspecified internal derangement of knee R26.9 Abnormality of gait LUMBOSACRAL PROTOCOL (Muscles tested: Paraspinal L1-L3, Paraspinal L4-S1, Quadratus Lumborum, Gluteus Maximus, Rectus Abdominis, Abdominal Oblique, Hamstrings) M47.16 Spondylosis with myelopathy lumbar region M54.5 Lumbago M51.26 Displacement of lumbar intervertebral disc without myelopathy S33.6XXA Sacroiliac (ligament) sprain M51.36 Degeneration of lumbar or lumbosacral intervertebral disc S33.5XX Lumbar sprain M51.37 Degeneration of intervertebral disc site unspecified MEDIAN NERVE(CARPAL TUNNEL) PROTOCOL (Muscles tested: Paracervical, Upper Trapezius, Deltoids, Biceps, Triceps, Medial Epicondyle, Lateral Epicondyle, Wrist Flexors/Extensors, Thenar/Palmar Musculature) G56.00 Carpal tunnel syndrome S53.409A Sprain of unspecified site of elbow and forearm G56.10 Other lesion of median nerve S63.519A Sprain of carpal (joint) of wrist M54.12 Brachial neuritis or radiculitis nos S63.90XA Sprain of unspecified site of hand M53.82 Other syndromes affecting cervical region S44.10XA Injury to median nerve M77.00 Medial epicondylitis S44.00XA Injury to ulnar nerve M77.10 Lateral epicondylitis S44.20XA Injury to radial nerve SHOULDER PROTOCOL (Muscles tested: Scalene, Paracervical, Upper Trapezius, Pectoralis Major, Supraspinatus, Teres Major, Latisimus Dorsi, Deltoids, Biceps, Medial Epicondyle, Lateral Epicondyle) M Pain in joint involving shoulder region M77.10 Lateral epicondylitis M Stiffness of joint not elsewhere classified involving shoulder region S Rotator cuff (capsule) sprain M75.50 Disorders of bursae and tendons in shoulder region unspecified S43.80XA Supraspinatus (muscle) (tendon) sprain M75.80 Other affections of shoulder region not elsewhere classified S46.919A Sprain of unspecified site of shoulder and upper arm M77.00 Medial epicondylitis S43.409A Sprain of unspecified site of elbow and forearm THORACIC PROTOCOL (Muscles tested: Middle Trapezius, Lower Trapezius, Paraspinal T5-T8, Paraspinal T8-T12, Latissimus Dorsi, Serratus Posterior) M47.14 Spondylosis with myelopathy thoracic region M54.6 Pain in thoracic spine M51.24 Displacement of thoracic intervertebral disc without myelopathy S23.3XXA Thoracic sprain M51.34 Degeneration of intervertebral disc site unspecified

5 PROTOCOLS o CERVICAL PROTOCOL Paracervical, Upper Trapezius ICD 9: 721.0, 723.1, 723.4, 723.8, o THORACIC PROTOCOL Middle Trapezius, Lower Trapezius, Paraspinal T5-T8, Paraspinal T9-T12, Latissimus Dorsi, Serratus Posterior ICD 9: , , 722.6, 724.1, o HIP/GROIN PROTOCOL Paraspinal L5-S1, Gluteus Maximus, Iliopsoas, Rectus Abdominis, Abdominal Oblique, Gracilis, Hamstrings ICD 9: , o LUMBOSACRAL PROTOCOL** Paraspinal L1-L3, Paraspinal L4-S1, Quadratus Lumborum, Gluteus Maximus, Rectus Abdominis, Abdominal Oblique, Hamstrings ICD 9: , , , 722.6, 724.2, 846.1, * Median nerve protocol and shoulder protocol both include regions covered by cervical protocol **Combine lumbosacral and lower extremities protocols if referred pain or radiculitis is a concern o MEDIAN NERVE PROTOCOL* (CARPAL TUNNEL) Paracervical, Upper Trapezius, Deltoids, Biceps, Triceps, Medial Epicondyle, Lateral Epicondyle, Wrist Flexors/Extensors, Thenar/Palmar Musculature ICD 9: 354.0, 354.1, 723.4, 723.8, , , 841.9, , , 955.1, 955.2, o SHOULDER PROTOCOL* Scalene, Paracervical, Upper Trapezius, Pectoralis Major, Supraspinatus, Teres Major, Latissimus Dorsi, Deltoids, Biceps, Medial Epicondyle, Lateral Epicondyle ICD 9: , , , 726.2, , , 840.4, 840.6, 840.9, o FOOT AND ANKLE PROTOCOL Tibialis Anterior, Gastrocnemius, Lateral and Medial Ankle ICD 9: 355.5, , , o LOWER EXTREMITIES PROTOCOL** Hamstrings, Tibialis Anterior, Gastrocnemius, Anterior Thigh ICD 9: , 717.9, , 781.2

6 Intended Use CMAPPro is a standalone dynamic muscle function monitoring system. It gathers information related to muscle contraction patterns, range of motion and strength (functional capacity) testing simultaneously while the patient is in motion. The CMAPPro is specifically designed to test the cervical, thoracic and lumbar spine as well as both upper and lower extremities. It has applications in a number of arenas such as occupational and sports medicine, as well as in rehabilitation clinics. CIS Group CMAP Interpretive Services (CIS) is a group of physicians who are uniquely trained and specialize in interpreting data gathered by the CMAPPro device. The team of doctors is led by a physician who is board certified in various disciplines including Internal, Emergency and Forensic Medicine. Data gathered during a CMAPPro evaluation and interpreted by CIS physicians can provide information about: Muscle Activity High resolution spatial electromyography captures unique patterns of muscle electric discharge with high sensitivity, both while the muscle is at rest and during activity. Studies have shown these patterns correlate with the following states: Normal muscle at rest: consistent with no motor activity Acute pathology: consistent with vasodilatation Chronic pathology: consistent with vasoconstriction Range of Motion (ROM) Dual inclinometer sensors measure relative motion between two points. A patient s ROM data can yield information about capabilities and limitations regarding multiple movements including flexion/extension, inversion/eversion and rotation. CMAPPro Protocols Cervical Thoracic Lumbosacral Hip / Groin Shoulder Median Nerve (Carpal Tunnel) Lower Extremities Ankle Sciatica Plus Isometric Functional Testing (IFT) / Functional Capacity Evaluation (FCE) Proprietary integrated isometric functional capacity evaluation sensors measure lift, grip and pinch strength. Muscle Fatigue & Strength Loss Index (SLI) Muscle fatigue reflects the individual s personal loss of strength as he or she exerts effort over time. The SLI quantifies a patient s approximation to minimum population based criteria for strength testing. Sincerity of Effort The tools which comprise CMAPPro semg, ROM sensors and isometric functional testing devices are combined to capture data on the patient s effort, or lack thereof, exerted by a muscle during any given activity.

7 Components of a CMAP Report MUSCLE PATHOLOGY SECTION Introduction to the CMAP Report CMAPPro provides physicians with objective data about a patient s soft tissues and how pathology might affect the ability of a patient to reach expected minimum goals for range of motion (ROM) and strength (or functional capacity/fc). The performance of muscles is recorded while the patient is in motion. As a result, a CMAP report also provides data about the patient s sincerity of effort in complying with the aforementioned ROM and FC activities. This information is then reported in a tabular form and is followed by a narrative which is further separated into a Findings Section and a Summary and Analysis Section. CMAPPro evaluates whether a muscle is firing normally or if it demonstrates abnormal pathology consistent with acute or chronic injury. This information is garnered via semg and proprietary pattern recognition technology. RANGE OF MOTION (ROM) SECTION Range of motion testing shows the quantitative results of a patient s performance. The AMA has historically reported minimum criteria of angles for basic range of motion (i.e. cervical flexion, wrist ulnar deviation). CMAPPro data is compared to the AMA s minimum standards to evaluate whether a patient is able to perform activities to his or her expected potential. In addition, this information allows for a binary maximal vs. submaximal assessment of a patient s sincerity of effort and may be used to determine if a patient s failure to meet minimum goals for ROM and Strength/FC was hampered by lack of effort, perhaps secondary to fear, pain, etc. Sample findings: Acute injury in the Right Wrist Flexor muscles was revealed by the waveform morphology of the electromyographic examination. Sample findings: The patient met AMA criteria for minimum Range of Motion (ROM) for all activity studies. Patient demonstrated full sincerity of effort. This was evidenced by the expected recruitment of primary agonist muscles for each individual activity study. The information contained in a CMAP report can be used: To confirm or refute diagnoses considered To assist in revealing possible alternative diagnoses which maybe added to the differential To help develop and adjust treatment plans which are more precisely targeted to the specific injured muscles To collect evidence of maximal medical improvement (MMI)or permanent and stationary (P&S) status To provide specific return to work capabilities STRENGTH / FC SECTION Strength is measured via grip, pinch and lift testing. Above is an example of grip strength testing results. As noted above, sincerity of effort is also assessed during Strength/Functional Capacity testing. The Strength Loss Index (SLI) evaluates the patient s current strength in comparison to the strength expected for an average person in a similar demographic category. Muscle Fatigue is defined as a diminution in muscle output with fixed effort over 10 seconds. SUMMARY AND ANALYSIS SECTION In addition to the objective information listed above, the report also yields a list of conditions which are consistent with the particular pattern of pathology in a given patient. Rather than an exhaustive collection, this list is selective and highlights, in particular, whether a pattern of soft tissue injury is more consistent with a muscular or a neurologic etiology. Furthermore, if a neurologic origin is suggested by the information gathered, further analysis is undertaken to report whether the data is compatible with central or peripheral neuropathy. Finally, data on muscular injury and failure to meet expected goals (ROM/FC) are compared to determine if pathology might have contributed to suboptimal performance by the patient. Sample findings: This patient did not meet AMA criteria for minimum Strength/Functional Capacity (FC) for the Right Hand Grip. The patient demonstrated full sincerity of effort. The SLI for this patient is 12.2% in the Right Hand Grip (of note, an SLI greater than 20% indicates a more severe injury). Patient s Muscle Fatigue measures at 40% (of note, muscle fatigue greater than 20% indicates a more severe injury). Sample findings: The data displayed in the Findings section has been deliberately processed to derive likely clinical outcomes. Possible conditions to consider for the Acute muscle abnormalities include Carpal Tunnel Syndrome at the Right Wrist. There was no objective EMG evidence to suggest Chronic injury. The patient displayed full sincerity of effort on all activity studies. The patient met minimum AMA criteria for all Range of Motion activities. The patient did NOT meet minimum AMA criteria for Strength/Functional Capacity (FC) in the specific activities listed in the Findings section. Of the aforementioned studies, there is evidence that acute pathology may have been a factor in the suboptimal outcomes in the following cases: Right Hand Grip, Right Hand Pinch activities.