3/5/2014. Rehabilitation Technology versus Research Technology: Where/What is the Value?

Size: px

Start display at page:

Download "3/5/2014. Rehabilitation Technology versus Research Technology: Where/What is the Value?"

Oswin O’Neal’
5 years ago
Views:

Technology Applied to SCI: The Value of Assistive Devices During SCI Recovery and

, FACSM Departments of Neurological Surgery and Rehabilitation Medicine Principal

Research in Rehabilitation Medicine Miller School of Medicine, University of Miami

Its purpose is to eliminate barriers and enhance opportunities in education,

Rehabilitation Technology versus Research Technology: Where/What is the Value?

User Known User Indications Known User Contraindications Known Benefits Known Risks

1 Technology Applied to SCI: The Value of Assistive Devices During SCI Recovery and While Living with SCI Mark S. Nash, Ph.D., FACSM Departments of Neurological Surgery and Rehabilitation Medicine Principal Investigator [Applied Physiology] The Miami Project to Cure Paralysis Director of Research in Rehabilitation Medicine Miller School of Medicine, University of Miami The application of technology to meet the needs of people with disabilities. Its purpose is to eliminate barriers and enhance opportunities in education, rehabilitation, health, employment, transportation, independent living and recreation. Rehabilitation Technology versus Research Technology: Where/What is the Value? Rehabilitation Technology versus Research Technology: Where/What is the Value? Addresses a Functional or Rehabilitative Need Clearly Defined Purpose Clearly Defined User Known User Indications Known User Contraindications Known Benefits Known Risks The impractical, or unfeasible Addresses a Functional or Rehabilitative Need Clearly Defined Purpose Clearly Defined User Known User Indications Known User Contraindications Known Benefits Known Risks Still in development, refinement and application. 1

Almost all injuries unless very low level or very incomplete or if energy

Contraindications: Instability Confirmed Benefits: Transportation,

pressure ulcers, mostly due to poor fitting, seating (cushion) or

Closed loop control Purpose: Fitness, conditioning, muscle hypertrophy,

User: SCI with sensory deficit, no contractures, joint dysfunction, or

injury abobe T10 (no denervation) No implanted pacemakers Benefits:

2 35 Kg! Purpose: transportation, independence, recreation, competition User: Almost all injuries unless very low level or very incomplete or if energy cost of ambulation is intolerable Indications: Loss of motor function Contraindications: Instability Confirmed Benefits: Transportation, independence, recreation, competition Risks: Musculoskeletal injury and pressure ulcers, mostly due to poor fitting, seating (cushion) or propulsion mechanics which change over time controllers Open loop control Closed loop control Purpose: Fitness, conditioning, muscle hypertrophy, blood flow, cardiac conditioning, improved endocrine function, and affect User: SCI with sensory deficit, no contractures, joint dysfunction, or excessive tone.injury abobe T10 (no denervation) No implanted pacemakers Benefits: Improved fitness, blood flow, blood flow in response to circulatory stasis, muscle hypertrophy, improved orthostatic vasomotor responses, and affect. Risks: fracture, dislocation, hypotensive crisis, autonomic dysreflexia (above T6), and skin burn. 2

Purpose: Recreation, competition, high fitness levels User:

extremity denervation (T10 and higher) Benefits: Exercise

$fracture, dislocation, skin burn, autonomic dysreflexia,$ lesions!

muscles, lack of shoulder control, atrophy of thenar

prehension and 3-chuck pinch Risks: Infection, lead problems

prehension and 3-chuck pinch Risks: none known 3

3 Purpose: Recreation, competition, high fitness levels User: SCI with good hand grip, more trunk is better, no lower extremity denervation (T10 and higher) Benefits: Exercise conditioning, cecreation, competition Risks: FES-related, fracture, dislocation, skin burn, autonomic dysreflexia, hyperthemia Beware hyperthermia in persons with higher level lesions! Purpose: Restore or enhance hand control after tetraplegia User: C5, 6 or C7 (?) Tetraplegia Contraindications: Denervation of contracting muscles, lack of shoulder control, atrophy of thenar muscles, excessive tone Benefits: Improved grasp in lateral prehension and 3-chuck pinch Risks: Infection, lead problems Purpose: Restore or enhance hand control after tetraplegia User: C5, 6 or C7 (?) Tetraplegia Contraindications: Denervation of contracting muscles, lack of shoulder function, atrophy of thenar muscles, excessive tone Benefits: Improved grasp in lateral prehension and 3-chuck pinch Risks: none known 3

$sensitivity to FES, fracture/joint$ instability, LE denervation,

4 Purpose: Ambulation, exercise User: SCI with trunk support and hand control Contraindications: Topical sensitivity to FES, fracture/joint instability, LE denervation, excessive tone/spasticity Benefits: Ambulation, exercise Risks: Falls, fatigue, high energy costs Purpose: Gaiting/Standing/Exercise differs by unit User: Paraplegic or incomplete tetraplegic with trunk and hand control Indications: Paralysis (SCI, MS, Ambulatory CP) Contraindications: Excessive tone, contracture, height/weight Benefits: Device-dependent Risks: Fall, fracture, dislocation Gamecycle Wii IREX Community ambulation? 4

5 Gamecycle Wii IREX Issues: Modifiable Intensity Sustainability Continuous 20 customizable virtual environments: football (soccer), basketball, volleyball, juggling, playing the drums and snowboarding Purpose: Myoelectric motor-driven customizable prosthesis User: Spinal Cord Injury, Cerebral Palsy, TBI, MS, ALS, Indications: Upper limb weakness Contraindications: Elbow contractures, excessive tone, inability to follow commands, denervation in biceps/triceps, less than trace MMT in biceps/triceps Benefits: Enhanced ADLs, massed practice, volitional control (?), strength, increased ROM Risks: None known yet Surface electrodes are inside the biceps/triceps cuffs Electrodes read EMG from biceps and triceps EMG is converted by software to power a motor that provides flexion and extension Not FES-initiated A rechargeable battery is attached to the brace Can be fabricated at local sites! 5

Purpose: An upper extremity rehabilitation workstation for ADL retraining User: Any upper limb sensorimotor deficit Indications: impaired function from orthopedic and neurological disease or trauma,

representing activities of daily living (ADLs) Risks: None reported Technology Diaphragmatic Pacing Vibration Platforms Brain-Computer Interface Hands Free home modifications Van Modifications Sacral

control not yet established, but promising.

Technology has the potential to enhance activity, productivity, life satisfaction, and health after SCI. End-user contributions are important to conceptualization, production, and testing.

6 Purpose: An upper extremity rehabilitation workstation for ADL retraining User: Any upper limb sensorimotor deficit Indications: impaired function from orthopedic and neurological disease or trauma, pattern training after TBI Contraindications: Contracture, excessive tone or spastic dys-synergy Benefits: A computerized task oriented training system provides standardized upper limb exercises representing activities of daily living (ADLs) Risks: None reported Technology Diaphragmatic Pacing Vibration Platforms Brain-Computer Interface Hands Free home modifications Van Modifications Sacral Stimulators for Bladder Control Adaptive Equipment for Computers/Eye-gaze Voice Recognition Status Humanitarian Use Approval Enhanced walking function, acute strengthening in incomplete SCI Fine control not yet established, but promising. Exciting ways to ease the burden of living and transportation -> independence Not yet approved Significant improvements in accuracy and processing speeds Automation not always desired What you see Technology has the potential to enhance activity, productivity, life satisfaction, and health after SCI. End-user contributions are important to conceptualization, production, and testing. Compliance with use and long-term durability must be assured. In a cost-constrained world we must carefully evaluate and select tools that will best benefit specific needs of people with disabilities. Technology must be tested for application to rehabilitation principles and goals, and be relevant for the specific disability and individual user, keeping in mind that One size doesn t always fit all isn t always what you get! 6

Disclosure. Esquenazi

Disclosure. Esquenazi Learning Objectives At the conclusion of this activity, the participant will be able to: A. Understand the purpose and function of the ReWalk exoskeletal orthotic device. B. Understand the variation in