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Changing current
Monday June 10, 2013


For Kristine Hansen, PT, ATP, the best part of working with patients and e-stim devices for footdrop at the Cleveland Functional Electrical Stimulation Center is their success. "When they see the foot move, and they couldnít do it on their own, thatís the immediate feedback you get from them," Hansen said. Developments in electrotherapy devices are helping more patients regain mobility, relieve pain and become more involved in activities of daily living.

Hansen has been a PT for 10 years and also has been doing research for the past eight years. She works with patients following strokes and spinal cord injuries in research programs at the Cleveland FES Center, which is a consortium in functional e-stim technology that includes the Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Case Western Reserve University and MetroHealth Medical Center. Hansen said the programs are specific to the center, but some of the devices they use are available to clinicians. She said they use the Odstock Dropped Foot Stimulator Pace and Bioness L300 Foot Drop System lower extremity e-stim devices and an upper extremity Bioness device in the clinics.

Bioness Inc.ís L300 includes a wireless sensor worn in the personís shoe, a hand-held remote and a leg cuff worn just below the knee. Each part of the system communicates wirelessly. In January, the device received Food and Drug Administration approval for use with pediatric patients, according to a company news release. Odstock Medical Limited in the U.K. offers two versions of the device. The ODFS Pace kit includes electrodes that are placed on the patientís leg, the stimulator and a footswitch. The newer ODFS Pace XL has a wireless footswitch, which eliminates the lead from the switch to the stimulator. The ODFS Pace stimulator can be worn at the waist, in a pocket or on the patientís leg, according to the company website.

The wired ODFS Pace is less expensive than either companyís wireless versions, which Hansen said is nice because it makes the device an option for people who might not have been able to afford one before. Hansen likes both companiesí devices and said patients do very well with them. "Youíd think it would be really complicated for stroke patients to set it up on their own, but it isnít," she said.

Patients come to CFES both as part of their initial therapy and even years after completing their physical therapy after stroke, according to Mary Buckett, communications manager for CFES. Hansen thinks many patients see improvement because for research, each patient is sent home with a device — so they use it every day — versus using the device only during clinical visits. Unfortunately, she said, right now Medicare doesnít cover NMES devices and neither does most health insurance, although some will cover a portion of the costs.

As the population ages and stroke is becoming more common in younger people, Hansen said she thinks FES will continue to grow. "The patients are really seeking out this technology," she said. "The age group coming up are used to technology and theyíre really seeking out more advanced treatments. [Younger ones] really seek technology, things to be wireless, digital and easier to use."

For PTs who like to use e-stim to treat patients with pain in the clinic, Dynatronics Corp. redesigned their Solaris line of devices with upgraded components and easier-to-use interfaces, according to Mike Pavia, general sales manager with Dynatronics. "Itís kind of a unique thing, with the way reimbursement is going, not too many people are looking to re-engineer and use technology to move forward," he said. "[E-stim] is not a code thatís billed very well, but itís one of those necessity treatments that a lot of therapists like to use when treating their patients."

Another unique feature of Dynatronicsí Solaris line is that every model has three wavelengths of light therapy. The models differ by number of channels of e-stim and whether ultrasound is included. Dynatronics just introduced a new accessory, the Thermostim probe, which allows the clinician to use heat or cold therapy at the same time as using e-stim or light therapy, Pavia said. "It gives them multiple tools in the toolbox to treat patients," he said. Other accessories PTs can buy to use with the base unit are the Triwave light probe and the Triwave light pad, so they can choose the ones that are most helpful for their patients. The device sits on a cart, so it can be mobile throughout the physical therapy clinic, he said, adding the unit has battery capability so it could be used by a trainer treating on the field.

Pavia said mostly Solaris 709 Plus units and 708 units are sold to PTs because it includes ultrasound, so the clinicians have one unit that does both. "Itís much cheaper to get the combined version with the ultrasound than getting a separate machine," he said. "With the five channel [709 Plus] unit, you can use one unit and treat multiple patients at the same time."

Judy Carmick, PT, MA, works with children who have cerebral palsy and uses e-stim to exercise their muscles. "Children with CP are often not able to contract their muscles adequately enough to hypertrophy them," Carmick said, adding that as the children grow their muscles donít keep up with bone growth, so they become weaker. "The e-stim stimulates the needed muscles, spastic or not, and helps them with sensory motor learning if given a task specifically."

She uses a hand-held remote switch to turn the e-stim on and off with the normal timing of the gait as the child is walking to prompt the appropriate muscles to fire. Carmick said it is vital a unit quickly turns down in case an electrode comes off, so the child doesnít get shocked. Units such as Empi Continuum from DJO Global offer the remote switch, however a clinician would need one unit for each leg. In some ways, Carmick said, having two units means having two hand-held switches, which might improve safety.

Some of the newer research into electrical stimulation deals with using peripheral nerve stimulation to treat pain in the shoulder, or after a joint replacement. SPR Therapeuticís Smartpatch minimally invasive medical device was recently granted a CE mark for use in patients with shoulder pain, according to CEO Maria Bennett. "They start at physical therapy and OTC medications, thatís the less invasive, less costly approaches ... the most invasive or costly are surgeries or fully implanted devices," Bennett said.

The Smartpatch electrode is a fine wire that is percutaneously placed near a specific nerve by a physician. Once the lead is placed, the PT can program several levels of stimulation that fit into a patientís specific treatment window, so there are weaker or stronger options, Bennett said. It can be used for up to 30 days. •

Bonnie Benton is a copy editor.

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Monday June 10, 2013
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