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Michelle Kinsella practices grasping exercises with the NESS H200 device.

It was the end of January and 16-year-old Michelle Kinsella was on her way to soccer practice with a friend when the car in which she was riding was broadsided. In one moment, her life was drastically changed. She couldn’t walk, talk or do anything for herself when she awoke 20 days later in ICU. Among other injuries, the most severe was to her right side motor skills.

Seven months later, she took her first jog through the hallways of Baptist Rehabilitation-Germantown with the help of their latest neurological therapy equipment, wireless FES (functional electrical stimulation) devices for upper and lower extremities.

To expand the capabilities of a growing comprehensive neurological program, The Baptist Health Care Foundation gave Baptist Rehab a grant to purchase the Bioness Inc™ NESS L300™ for lower extremities and the NESS H200™ for upper extremities. These state-of-the-art systems are designed to help patients with life-altering neurological disorders that affect these extremities, including sufferers of stroke, traumatic brain injury, multiple sclerosis and cerebral palsy.

What is revolutionary about the Bioness devices is the ability to create an individualized fit to each patient. Setup is only needed once. The patient wears the device and the therapist uses the portable clinician’s programmer to conveniently manage the patient’s database, and configure stimulation, gait and training settings. Traditionally, to utilize FES, therapists would have to spend a significant amount of time in setup to locate, fit and place electrodes, which were connected to wires. That process would have to be replicated on each treatment which made it so complex to deliver it was almost prohibitive.

“This device makes that process efficient and easy so therapists can focus their time on patient care and not device setup,” said physical therapist Amy Barringer, clinical director of Baptist Rehabilitation-Germantown.

Each device has multiple electrodes which stimulate multiple muscle groups in a synchronized, coordinated fashion which actually produces functional movements. The repetition of functional movements is designed to retrain the nervous system to use these muscles, eventually, without assistance.

“One of the real differences is, with traditional therapy and splinting, therapists have only been able to provide passive or external stimulation to place or move affected body parts through normal movement patterns, but the muscles were not really engaged,” explained Barringer. “The Bioness device actually stimulates the patients’ nerves; it stimulates their muscles to place and position the extremity.”

Therapists continue to provide interventions such as supporting and facilitating the movements, just in conjunction with the Bioness units.

The NESS L300 is a low-profile, non-invasive device worn on the lower leg with an attachment placed under the heel. It’s designed to help patients with upper motor neuron injuries resulting in foot drop, the inability to lift the foot and toes while walking. When the heel touches the ground to step, the device sends a twinge of stimulation to the muscles, allowing the patient to pick up her foot and step. The technology allows patients to walk smoother and faster and has a built-in sensor that recognizes and adjusts to the surface being walked upon.

According to the Bioness Web site, in addition to facilitating a more fluid gait, research suggest the NESS L300 may also stimulate muscle re-education, prevent or retard disuse atrophy, maintain or increase joint range of motion and increase blood flow. Because it’s easy to take on and off, and simple to use, the device is ideal for inpatient or outpatient use.

The NESS H200 is worn on the forearm and hand, enabling patients to perform everyday activities such as grasping a cup or picking up the newspaper. It helps the hand open and close, reduces stiffness, increases range of motion and strength and improves circulation, assisting in regaining awareness of an impaired limb.

The H200 incorporates a self adjusting fit to hold the wrist and hand in a functional position.

This patented technology of the H200 provides six different stimulation patterns to enable patients to perform a variety of tasks and is versatile enough to be used in varied settings with little technical expertise needed, including at home.

When Kinsella came to Baptist Rehab in June, she had no control of her trunk or balance. The first goal for Kinsella, said physical therapist Melanie Mitchell, was core stability and strength. For Kinsella, being able to play soccer again is a high priority, so Mitchell made sure to incorporate soccer drills into her treatment.

“I’ve seen tremendous improvement,” said Kinsella’s mother, Angela. “There is a lot more independent walking and she’s gaining strength.”

Kinsella came at the right time to receive therapy with the Bioness devices, which over the past three months have helped her improve her gait and mobility, allowing her to now walk, jog and even kick a soccer ball.

“What research has shown is that our nervous system is flexible,” maintained Barringer.

In other words, she said, although the brain and central nervous system cannot heal, it can adapt.

“New areas of the brain can be trained to take over control of effective movements,” Barringer added. “If you’ve had a neurologic injury, typically your innate response will be to substitute and work around that injury. What our goal and the goal of the Bioness therapy is, is to help patients to push through the human body, to work through their limitations instead of around their limitations.”

A controlled study conducted by the University of Maryland School of Medicine, department of physical therapy, stated the stroke patients who used the NESS™ system improved gait and hand function significantly more than the group using traditional therapeutic exercises alone. The study revealed that when multiple sites stimulation is combined with task-specific functional training, the NESS system can help to improve selected functional outcomes of stroke survivors.

“When somebody has been unable to move their hand or foot, and then they see that part begin to move and possibly accomplish something meaningful, you just see their face light up and you see hope return,” said Barringer. “The body can relearn. It’s just hard work and it requires the appropriate stimulus, the appropriate input and the appropriate training.”

The device is interchangeable between physical and occupational therapy depending on the activity and task. The Bioness devices have been shown to be effective with both acute and long term neurologic injuries, although the older the injury, the more complex the rehabilitation.



October 2007

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