Posts Tagged Bioness
Regain More Natural Hand Function — With Wireless Freedom.
The H200 Wireless Hand Rehabilitation System
Now you can get back to your daily living activities with the H200 Wireless Hand Rehabilitation System that offers the freedom and convenience of wireless operation. The H200 Wireless Hand Rehabilitation System is an ergonomically designed, easy-to-operate system that helps you achieve your personal recovery goals. Reaching, grasping, opening and closing the hand are all possible with the H200 Wireless Hand Rehabilitation System.
With wireless operation, it’s easy to integrate into your daily life.
The system’s advanced technology delivers low-level electrical stimulation to activate the nerves that control the muscles in the hand and forearm, helping you regain your freedom and independence.1
The H200 Wireless Hand Rehabilitation System is a medical device cleared by the U.S. Food and Drug Administration (FDA) and CE-marked for the European Union.
If you are currently a H200 Hand Rehabilitation System user, Bioness will continue to support your current system through April 2014. However, to help you upgrade to the new H200 Wireless System, we are offering a substantial trade-in allowance for your current system for a limited time.
1. Hausdorff JM, Ring H. 2006. The effect of the NESS L300 neuroprosthesis on gait stability and symmetry (abstract included in CSM 2007 Platform Presentations). J Neurol Phys Ther. 30(4):198.
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Regain Independence, Function, and Mobility.
Regain function with Bioness’ innovative solutions designed to help those living with Foot Drop or Hand Paralysis due to conditions such as Stroke, Multiple Sclerosis, Cerebral Palsy, Traumatic Brain Injury, or Incomplete Spinal Cord Injury.
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In the rehabilitation world, there are a number of approaches to manage the physical sequelae that occur post-stroke. One of those sequelae is foot drop, which is most common among the impairments characteristic of post-stroke patients, and experienced by an estimated 20% of all stroke survivors.1 Since foot drop affects ability to safely ambulate throughout the home and community, retraining the impaired muscles that contribute to foot drop becomes a priority. Lower-extremity bracing is one measure that can be used to manage foot drop. Correctly timing the decision to fit a patient with a brace or other orthosis has been heavily discussed in the literature, and understanding the considerations that can help pinpoint that optimum time are explored in this article.
Multidisciplinary Expertise is Essential
At the Kessler Institute for Rehabilitation, patients affected by stroke are seen for initial bracing evaluations during the inpatient and outpatient phases of recovery. They are also reassessed as needed throughout the continuum of care. For some patients, a brace or orthosis for daily use may be prescribed. In such cases, a team of rehabilitation professionals is called on to participate in the decision-making process.
The team physician leads the decision-making process and is ultimately responsible for determining which orthotic best suits the patient’s needs. The physical therapist assists with the bracing decision-making process by contributing gait analysis expertise. An orthotist designs and fabricates an ankle-foot orthosis (AFO) when prescribed, provides expertise in biomechanical gait principles, and integrates that expertise with orthotic-based materials. The patient/caregiver provides feedback for discussion among the other team members and ultimately makes the decision about bracing based on recommendations made by the team.
Other factors weighed during the decision-making process for bracing include limited insurance or financial restrictions put on custom bracing, limited access to an orthotist, and likelihood of compliance.
Making the decision about the optimal point in time to fit a patient with an orthosis is multifactorial. This decision can be dependent on discharge disposition with particular regard to whether the patient is discharging to home, and if safety is a primary concern secondary to a lack of ankle control. The level of impairment as well as weakness and instability should be taken into consideration, coupled with any prognostic indicators for a positive return in muscle control.
Many variables can account for how an AFO can improve walking endurance and functional ambulation long-term among patients affected by chronic stroke. For example, the AFO will create ankle joint stability and enhance foot clearance through swing phase of gait. This will alter gait mechanics and ultimately help to enhance the patient’s confidence in their own gait ability. An AFO preserves first ankle rocker with hemiplegic patients and provides a more efficient weight acceptance at initial contact to allow for enhanced double limb support and, thus, increased gait speed.2 Gait efficiency is also an important factor to consider when discussing energy expenditure and a patient’s ability to perform functional ambulation. Dynamic AFOs were shown to decrease energy cost of walking, as demonstrated from the Physiological Cost Index when compared to shoes only with chronic stroke patients.3
Comparing Braces and Orthoses
There are important pros and cons for each type of orthosis, with cost and weight the two most common factors. Also, there are drawbacks generally associated with the use of an orthosis that include compliance secondary to comfort, limited ankle motion, and a relatively fixed position (unless an articulating AFO is prescribed).
Part of the decision about bracing may come down to trade-offs between a customized AFO and an “off the shelf,” prefabricated brace. The advantages each confers are distinct. For example, a custom molded AFO offers the ability to create an optimal fit and provides maximum control of the limb. In contrast, while mass-produced prefabricated orthoses may sacrifice quality of fit and limb control, they can be used as an evaluative tool or a short-term fix during the rehabilitation process.
The conventional double upright AFO is another common bracing solution that may require review by the multidisciplinary team. This design is used when there is significant or fluctuating edema that may constrict the limb and present pressure-related issues with the fit of an AFO. An articulating (hinge) AFO is used to assist with continued dorsiflexion and allow for great ankle ROM. It is not appropriate if spasticity is present, and can be challenging for shoe wear because width is typically wider to accommodate joint of brace.
Carbon composite AFOs are a dynamic bracing option that allow for push-off during third (forefoot) ankle rocker of gait. These AFOs are made to keep the foot up during swing phase, and provide a soft heel strike and stability in stance. This type of brace is contraindicated for patients affected by significant edema, ulcers, and spasticity. Several types of carbon composite AFOs are offered by Allard USA, Rockaway, NJ, including the ToeOFF, ToeOFF Short, BlueROCKER, KiddieROCKER, KiddieGAIT, and Ypsilon. Each brace in this carbon fiber AFO product line is designed to offer specific benefits such as increased rigid orthotic control, size optimized to wearer’s stature, and to accommodate varying levels of spasticity.
Posterior Leaf Spring (PLS) is another common bracing option usually offered as a prefabricated product. The Superior C-90 from AliMed, Dedham, Mass, is an example of this type of brace, and built to provide a full range of plantar and dorsiflexion. The Superior C-90 also provides a thin trim line and allows for eccentric lowering of foot and dorsiflexion for tibial advancement over foot through mid-stance. One drawback to this design, however, is the lack of medial/lateral stability of ankle and poor knee control. It is also contraindicated for patients with spasticity and genu recurvatum or extensor thrust.
Functional Electrical Stimulation is an Option
Orthoses engineered to provide functional electrical stimulation (FES) to the wearer during use can be an alternative to traditional AFOs. The use of FES, particularly for lower extremity bracing, has been associated with increased gait velocity, decreased energy expenditure with gait, and improved gait symmetry. Two manufacturers that provide these devices include Reno, Nevada-based Innovative Neurotronics, which manufactures the WalkAide, and Valencia, Calif-headquartered Bioness, which manufactures the Bioness L300. Among the two products’ distinguishing structural characteristics, the WalkAide has a built-in tilt sensor while the L300 is designed with a heel switch sensor. Both products are considered FES devices, yet the mechanism of action used by each differs slightly.
At Kessler, the Bioness L300 is available for patients to trial. In my experience, and one of the advantages of using the L300, is the result in physiological changes such as increased muscle strength, improved volitional control, and increased joint range of motion. These changes indicate an increased therapeutic effect not associated with the use of traditional AFOs. Another advantage is highlighted in a study by Everaert et al that examined patient preferences for devices and revealed a statistical difference between patients who preferred to use the WalkAide versus an AFO.4 An additional benefit of using FES devices is a purported decrease in spasticity, which further improves the therapeutic effect.
There are some drawbacks associated with the use of an FES device, however, and the most common is cost. Third-party payors often decline coverage for FES devices, so the cost typically falls to the patient. The patient must also tolerate the stimulation so the motor nerve can be activated. Skin irritation is an undesirable side effect, and the wearer’s tolerance must be carefully monitored. Contraindications for these devices include demand-type pacemakers, any cancerous lesion, fractures, or dislocation. Cognitive impairment that could affect ability to use the device is another important consideration. Ultimately, the decision to use a brace as therapeutic treatment for foot drop is a collaboration with one goal: to improve a patient’s ability to safely ambulate and maximize functional independence. PTP
Farris Fakhoury, PT, DPT, has been a physical therapist in the Outpatient Neurologic Gym at Kessler Institute for Rehabilitation for 4 years, and is also the physical therapy lead for the facility’s amputee program. Fakhoury is the physical therapy lead for Kessler’s Amputees Coming Together (ACT) support group as well as for the Bioness program for outpatient services. He earned a bachelor of arts in psychology from Villanova University and a doctor of physical therapy from the joint program of Rutgers University/University of Medicine and Dentistry of New Jersey PT Program in Stratford, NJ. For more information, contactPTProductsEditor@allied360.com.
Rich Klager, PT, DPT, NCS, has been a physical therapist at the Kessler Institute for Rehabilitation in West Orange, NJ, for more than 8 years. His clinical practice experience expands over the Inpatient and Outpatient facilities in the neurologic population. He currently assists with the Outpatient orthotic clinic decision-making process with the Team Physician and Orthotist for patient bracing needs.
1. Bethoux F, Rogers HL, Nolan K, et al. Long term follow-up to a randomized controlled trial comparing peroneal nerve functional electrical stimulation to an ankle foot orthosis for patients with chronic stroke. Neurorehabil Neural Repair. 2015;29(10):911-922.
2. Nolan KJ, Yarossi M. Preservation of the first rocker is related to increases in gait speed in individuals with hemiplegia and AFO. Clin Biomech (Bristol, Avon). 2011;26(6):655-660.
3. Erel S, Uygur F, Engin Simsek I, Yakut Y. The effects of dynamic ankle-foot orthoses in chronic stroke patients at three-month follow-up: a randomized controlled trial. Clin Rehabil. 2011;25(6):515-523.
4. Everaert DG, Stein RB, Abrams GM, et al. Effect of foot-drop stimulator and ankle-foot orthosis on walking performance after stroke: A multicenter randomized controlled trial.Neurorehabil Neural Repair. 2013;27(7):579-591.
Lusardi MM, Jorge M, Nielsen CC. Orthotics and Prosthetics in Rehabilitation. St Louis: Saunders Elsevier, 2007.
[VIDEO] BIONESS 2015 North American Functional Electrical Stimulation for Walking Market Leadership Award – YouTube
[WEB SITE] The Latest Technology to Help You Walk More Naturally. What is the L300 Plus System? – Bioness Inc.
The L300 Plus System builds on the success of the L300 Foot Drop System by adding a thigh cuff to give you greater control over bending and straightening your knee, which may help you walk more naturally.
The L300 Plus System’s wireless components adapt to changes in walking speed and terrain, allowing you to walk more easily on stairs, grass and carpet. Comfortably worn under most clothing, the system’s unique design may help you eliminate the need for a rigid knee-ankle-foot orthosis (KAFO), or braces, and may reduce the risk of falls and injuries.
The L300 Plus System may also:
Reach for the latest breakthrough in hand rehabilitation. Regain the freedom of performing daily activities with the Bioness H200 Wireless Hand Rehabilitation System.
Advanced Technology to Help You Return to Your Daily Activities.
The H200 Wireless Hand Rehabilitation System Helps People Living With:
Stroke, Brain Injury, Spinal Cord Injury, and other disorders of the central nervous system resulting in functional deficits and impairments of the upper limb
The H200 Wireless Hand Rehabilitation System supports the wrist in a functioning position, allowing the fingers and thumb to move efficiently while reaching, grasping and pinching. This may allow you to regain hand function and get back to performing ordinary and essential activities of daily living. What’s more, the wireless model gives you the freedom to discreetly carry the Handheld Control Unit separately in your pocket, bag or purse.
Bioness L300 Foot Drop System Progressively Improves Walking Speed in Stroke Survivors | Business Wire
September 08, 2014 09:00 AM Eastern Daylight Time
VALENCIA, Calif.–(BUSINESS WIRE)–Bioness, Inc. today announced positive results from the Company’s 42-week Functional Ambulation: Standard Treatment vs. Electrical Stimulation Therapy (FASTEST) trial of the Bioness L300® Foot Drop System. The results have been published in the July issue of PM&R. The study, titled “Response and Prediction of Improvement in Gait Speed from Functional Electrical Stimulation in Post-Stroke Drop Foot,” demonstrated that persons with drop foot following stroke had clinically meaningful and statistically significant improvement in gait speed when using the Bioness L300.
“The long-term consequences of stroke, including limitations in mobility and walking, can be particularly isolating for patients. Often stroke survivors become dependent on others to complete self care and get around in the house and, especially, the community”
“The long-term consequences of stroke, including limitations in mobility and walking, can be particularly isolating for patients. Often stroke survivors become dependent on others to complete self care and get around in the house and, especially, the community,” said Michael W. O’Dell, M.D., chief of clinical rehabilitation services, New York-Presbyterian/Weill Cornell Medical Center, and lead author on the paper. “This study demonstrates that subjects with chronic stroke can achieve a meaningful improvement in the speed of their ambulation with functional electrical stimulation therapy. Moreover, at 42 weeks the subjects in this study walked faster with and without the device, indicating a therapeutic effect that can be sustained over time.”
Subjects using the L300 had their gait speed progressively improve over 42 weeks, with ≥50% of subjects achieving a clinically meaningful 42-week total effect and 50% achieving their maximum gait speed by 12-weeks. As a whole, the group experienced an immediate increase of walking speed of 19% which continued to improve to 33.3% and 45.2% at 30 and 42 weeks, respectively. “In addition to statistically important changes, we documented practical, clinically important changes in gait speed as a result of the treatment,” said Dr. O’Dell.
“The long-term results of the FASTEST trial reveal that the Bioness L300 provides clinically significant and sustaining benefit in this underserved cohort of persons with foot drop,” said Keith McBride, DPT, vice president of marketing and product development. “The magnitude of the outcomes under the rigorous controls and methods of the trial will provide additional essential data to third party payers to consider for coverage of the functional electrical stimulation systems like the L300 to include persons with foot drop following stroke.”
About the L300 Foot Drop System
The award winning L300 from Bioness, Inc. provides functional electrical stimulation to the muscles of the lower leg to help lift the foot up through wireless synchronization while walking. The L300 has been cleared by the FDA to improve gait in individuals with neurological impairments such as stroke, multiple sclerosis and spinal cord injury. The L300 is used as a primary medical device to address drop foot for individuals in the community and is also used for gait rehabilitation in inpatient or outpatient rehabilitation settings to potentially realize a variety of clinical benefits including improved mobility, maintaining or increasing range of motion, re-educating muscles, the prevention or slowing of muscle loss and increased local blood flow.
About Bioness Inc.
Bioness is the leading provider of innovative technologies to help people regain mobility and independence and improve quality of life. Neurological solutions for people suffering from hand and lower extremity paralysis include the L300® Foot Drop System, L300® Plus System, and the H200® Wireless Hand Rehabilitation System which utilize functional electrical stimulation (FES) to promote motor recovery and function for individuals affected by upper motor neuron disease and injury which may include stroke, multiple sclerosis, traumatic brain injury, spinal cord injury and cerebral palsy. Patients may also benefit from the Vector Gait and Safety System®, providing over-ground gait rehabilitation through dynamic body weight support and the Bioness Integrated Therapy System (BITS™), providing touch screen software based therapy programs. Individual results vary. Consult with a qualified physician to determine if this product is right for you. Contraindications, Adverse Reactions and Precautions are available on-line at http://www.bioness.com
L300®, L300® Plus, H200®, Vector Gait & Safety System®, BITS™ and Bioness® are trademarks of Bioness Inc. | http://www.bioness.com | Rx Only
Additional information about Bioness can be found at http://www.bioness.com.
Wendy Ryan/Maggie Fairchild, 781-684-0770
This video is a sequence of 3 videos spliced together to demonstrate the effectiveness of the Bioness L300. The shots were all taken in a period of about 30 minutes. The woman wearing the Bioness units had never used them prior to this experience.