Technology Gives Hope to Stroke Patients
Posted by Myomo Apr 26 2017
“When I had my stroke, I couldn’t do a lot of things for myself. It was an aggravation because I was used to doing things for myself.” Retired Marine Corps Veteran Jay Jay pretty much sums up how many stroke survivors feel.
Following surgery for a brain tumor, Lucinda had a stroke in 2009 that left her with right side weakness and a tightly clenched fist. “I had to ask whomever I was with ‘Can you cut my steak please?’ I wasn’t able to do anything with my hand. My arm would not move. I had pretty much given up hope of having both hands again.”Then Jay Jay and Lucinda, along with hundreds of other stroke survivors, were fitted with a unique and innovative powered brace. Now, Jay Jay says “I wear it everyday. I can definitely say the MyoPro has given me my independence back.” And Lucinda says “Now I can cut steak myself. Now I have both hands again. When you first put it on and your hand stretches out for the very first time, it’s the best feeling in the world.” Lucinda has been able to return to work and supporting her family.
To move a muscle, your body generates an electrical impulse called a myoelectric signal. Even when a limb is severely weakened by stroke, these signals are still present. Beginning in 1944, research began on detecting and interpreting these signals. In 1990, the U.S. Veterans Administration funded research on using myoelectric signals to control an orthosis or brace. By 2006, researchers at MIT in collaboration with Harvard Medical School had patented a way to make this a reality. That year, a company called Myomo® was spun out of MIT, gained an exclusive license to the patents, and through its own research and patents, eventually developed the only myoelectric-controlled powered arm brace (orthosis).
A new approach to stroke recovery
Other companies offer myoelectric artificial limbs for amputees. But the MyoPro® orthosis from Myomo is the only lightweight wearable device that can restore function in the paralyzed or weakened arms and hands of most individuals that have suffered a stroke, spinal cord or nerve injury, or other neuromuscular disability.
MyoPro does not require any implants or extensive training and it delivers no electric stimulation. Sensors built into the device simply contact the surface of the skin and read the myoelectric signals. It interprets these signals to move tiny motors in the device that assist in moving the elbow, wrist and hand the way the wearer intends. Most users find that they can use the device to move their arm and hand again immediately after donning it. Most find they can return to work, live independently and reduce their cost of care.
Clinical research shows “instantaneous” reduction in impairment
In January 2017 the Archives of Physical Medicine & Rehabilitation published research by Heather T. Peters, Stephen J. Page, and Andrew Persch from the Ohio State University School of Medicine Stroke Center. This study was conducted on 18 chronic stroke participants with moderate post-stroke upper extremity hemiparesis (arm and hand paralysis). The subjects were tested to evaluate the degree of impairment and function without the MyoPro and compare it with impairment while wearing the device. A standardized measurement tool was used (the Fugl-Meyer Impairment Scale (FM)) as well as observing functional tasks. The results show a clinically significant instantaneous reduction in arm and hand impairment and statistically significant improvements in a range of functional tasks and significant increases in ability for feeding and drinking. The subjects showed significant decreases in time taken to grasp a cup and increased gross manual dexterity while wearing the MyoPro. These changes exceeded the FM’s clinically important difference threshold.
Dr. Steve Page, the lead investigator on the Ohio State University study, summarized the results, saying, “The people we studied had moderate to severe arm impairment for whom there are not a lot of options. We found that in just the one session, not only did they learn to use the MyoPro very quickly with very little training, when the patients were wearing the MyoPro, across the board their performance of movements was significantly better. Patients were able to do things wearing the MyoPro that they would not be able to do with moderate to severely impaired arms under
normal circumstances. For example they were able to pick up a cup, many could turn pages in a book, they could grab items on a shelf and turn on a light switch. Patients also succeeded at many of the tasks that were bilateral, such has holding an item and opening it with the other hand.”
Additional clinical studies are underway with the Rehabilitation Institute of Chicago, the Mayo Clinic and the U.S. Veterans Administration.
World-renowned authorities recognize the value
Dr. Ross Zafonte is one of the world’s foremost authorities on brain injury rehabilitation. He is Head of the Department of Physical Medicine and Rehabilitation, Harvard Medical School, Chief of Physical Medicine and Rehabilitation at Massachusetts General Hospital as well as Senior Vice President Medical Affairs Research and Education at Spaulding Rehabilitation Network. Commenting on his experience with the MyoPro, Dr. Zafonte says “This innovative device, the MyoPro, is extremely important. This could enable people to change how they live their lives, at home or in a workplace. This is an exciting opportunity.”
Clinicians and patients find multiple benefits
Clearly MyoPro can help restore the use of a paralyzed or weakened arm and hand to aid in the activities of daily living. But there can be significant additional benefits.
More use of the affected arm can prevent overuse and injury to the unaffected arm. Being able to use the affected arm for balance or for holding a cane can reduce injury from falls. Many patients report improved independence gives them a better sense of well-being, and reduces feelings of depression.
Lucinda said, “I loved to bake with my kids. It’s a favorite pastime of mine.” Now she can enjoy that again by using both of her arms and hands in the kitchen.
David, another stroke survivor said, “The first time I had the device with the extended battery, I went to Costco and walked around for three hours. The device gives you the ability to do things like that.”
Jeremy, 30 years old and healthy, had a severe stroke, but with MyoPro he can pick up his young children again.
Dr. Anna Serels, a physiatrist at University Hospitals, Cleveland, sees real clinical and practical value in this. She states, “These patients who were functional members of society and of their households before all of a sudden find themselves at home, not being able to do the things they used to be doing. They become more and more down and depressed and their psychological state weakens. MyoPro helps the patient to feel like they are part of the house, to feel like they are out there in the world not just sitting on the couch and eventually get back out into the workforce if they were working before and become productive members of society.”
And surprisingly to many, continued use of the MyoPro is, in effect, continued physical therapy, and over time enables some patients to regain some use of their arm and hand even without the device through neuroplasticity, the body’s ability to create and strengthen new neuronal connections.
Dr. Serels continues, “In addition to creating a sense of belonging and independence, it just makes them stronger. It helps regenerate their nerve function and muscle growth. The MyoPro provides the ability for the arm to go through various ranges of motion that prevents spasticity from occurring or worsening.”
Dr. Page expands on that that point. “Studies that my group has performed over the past several years and that other groups have performed have actually shown that over time when the MyoPro is worn it can restore function – it can change the architecture of the brain and improve function. We can actually remove the MyoPro and people will have movement they didn’t have before.”
Stroke survivor and MyoPro user David says, “If I met somebody who recently had a stroke or had one a long time ago, and they were asking me should I get a device like this, my response would be think about your life, what you can do and can’t do, and think about enhancing the things you can’t do. Think about the benefits of what this device will do not just for your arm, but how it stimulates your brain and enhances many areas of life.”
For more information, and to watch videos of thepatients and physicians mentioned here, please visit www.myomo.com/stroke
Advancing technology, increasing awareness
The Myomo team is designing an enhanced version with even better hand and finger control. It’s working with the Children’s’ Hospital of Philadelphia on a pediatric version of MyoPro for kids suffering from brachial plexus injury, cerebral palsy or other conditions. And Myomo is increasing its sales and marketing efforts to ensure that more individuals with neurological disease or injury are aware of the possibilities MyoPro offers. Our work with the National Stroke Association is an important part of that outreach and patient awareness.
MyoPro is prescribed and available nationwide
MyoPro is prescribed by physicians such as neurologists and physical medicine specialists and recommended by physical and occupational therapists at leading hospitals and rehabilitation facilities, including Mayo Clinic, Cleveland Clinic, Massachusetts General Hospital, Kennedy Krieger Institute and Loma Linda Medical Center, among many others. It is approved by the VA system, and so far 20 VA facilities are delivering it. It is provided by Orthotics and Prosthetics (“O&P”) practices in locations across the country.
MyoPro is reimbursed by many commercial insurance companies and the VA. Myomo is working to secure reimbursement from Medicare.
In addition to stroke, MyoPro is successfully worn by those with arm and hand impairment caused by many forms of neurological disease or injury, including brachial plexus injury, spinal cord injury, traumatic brain injury, MS and ALS.
MyoPro is not for everyone, and individual results may vary. To discuss with a clinician whether MyoPro may be right for you, patients and caregivers may contact Myomo through its website, www.myomo.com/stroke.
The National Stroke Association provides educational information about treatments for post-stroke issues through real-life stories. Promotion of these stories does not imply endorsement of any product or service and it is recommended that patients ask a healthcare professional before using any product, medicine, or therapy.