John F. Schulte CPO FAAOP Has no financial interest or relationships to disclose

Transcription

1 John F. Schulte CPO FAAOP Has no financial interest or relationships to disclose CME Staff Disclosures Professional Education Services Group staff have no financial interest or relationships to disclose.

2 At the conclusion of this activity, the participant will be able to: A. Understand the benefits of ambulation in the SCI person. B. Become more objective in the decision making process in determining prescription considerations for the SCI involved person C. understanding the Physiological Benefits of the SCI person when determining treatment modalities

3 Changes in prescription considerations Orthotic componentry options and when to recommend them Patient Prescription Rationale (Don t Lock an Anatomical joint.. CONTROL IT!) Effective on both Root and peripheral nerve injuries! Obtaining Positive Outcomes through design recommendations

4 Any device that is strong enough to Control the extremity while allowing motion in planes that provides a more normal and functional gait.

5 Treating symptoms and instability in a whole new way. For years, we managed pain and instability by locking affected joint systems.

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7 Unlocks at Terminal Stance Free Flexion During Swing Locks Before the End of Terminal Swing

8 The essential benefits Energy usage is less (Body center of gravity does not need to be lifted, preventing circumduction) The risk of falling for the patient is reduced significantly (prevents the foot from catching obstacles) The patient feels more secure Increased level of Function and Distance!

9 Atlas of Orthotics Normal = 100% Ankle Immobilized = 79% Knee Immobilized = 75% Knee and Ankle = 63%

10 When wearing an Orthosis Knee motion pattern was drastically improved when the knee was allowed to flex and extend during ambulation. (Compared to an immobilized knee)

11 Energy Cost was significantly higher when the KAFO was locked vs. unlocked Similar to the O2 consumption rate, the Energy Cost was higher for the subject than normal subjects

12 Gait efficiency was 58% when Locked Gait efficiency was 72% when Unlocked The difference is statistically significant p=0.032

13 Consumption was ALWAYS greater in the Locked mode Energy requirements were higher than those for normal subjects

14 The KAFO design in this study reduced the metabolic energy requirements during gait The ability to freely move the knee during swing phase of gait results in more energy-efficient ambulation

15 Normal Gait consists of 60% Stance Phase and 40% Swing Phase Stance Phase requires a Locked and Stable Knee in Extension Swing Phase requires the Knee to begin to Flex at Terminal Stance and to achieve Full extension at the end of the Swing Phase

16 Decreased Vertical Oscillation Knee Flexes at Pre-Swing More Efficient Gait Cosmetic Stance Phase more Equal Increased Speed

17 Biomechanics Effects of a locked knee during Swing Phase Watch the Weight line During gait.. Natural throughout the ENTIRE Cycle!

18 Simulates Normal Gait Eliminates Hip Hiking No Circumduction Less Energy Consumption Decrease Risk of Falling Patient Security

19 Allowing Free Knee Motion during the Swing Phase (of gait) Increases Gait Efficiency Decreases Energy Cost

20 Dynamic Control IS The Most Appropriate solution for your treatment recommendations

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22 "Only when standing up can I feel how tall I really am and speak to people eye to eye, not from below." (RGO wearer about being able to stand and walk after being paralyzed for 20 years )

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24 Incidence: new cases/mm population Prevalence: 06 per MM population Growing rate of survival WWI: 80% SCI die within 2 weeks WWII: 20% SCI die within 2 weeks Today: < 2.4% (10 year > 86%) (Battlefield statistics) Source: NBC.com/wramc 8/16/2011 WRAMC

25 Lifetime Cost: Up to 1.5 MM per patient (Average $569K) Does not include loss of productivity 1974: 137 days Current average length of stay: 79 days < 46% in 25 yr. Vary according to severity of injury & age at injury

26 BENEFITS OF AMBULATION IN THE SCI PERSON Physiological Benefits Pressure relief Normalizing of kidney and bladder functions Improving digestive and bowel function Maintenance of bone density Improving flexibility and decreasing spasticity Greater circulation Improved respiration

27 It has been well documented that continuous sitting inhibits weight bearing, which causes weakening of the bones and ultimately, Osteoporosis. Ambulation and even Passive standing can reverse the loss of bone density. Standing in spinal cord injury patients can reduce bone density loss and even build calcium in the bones Source: Journal of Applied Physiology

28 Continuous sitting contributes to poor blood circulation, which can result in pooling of blood in the lower extremities. The result is often fatigue, nausea, and dizziness. Thomas P. Stewart, Ph.D. reports in his research of passive standing that low blood pressure can be improved by repeated standing. Persons walking in the RGO showed the lowest heart rate of 119 pulses / minute at the end of a 30 m walk compared with 134 ppm for the Para Walker, 150 ppm for those persons wearing Bilateral KAFO s Source: The Journal of Spinal Cord Injury Rehabilitation (Spring 2000,(pgs 48-53)

29 Continuous sitting often causes tightening or shortening of the leg muscles. Joints lose flexibility and can form contractures in the knees, hip and ankle joints. The use of standing and ambulation devices such as the RGO, increases flexibility and decreases spasticity in the legs. Spasticity is a muscular problem often found in spinal cord injury cases and other neurological disorders Source: James Walter, Ph.D. and Robert B. Dunn, Ph.D

30 Specific skin is designed for specific functions. Elbows, Knees, Soles of the feet and Hands are able to sustain pressures of increased force and usage. Other areas are prone to breakdown such as in the area of the Trunk, over the longbones and where muscle bellies underlie prominent bony structures..

31 Stage III Decubitus ulcer on Buttock after just 14 days of bedrest

32 The average vital capacity of the patients increased by 14.7% through the RGO training program

33 In the supine, or sitting position, a person cannot contract muscles for maximum inhalation and exhalation, which can lead to reduced respiratory efficiency and impairment resulting in pneumonia. It is widely believed that the standing position can induce better breathing. In a study by the American Physical Therapy Association, more than one third of the respondents reported better breathing after prolonged standing and during ambulation.

34 An increase in cardiac output was present at the end of the RGO training period increasing from 5.05 L/min at the beginning of the training to 5.41 L/min.

35 It is estimated the annual cost of UTI cases with prescriptions to be $1.6 billion in If the costs occurring after 1995 are discounted at 5% annually, the total cost over 20 years has a present value of $25.5 billion.

36 Bladder Cancer

37 Variations in Hydroxyproline, Calcium and Creatine as measured from Urine Tests during the RGO program training

38 Initial reports of eight patients with an average of initially high total cholesterol levels (>200 mg/dl) demonstrated a significant (P <.02 paired test) decrease from 231 mg/dl to 196 mg/dl at the end of their training (average length of training 14.6 weeks). Their high-density lipoprotein (HDL Good) level showed a slight, insignificant decrease, while their low-density lipoprotein (LDL Bad) level demonstrated a significant (P <.009 decrease from 160 mg / dl.

39 Variations in total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels in eight patients who started the RGO program with a total cholesterol level >200 mg/dl.

40 People who are upright and mobile are healthier, live with fewer secondary diseases that result from wheelchair use and live a longer life! Dr. Hamayoon Kazerooni PhD

41 Big or small, Standing Benefits them All!!

42 If you would like to receive CME credit for this activity, please visit: 11/ This information can also be found in the Summit 2011 Program on page 8 John F. Schulte CPO FAAOP Clinical Educator The Fillauer Companies Inc.

43 If you would like to receive CME credit for this activity, please visit: This information can also be found in the Summit 2011 Program on page 8.