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Transcript of Interface of Neuromodulation, Rehabilitation and Biomedical Engineering 1 Neuromodulation and...
Interface of Neuromodulation, Rehabilitation and Biomedical Engineering
1
Neuromodulation and Rehabilitation: Overview
W. Jerry Mysiw, M.D.Bert C. Wiley Chair of Physical Medicine and Rehabilitation
Chairman, Department of Physical Medicine and Rehabilitation
The Ohio State University
2
Health care reform TeleRehabilitation
Emerging technology Assistive technology
Advances in neurosciences
Advances in neuroimaging
Neuromodulation
Disability Statistics
Almost one-third of Americans entering the work force today (3 in 10) will become disabled before they retire.
Over 51 million Americans - 18% of the population - classify themselves as fully or partially disabled.
8 million disabled wage earners, over 5% of U.S. workers, were receiving Social Security Disability (SSDI) benefits at the conclusion of June, 2010.
In June of 2010, there were nearly 2.5 million disabled workers in their 20s, 30s, and 40s receiving SSDI benefits.
Common causes of disability
According to CDA’s 2010 Long-Term Disability Claims Review the following are the leading causes of new disability claims in 2009:
Musculoskeletal/connective tissue disorders caused 26.2% Nervous System-Related disorders caused 13.7% Cardiovascular/circulatory disorders caused 13.1%Cancer was the 4th leading cause of new disability claims at 8.4%.
Approximately 90% of disabilities are caused by illnesses
rather than accidents. Neurological disorders consume over one
third of the global chronic disease health burden
Stroke Related Disability Stroke is a leading cause of adult disability in the
US. Data from GCNKSS/NINDS studies show that
about 795,000 people suffer a new or recurrent stroke each year. About 610,000 of these are first attacks
About 6,400,000 stroke survivors are alive today In 2010, stroke will cost the US $73.7 billion in
health care services, medications, and lost productivity.
With timely treatment, the risk of death and disability from stroke can be lowered.
Early poststroke complications deprive patients of approximately 2 years of optimum health. Greater numbers of complications are associated with greater loss of healthy life-years.
CDC; AHA
Stroke Rehabilitation Outcomes
80% -Independent Mobility 70% -Independent Personal Care 40% -Independent Outside the Home 30%- Work
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Stroke is the leading cause of Adult Disability
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Depressive symptoms
Poor motor function
Ambulation/gait restricted
Verbal expression deficits Cerebrovasc Dis 2009;27:456–464
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One year after stroke/TIA, 66% of patients reported a worsening of life satisfaction compared with the prestroke level. The SF-36 physical component
summary was reduced throughout the observation period.
The SF-36 mental component summary deteriorated between the 6-and 12-months follow-up
The SF-36 domains “physical functioning” and “social functioning” deteriorate between 6 and 12 months post stroke
Neurological status and the degree of disability remained stable
Post Stroke Impairments: Predictors of Disability Motor deficits
Hemiplegia Spasticity
Neglect syndromes Apraxia Aphasia Dysphagia Depression Cognition
Dementia Executive Dysfunction
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Other Quality of Life Issues
Sexuality Spirituality Driving Employment Education Recreation Family Involvement
January 2005Slide 12
TBI in the United States
An estimated 1.4 million people sustain a TBI annually; of these: 50,000 die 235,000 are hospitalized 1.1 million are treated and released from an ED
The number reported with TBI underestimates the magnitude of the problem because the following are not included: TBIs treated by private physicians Individuals who did not seek medical care
FACTThe annual
incidence of TBI is
more than that of MS, spinal cord
injury, HIV/AIDS, and breast
cancer
COMBINED.
TBI as Chronic Illness(the “Silent Epidemic”) 80,000-90,000 new TBI survivors experience onset of long-
term disability annually About 1 in 4 adults with TBI is unable to return to work 1 year
after injury 5.3 million Americans (2% of U.S. population) currently live
with TBI-related disabilities Based on hospitalized survivors only
65% of costs are accrued among TBI survivors Annual acute care and rehab costs of TBI = $9 - $10 billion * Estimated annual lifetime costs of TBI survivors in year 2000 =
$60 billion *** NIH Consensus Development Panel on Rehabilitation, 1999
** Finkelstein E, Corso P, Miller T, et al. The Incidence and Economic Burden of Injuries. New York,
Oxford Univ Press, 2006
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Sensorimotor
Impairm
ents
Pre-injury
Function Injury S
everit
y
Disability secondary to
Traumatic Brain Injury
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Modified Institute of Medicine Enabling – Disabling Process
Person – Environment Interaction
The Person
Environmental Lifestyle
Biology
The Environment
social
Disability
socialphysical
QOL
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Modified Institute of Medicine Model The Enabling – Disabling Process
Transitional Factors
Biology
Environmental Lifestyle
No Disabling Condition Pathology Impairment Functional Limitation
Quality of Life
The Goals of NeuroRehabilitation
Prevent and Manage Comorbid Conditions Decrease impairment Maximize Functional Independence Stabilize mood and self regulation
impairments Optimize Psychosocial Adaptation Facilitate Resumption of Prior Life Roles and
Community Reintegration Enhance Quality of Life Decrease costs and need for long term care
Body Weight-Supported Treadmill Training
Pedaling
Biofeedback
Electrical Stimulation
Constraint-Induced Muscle Training
Robotic-Assisted Therapeutic Exercise
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Alternative and Augmentative Communication
Environmental Controls Brain Machine interface Orthotics/Prosthetics
Neuralprosthesis
Mobility Aids Exoskeletal systems
Therapeutic aids Robotics Virtual reality
Emerging Assistive Technologies
Exoskeleton Robotic Applications in Rehabilitation Populations ‘Forced Application of Technology’ EWJ
TeleRehabilitationThe provision of therapy at a distance Augmented communication Cognitive rehabilitation Motor/Mobility rehabilitation Vocational rehabilitation Prevention and management of complications
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Spinal Cord Injury•Pain•Spasticity•Mobility
Stroke•Spasticity•Central pain•Mobility•Plasticity?
Traumatic Brain Injury•NeuroBehavior changes•Cognitive changes•Movement disorders•Central Pain•Plasticity?•Headaches
NeuralModulation•Deep Brain Stimulation•Spinal cord stimulation•Peripheral nerve stimulator•Intrathecal Pumps•rTMS•Functional electrical stimulation
The Ohio State University Medical CenterNeuroModulation Center Clinical Programs
REHABILITATION SERVICESCognitive behavioral therapy
Inpatient rehabilitationOutpatient comprehensive rehabilitation
Vision rehabilitationAssistive technology
Functional reconditioningFunctional capacity/vocational rehabilitation
Work hardening
OSU Center for Neuromodulation:Multidisciplinary Practitioners
The neuromodulation program involves multiple specialties at OSU and provides comprehensive and holistic care of disabled patients.
– Neurosurgeon– Neurologists– Psychiatrist– Psychologists– Physical Medicine and Rehabilitation (OT, PT, RT, Speech, Gait)– Pain Management– Neuro-radiology– Biomedical engineering– Neuroscientists– Ethicists– Social workers
ImprovePeoples Lives through…
NEW PROGRAMS
CORE PROGRAMS SPECIALIZED SERVICES
REHABILITATION PROGRAMS AT OSUMC
ARTHRITIS AMPUTATION
SPINAL CORD INJURY
STROKE
NEUROMODULATION
ASSISTIVE TECHNOLOGY
MUSCULOSKELETAL/SPINE/PAIN
PEDIATRICSEATING/ADAPTIVE EQUIPMENT
METABOLIC BONE
SCI NEURORECOVERY NETWORK
Ohio Valley Center for TBI Prevention/Rehab
REHABILITATION PSYCHOLOGY
NEUROVISION REHABILITATION
QUANTITATIVE MOTION ANALYSIS
QUANTITATIfied NEURORECOVERY
•TeleRehabilitation
Traumatic Brain Injury
OSUMC Center for Neuromodulation Chronic Disabilities Initiative
In-patient and out-patient Home based therapeutic exercise program Vocational rehabilitation, recreational therapy
Physical, speech, occupational therapy Rehabilitation psychology Case management
Gait therapy with quantitative motion analysis and body weight support therapy
Assistive technologies
Summary
NeuroRehabilitation is an important transition Healthcare reform Advances in Neuroscience New neuroimaging techniques
New modalities on horizon Neuromodulation Assistive Technology
The new modalities are complements not replacements for the work of therapists and other clinicians
Creating the future of medicine to improve people's lives through personalized health care