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Neuromove training presentation

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  • 1. NeuromoveNeuromove
  • 2. What is theWhat is the NeuroMoveNeuroMove?? It is an EMG TriggeredIt is an EMG Triggered Neurological Relearning tool forNeurological Relearning tool for 2 Neurological Relearning tool forNeurological Relearning tool for Stroke and Brain Injury ParalysisStroke and Brain Injury Paralysis
  • 3. Stroke and TBI Rehabilitation Centers Spinal Cord Rehabilitation Centers Where are you going to sell the NeuroMove? 3 Spinal Cord Rehabilitation Centers Why do Rehab Clinics need such a product? Shortens patients time spent in Rehab Motivates patients to work at their own therapy Works when there is total paralysis or no voluntary movement.
  • 4. What Neuro-rehabilitation devices do you use for Opening Lines 4 What Neuro-rehabilitation devices do you use for stroke patients? Do you have a Neuro Re-learning Tool? The NeuroMove retrains the brain to regain voluntary movement.
  • 5. Who Benefits from theWho Benefits from the NeuroMoveNeuroMove?? StrokeStroke PatientsPatients 5 StrokeStroke PatientsPatients The number One cause of treatableThe number One cause of treatable paralysisparalysis ••Traumatic Brain InjuryTraumatic Brain Injury ••Palsy and other congenital paralysisPalsy and other congenital paralysis ••Spinal Cord InjurySpinal Cord Injury
  • 6. Sales Tools:Sales Tools: Establish an invite toEstablish an invite to on our websiteon our website 6 Establish an invite toEstablish an invite to on our websiteon our website I will send it to your email addressI will send it to your email address All documents can be modified and saved.All documents can be modified and saved. Power pointsPower points Marketing itemsMarketing items Clinical StudiesClinical Studies PicturesPictures
  • 7. U.S. FDAU.S. FDA --For Stroke, TBI and SCI RehabilitationFor Stroke, TBI and SCI Rehabilitation --Relaxation of Muscle Spasms & Muscle ReRelaxation of Muscle Spasms & Muscle Re--educationeducation --Prevention of Retardation of disuse atrophyPrevention of Retardation of disuse atrophy --Increase Local Blood CirculationIncrease Local Blood Circulation --Maintaining or Increasing Range of MotionMaintaining or Increasing Range of Motion 7 --Maintaining or Increasing Range of MotionMaintaining or Increasing Range of Motion European Heath StandardsEuropean Heath Standards CConformitéonformité EEuropéeneuropéene -- CECE --Approved forApproved for –– Stroke RecoveryStroke Recovery --class II deviceclass II device ZynexZynex is an ISOis an ISO--13485 Company13485 Company The NeuroMove is manufactured in the U.S.The NeuroMove is manufactured in the U.S. SFDA PendingSFDA Pending
  • 8. Evidenced Based Success --Peer Reviewed Clinical TrialsPeer Reviewed Clinical Trials 8 --Peer Reviewed Clinical TrialsPeer Reviewed Clinical Trials Direct clinicians toDirect clinicians to www.neuromove.comwww.neuromove.com --Patient TestimonialsPatient Testimonials --Rehab Hospitals usage protocolRehab Hospitals usage protocol Show hospital listShow hospital list
  • 9. Clinical StudiesClinical Studies Chronic Motor Dysfunction AfterChronic Motor Dysfunction After StrokeStroke ConclusionConclusion: “Two lines of evidence clearly: “Two lines of evidence clearly support the use of EMG triggered NMESsupport the use of EMG triggered NMES treatment to rehabilitate wrist and fingerstreatment to rehabilitate wrist and fingers 9 support the use of EMG triggered NMESsupport the use of EMG triggered NMES treatment to rehabilitate wrist and fingerstreatment to rehabilitate wrist and fingers extension movements ofextension movements of hemiparetichemiparetic individuals > 1 year after stroke…individuals > 1 year after stroke… Recovering Wrist and Finger Extension by EMGRecovering Wrist and Finger Extension by EMG TriggereTriggere Neuromuscular stimulation.Neuromuscular stimulation. By JamesBy James CaraughCaraugh,, Ph.DPh.D See all clinical studies atSee all clinical studies at www.neuromove.comwww.neuromove.com
  • 10. Clinical StudiesClinical Studies ““Progress often far exceeded that ofProgress often far exceeded that of previous conventional therapy. Regardingprevious conventional therapy. Regarding mechanisms, impaired proprioceptivemechanisms, impaired proprioceptive feedback is considered central to strokefeedback is considered central to stroke-- disrupted sensorimotor control. EMGdisrupted sensorimotor control. EMG-- 10 disrupted sensorimotor control. EMGdisrupted sensorimotor control. EMG-- triggered EMS is intended to improve braintriggered EMS is intended to improve brain relearning by reinstating proprioceptiverelearning by reinstating proprioceptive feedback timefeedback time--locked to each attemptedlocked to each attempted movement. Clinical results were consistentmovement. Clinical results were consistent with this theorywith this theory.”” See all clinical studies at www.neuromove.com
  • 11. NeuroMoveNeuroMove Prescribed by Leading Rehab HospitalsPrescribed by Leading Rehab Hospitals Johns Hopkins, MDJohns Hopkins, MD TawamTawam Hospital, UAEHospital, UAE Cleveland ClinicCleveland Clinic Kennedy Krieger Intl.Kennedy Krieger Intl. St. John’s Mercy, St. LouisSt. John’s Mercy, St. Louis Mt. Sinai, NYMt. Sinai, NY Marlton Rehab, NJMarlton Rehab, NJ Montefiore, Bronx, NYMontefiore, Bronx, NY 11 Kennedy Krieger Intl.Kennedy Krieger Intl. Spine InstituteSpine Institute Rehab Institute ofRehab Institute of ChicagoChicago Mayo Clinic, MNMayo Clinic, MN Kessler, NJKessler, NJ Moss Magee Rehab, PAMoss Magee Rehab, PA Queen Elizabeth, H.K.Queen Elizabeth, H.K. Montefiore, Bronx, NYMontefiore, Bronx, NY Lutheran Hospital,Lutheran Hospital, Brooklyn, NYBrooklyn, NY TIRR of HoustonTIRR of Houston Mission Hospital, CAMission Hospital, CA LethbridgeLethbridge Hosp. CanadaHosp. Canada TanTan TokTok SengSeng, Singapore, Singapore
  • 12. What Hospitals SayWhat Hospitals Say about theabout the NeuroMoveNeuroMove ““……treatmentstreatments areare focusedfocused onon patientspatients whowho havehave hadhad aa recentrecent strokestroke asas wellwell asas thosethose whowho havehave sufferedsuffered fromfrom strokestroke--relatedrelated disabilitiesdisabilities forfor yearsyears.. 12 sufferedsuffered fromfrom strokestroke--relatedrelated disabilitiesdisabilities forfor yearsyears.. Lutheran'sLutheran's "Re"Re--traintrain thethe Brain"Brain" strokestroke recoveryrecovery programprogram manymany longlong--sufferingsuffering patientspatients cancan regainregain longlong lostlost mobilitymobility andand functionfunction..”” RR.. Ahmad,Ahmad, OTR,OTR, DirectorDirector LutheranLutheran RehabRehab Network,Network, Brooklyn,Brooklyn, NYNY TalkTalk toto thethe leadlead therapisttherapist aboutabout adoptingadopting aa NeuroNeuro RehabilitationRehabilitation programprogram..
  • 13. 13 85% of strokes are Ischemic85% of strokes are Ischemic Restriction of Blood to the BrainRestriction of Blood to the Brain Hemorrhagic StrokeHemorrhagic Stroke Bleeding into the brainBleeding into the brain
  • 14. What HappenedWhat Happened 14 What HappenedWhat Happened Loss of Brain Cells and theLoss of Brain Cells and the functions they controlfunctions they control Causing HemiplegiaCausing Hemiplegia
  • 15. Be aware of what is done in the stroke rehab clinics -Find lead Occupational Therapist -Private and Gov’t programs 15 Treatment of Stroke ParalysisTreatment of Stroke Paralysis Physical training including:Physical training including: Therapeutic exercisesTherapeutic exercises Movement modificationMovement modification Special equipmentSpecial equipment -- FESFES Assistive devicesAssistive devices OrthoticsOrthotics
  • 16. Treatment ApplicationTreatment Application 16 Treatment ApplicationTreatment Application Acute RehabAcute Rehab OnceOnce stabilizedstabilized Out patient RehabOut patient Rehab Home Care TherapyHome Care Therapy This is the goalThis is the goal
  • 17. Re Train the Brain ToolRe Train the Brain Tool 17
  • 18. NeuroplasticityNeuroplasticity ReRe--Mapping the brain pathways byMapping the brain pathways by driving thedriving the healthy neurons to take over for damagedhealthy neurons to take over for damaged neurons thus regaining voluntary contractionsneurons thus regaining voluntary contractions TheThe NeuroMoveNeuroMove: Not just FES!: Not just FES! 18 TheThe NeuroMoveNeuroMove: Not just FES!: Not just FES! PPatient imagines movement and is rewardedatient imagines movement and is rewarded through stimulated muscle contraction…through stimulated muscle contraction… MOVEMENT!MOVEMENT!
  • 19. What makes a SuccessfulWhat makes a Successful Brain Relearning Tool?Brain Relearning Tool? Patient must be CognitivePatient must be Cognitive Engages the BrainEngages the Brain 19 IntensiveIntensive Concentrated EffortConcentrated Effort FrequencyFrequency Focused RepetitionFocused Repetition
  • 20. The Re-learning Tool - NeuroMove 20 EMG detects targeted neurological attempts to move the muscle Utilizing Repetitive attempts and reward to stimulate Neural re- mapping
  • 21. Patients can experiencePatients can experience 21 Patients can experiencePatients can experience immediate results.immediate results. Gives Stroke patientsGives Stroke patients realreal hopehope and motivationand motivation
  • 22. Contraindications/PrecautionsContraindications/Precautions Implanted electrical devicesImplanted electrical devices Cardiologist approval for use withCardiologist approval for use with pacemakers.pacemakers. 22 pacemakers.pacemakers. EpilepsyEpilepsy Cancer LesionsCancer Lesions Use on Muscles onlyUse on Muscles only
  • 23. In the KitIn the Kit 23 Electrode Placement Guide Book Instructional CD AC Cord for recharging 3-Packs of 3-Electrodes Connecting lead wire Program Manual
  • 24. TherapyTherapy SessionSession SetSet--upup Attach electrodesAttach electrodes musclemuscle 24 Attach electrodesAttach electrodes musclemuscle groupgroup Turn on Unit.Turn on Unit. Set eSet e--stimstim to visible yetto visible yet comfortable contractioncomfortable contraction
  • 25. Start onStart on Any Group of MusclesAny Group of Muscles Wrist & Finger ExtensionWrist & Finger Extension -- FlexionFlexion Front & Back Elbow FlexionFront & Back Elbow Flexion Shoulder Subluxation/AbductionShoulder Subluxation/Abduction Ankle DorsiflexionAnkle Dorsiflexion 25 Ankle DorsiflexionAnkle Dorsiflexion Knee ExtensionKnee Extension Starting pointsStarting points upper or lower extremitiesupper or lower extremities distally or proximallydistally or proximally
  • 26. Ankle Dorsiflexion (Drop Foot)/Flexion Red Black Red Knee Extension - Front Red Red Black Shoulder Subluxation/Abduction 26 Knee Extension - Front Red Red Black Flexible: Use on any Muscle Group Refer to the Guide
  • 27. Therapy Session OverviewTherapy Session Overview 27 Cycle of Therapy RELAX: NM is Setting Threshold READY: Patient makes ATTEMPT GOOD: Stimulation or Reward RELAX: Deliberate rest
  • 28. RELAXRELAX The processor begins to detect EMG and set the threshold 28 Threshold is adjusted up or down every 15 seconds Automatically
  • 29. READYREADY Patient makes concentrated attemptsPatient makes concentrated attempts to make muscle exertion sensorsto make muscle exertion sensors detect real attempts.detect real attempts. 29 Encourage the patient to imagine or visualize movement, have them close their eyes. Engage the brain!
  • 30. RewardReward Imagination or attempt “strikes” the threshold and triggers physical movement…the reward. 30
  • 31. Cycle is RepeatedCycle is Repeated 31 The threshold is re-set every cycle and moves up or down to continually challenge or encourage the patient.
  • 32. NeuroMoveNeuroMove Hands On!Hands On! 32
  • 33. Other ApplicationsOther Applications Spinal Cord InjurySpinal Cord Injury *Set SCI Mode*Set SCI Mode 33 Other ReliefOther Relief Erb’sErb’s PalsyPalsy Bell’sBell’s PalseyPalsey Cerebral PalsyCerebral Palsy Multiple SclerosisMultiple Sclerosis
  • 34. Trouble ShootingTrouble Shooting SignalsSignals “check electrodes“check electrodes”” clean skin and wet electrodesclean skin and wet electrodes “Poor or sporadic Signal on Screen”“Poor or sporadic Signal on Screen” Restart NM between muscle groups changesRestart NM between muscle groups changes 34 Make sure Full Battery ChargeMake sure Full Battery Charge Set DefaultSet Default –– See Program GuideSee Program Guide Check for Broken lead wiresCheck for Broken lead wires EMG signal too low or too highEMG signal too low or too high Set Defaults and restartSet Defaults and restart See Trouble Shooting Guide onSee Trouble Shooting Guide on dropboxdropbox
  • 35. NeuroMove PatientsNeuroMove Patients Post stroke and SCI treatment may begin:Post stroke and SCI treatment may begin: Once stabilizedOnce stabilized Out patient or home useOut patient or home use Must be cognitiveMust be cognitive Up to 30 years post strokeUp to 30 years post stroke Treatment TimeTreatment Time 35 Treatment TimeTreatment Time 1515--60 Minutes each session60 Minutes each session Once a day building to 2 or 3 times a dayOnce a day building to 2 or 3 times a day Expect 4 months to a year treatment planExpect 4 months to a year treatment plan Can be used with:Can be used with: BotoxBotox –– High Tone patientsHigh Tone patients Baclofen PumpBaclofen Pump –– Spinal Cord patientsSpinal Cord patients
  • 36. Ancillary Benefits of NMAncillary Benefits of NM High Quality NMESHigh Quality NMES Programmable ParametersProgrammable Parameters Treatment of Muscle AtrophyTreatment of Muscle Atrophy & Re& Re--educationeducation 36 & Re& Re--educationeducation Muscle SpasmsMuscle Spasms Pain ReliefPain Relief
  • 37. Is this like regular biofeedback?Is this like regular biofeedback? No - Regular EMG (electromyography) may also have a very sensitive input, but for most other applications the input signals are filtered and averaged. Some stroke survivors have no EMG activity or a strong muscle tone 37 Some stroke survivors have no EMG activity or a strong muscle tone with high background “noise” - regular EMG/biofeedback will not stand a chance of detecting the changes that indicate a real attempt from the brain. The NeuroMove measures peak values in the EMG and has very fast input circuitry. Instead of averaging the input it does the opposite – it looks for a pattern in the small changes that indicate a real attempt. A very effective demonstration of this is when a non-patient actually triggers the NeuroMove just by thinking about it and imagining a movement
  • 38. Why only one channel?Why only one channel? FESFES vsvs NeuroMoveNeuroMove It has one channel, patient must concentrate on one movement at a time Is it like FES – No, FES or an elaborate functional 38 Is it like FES – No, FES or an elaborate functional stimulation product does not engage the brain. The patient can be watching TV and doing FES, but the brain will not relearn new pathways
  • 39. Is it complicated to set up?Is it complicated to set up? No – Encourage Home-use. Turn on the device and turn stimulation level up slowly for a comfortable contraction of the muscle Think very hard about moving the fingers, wrist, shoulder, 39 Think very hard about moving the fingers, wrist, shoulder, foot and other muscles After relaxing, it returns to “Ready” and is ready for the next attempt, relaxing is as important as concentrating
  • 40. Program SettingsProgram Settings Set thresholdSet threshold to increaseto increase or decrease challenge (can be setor decrease challenge (can be set during session)during session) Rest PeriodRest Period 40 Rest PeriodRest Period (default(default –– 15 sec. Set:6015 sec. Set:60 seconds)seconds) Mode: Stroke & SCIMode: Stroke & SCI SesitivitySesitivity Set Audio On or OffSet Audio On or Off Compliance DataCompliance Data (number of sessions(number of sessions and total time used)and total time used)
  • 41. Program SettingsProgram Settings 41 Change ParametersChange Parameters oo Frequency and pulse width, ramp up/off timeFrequency and pulse width, ramp up/off time oo stimstim periodperiod (default at 5 sec.)(default at 5 sec.) oo RangeRange:: Can only be set when SCI Mode is selectedCan only be set when SCI Mode is selected SCI two sensitivity ranges:SCI two sensitivity ranges: oo 0.250.25--2525 uVuV oo 0.500.50--5050 uVuV ((use if signal is off screenuse if signal is off screen w stroke patients)w stroke patients)
  • 42. Hands on Therapy SessionHands on Therapy Session Email: info@painezee.com Tel: +91 9030022402 Web: www.junopharm.com 42