This document provides supplemental instructions for using the NeuroMove system to treat stroke and spinal cord injury patients in a hospital clinic setting. It outlines a 10-step process for clinicians: 1) assessing patients, 2) creating a treatment plan, 3) using muscle stimulation, 4) starting in manual mode, 5) progressing to automatic mode, 6) adjusting stimulation parameters, 7) treating additional muscle groups, 8) monitoring patient compliance, 9) incorporating mCIMT therapy, and 10) using multi-channel EMG to improve muscle coordination. The goal is to efficiently develop patients' muscle function and motor skills to maximize recovery.

1. ™
Supplemental Instructions for the Hospital & Clinic
Treating Stroke & Spinal Cord Injuries
THE NEUROMOVE uses electromyography-triggered neuromuscular stimulation (ETMS) to produce the cortical reorganization
needed for progress toward functional recovery. With its
automatic features, the stroke patient can use the system as
supplied, right out of the box, in clinic or home training. It is
especially helpful where the patient has the benefit of a physiotherapy rehabilitation program and is already somewhat familiar
with muscle stimulation concepts.
However, in a hospital clinic, new patients often present with very
low function, spasm and significant atrophy. A more structured
approach is then needed to make the best use of the NeuroMove.
Progress is faster and easier if treatment is started sooner.
However, it is also important that the patient is well motivated, will
spend the time needed and is ready for some hard work to make
the therapy succeed. If not, due to other medical issues, immediate
trauma or personal matters, then rescheduling the therapy
sessions to a later time, when the patient will be more available
and committed, is best.
1. Assessment
Assessing the extent of muscle and nerve damage, cognitive
ability and mapping the involved muscle groups is important.
Ask the patient to view the instructional DVD
2. Treatment Plan
The NeuroMove operates with only one muscle at a time. Choose
a practical sequence for progressing through the affected area.
Starting with a muscle showing only moderate dysfunction is
usually best. The patient will see progress more quickly, will
understand the therapeutic concept more clearly and will be
better motivated to progress on to the more challenging areas.
After this initial familiarization, moving to the areas of most
concern and lowest function is best because that is where ETMS
will produce the overall most benefit.
3. Muscle Stimulation
At the beginning of the session, a few minutes of muscle stimulation can sometimes help to reduce spasms and prepare for
therapy. Usually the process of adjusting the stimulation level
and the first few trigger cycles provides enough warm-up. If not,
you can use Stimulation Only. Press the Program Button three
times to select Operational Mode. Press the Up/Down buttons to
select Stim-only.
Press the Program Button again to select Change Parameters and
press the Down button. Set the stimulation parameters as
required. Press the program button several times to return to the
main screen. Press the Up/Down buttons to adjust the amplitude.
The amplitude will need to be at least 12 mA for the NeuroMove
to work correctly in Manual Mode and Automatic Mode. If the
patient will not tolerate more than 12 mA, lower the pulse width
or frequency so that you can set the amplitude higher. Readjust
the parameters as needed. Go through a few Work/Rest cycles of
stimulation to the muscle.
Refer to the NeuroMove NM900 Programming Guidelines and
the User's Manual for detailed operating instructions.
4. Manual Mode
To begin muscle training, and for better control, starting a new
patient in Manual Mode is usually best. Press the Program Button
three times to select Operational Mode. Press the Up/Down
buttons to select Manual. Press the program button several more
times or wait to return to the main screen.
Increase the stimulation level using the Up/Down buttons. The
NeuroMove will start to cycle. At the end of each rest phase,
instruct the patient to try a movement for the purpose of contracting the muscle. If the patient has difficulty accessing the muscle,
suggest that the patient just think hard about the muscle and
concentrates on it. Watch the screen to see the height of the EMG
bars. Press the program button once, and then use the Up/Down
buttons to adjust the threshold line which represents the target
for the patient. Adjust the threshold to just below the maximum
contraction so that the patient can easily achieve the threshold
most of the time. After a few cycles, adjust the threshold up or
down as needed.
5. Automatic Mode
After the patient seems to understand the concept, and the
NeuroMove process is working well, you can move on to Automatic Mode. This is the main therapy mode, and the method by
which the patient will make the best progress. Press the Program
Button 3 times to select Operational Mode. Press the Up/Down
buttons to select Stroke Rehab. If the target in Manual Mode has
been very low, near the bottom of the screen, select SCI Mode
instead (Spinal Cord Injury) which is more sensitive. In SCI mode,
two sensitivity ranges can be selected in Change Parameters area.
Use the program button to step through each setting to verify
that the settings are as you want them. Make any needed parameter changes. Press the program button several more times to
return to the main screen.
6. Stimulation Parameters
At first, a shorter Stimulation Period (work time) of 4 to 5 seconds
is best. The rest time usually needs to be at least 8 seconds to give
the patient adequate time to relax and recover. As function
improves, you can increase the work time, increase the Ramp
On/Off times and increase the Stim. Amplitude to give a strong
functional movement.

2. ™
Supplemental Instructions for the Hospital & Clinic
Treating Stroke & Spinal Cord Injuries
To avoid over treating the patient, set the Treatment Timer to turn
off the NeuroMove unit at the end of the allotted treatment time
in case you are occupied elsewhere.
For a new patient, you can turn the audio prompts off, and give
verbal instructions. As the patient becomes familiar with the
NeuroMove, turning the audio prompts On is usually best so that
the patient does not need to watch the screen for prompts.
7. Treatment Progression
As muscle and nerve function return, you can progress to other
muscle groups until all muscle groups are active and the area has
overall improved function. The benefit of using NeuroMove is
that you can advance your patients more quickly. You can treat
patients that would otherwise not be considered candidates for
therapy.
8. Compliance Data
If you lend the NeuroMove to a patient for home use, you can use
the compliance monitor to verify the number of times and the
total length of time that the NeuroMove was used in active
therapy.
9. mCIMT
To realize improved motor skills, a regimen of modified constraint
induced movement therapy (mClMT) has been found to have
important clinical utility. Where the patient has little or no active
movement in the affected area, use ETMS first on each involved
muscle. ETMS will develop the active movement needed for the
patient to be able to participate effectively in the mCIMT
program.
10. Further Muscle Coordination
In areas of the body where mCiMT is not well suited, the patient
can best relearn the needed motor skills with multi-channel
surface EMG using agonist/antagonist pairs or single muscles in a
muscle training environment. The patient can efficiently develop
the needed muscle tone, coordination, relaxation and timing to
eliminate compensatory movements and perform advanced
isolated movements. ETMS, mCiMT and EMG muscle training can
be used concurrently for optimal motivation and progress.
Quick Reference Electrode Placement Guide
To Order NeuroMove
Contact your local Distributor
or call - +1 303.703.4906
fax- +1 303.867.3927
international@zynexmed.com