Wireless Electromyography (EMG) or surface EMG (sEMG)
The use of surface EMG to assess the individual’s muscle activation patterns during various activities like sit-to-stands, gait training, transfers, core exercises and even mat mobility, further allows us to objectify and confirm our observations. The surface EMG provides specific and accurate objective measure of the individual’s ability to activate muscles during the movements, which may otherwise be challenging.
The results from the surface EMG findings can assist in gaining a better understanding of the individual’s body, provide the individual with feedback and assist in setting functional and measurable goals for the individual.
sEMG as Biofeedback is another valuable part of our therapy sessions. It allows the individual to get auditory or visual feedback when performing an activity specific to their functional deficits. EMG electrodes are placed over the target muscles and auditory or visual feedback is chosen. The individual then performs the movement which is guided by the biofeedback. This can be challenging initially as their movements are predominated by increased tone, atypical movement patterns and even sensory deficits. As an example; for an individual who has difficulty in reaching for an object with his affected arm, the EMG can be first applied to his unaffected side so they are able to understand the movement. It is then applied to the affected side while they are performing the same movement. They are now able to use the feedback from the EMG to correct their movement and use an efficient pattern.
The Total Gym is one of the most versatile pieces of equipment with many exercise options and recovery aspects. The vertical incline of the sled increases gravitational force into the legs, thereby increasing bone density. Also, the feet are in a closed chain position that gives increased feedback into the lower extremities by stimulating the proprioceptors. Individuals with spinal cord and acquired brain injuries have impaired sensation, so stimulating the proprioceptors is important in enhancing the ability of the client to connect with their body.
Vertical Vibration Plate w/ Mounted Standing Frame
Vibration therapy increases the body’s response to training. The science behind vibration exercise follows a few different principals.
Force = Mass x Acceleration
When we exercise, we use force to either lift more or lift faster. Two ways to increase strength are by increasing mass to get more force, or by increasing the acceleration by lifting lighter weights faster. Our Vibration system works on increasing acceleration (due to the rapid movement of the platform), rather than increasing the mass. So the vibration plate allows for increased force by the method of acceleration.
This method of training is more effective for individuals with spinal cord injuries, simply because it’s not always safe to increase the load on the joints if sensation and movement are impaired. With vibration training, there’s less stress on the joints, ligaments and tendons, providing an effective solution to those who may benefit from weight training, but are unable to engage in it.
When a muscle is stretched, the nerves from the muscle spindles transmit an increased frequency of impulses, resulting in a contraction of the surrounding muscle. Contraction of the muscle stimulates the Golgi tendon organ, which acts as a brake or shock absorber to prevent a contraction that’s too quick or extreme. The stretch reflex helps maintain stability and also contracts back. The movement of the vibration plate, due to the small amplitude of 2 mm, stimulates the body’s natural “stretch reflex” or tonic vibration reflex, similar to the knee jerk.
Giger MD Locomotion System by Giger
The Giger MD is designed for coordinated dynamic therapy that consists of all parts of the body working together. This means the movements of the arms, hands, trunk, legs and feet must all be coordinated and working together dynamically. While engaging in this type of behavior, the central nervous system may re-learn how to coordinate the body by adapting to the movements (called supervised learning).
It’s important to engage in these normal patterns of movement because following injury, the central nervous system is reorganizing. The goal is to maximize the ability to reorganize the central nervous system with normal movement patterns and try to prevent abnormal ones from occurring.
Research has shown there’s more potential for optimal reorganization when both muscle spindle afferent and efferent neurons, as well as tract fibers for volitional movement, are stimulated. Dynamic coordinated therapy is an effective way to accomplish this objective. Research has also shown that coordinated rhythmical movements will stimulate the threshold for action potentials more often than non-coordinated movements.
The machine has an internal mechanism that changes the coordination patterning between the upper and lower extremities that stimulate the central pattern generators. Central pattern generators (CPGs) are one of the ways the body produces rhythmic motor patterns, such as walking. Rhythmic motor patterns make up a majority of the ways we move about. When a person is ambulating, all areas of the body are working together simultaneously to allow walking to occur. The central pattern generators are behind this internal mechanism. With a neurological injury, such as spinal cord injury, stimulation of the CPGs is a crucial element of recovery. If individual areas of the body are functioning, but it cannot coordinate and work as a whole, the result is impaired movement.
The Giger MD is an excellent biofeedback tool. When used properly, it can give the client good insight into areas of the body that have been affected by the injury. The client is encouraged to focus on pedaling, using the whole body and beginning with a strong core, so that connecting the movements from the upper and lower body are more controlled. Smooth, continuous movements along with a steady pace should be encouraged. Because a well-integrated core is imperative to good movement, much of the focus during sessions is on core-related tasks.
In addition to being a very effective neurological tool, the Giger MD has many other positive effects, such as increasing circulation, improving pelvic mobility and reducing spasticity, edema in the legs and pain. The Giger MD is also a great machine for incorporating cardiovascular workouts into the client’s session. Because of the unique position with the legs and arms elevated, the Giger MD can stimulate the gastrointestinal system, which tends to be the most common benefit for first-time users.
Rifton Pacer XL & Dynamic Pacer Gait Trainer by Rifton
The Rifton Pacer Gait Trainer and Rifton Dynamic Pacer are utilized to assist with the different styles and techniques of walking. Bothe the Pacer XL and Dynamic Pacer offers the benefit of improved step length, width and a more fluid gait pattern and cadence. Several safety features, including the hip stabilizer, the pelvic support device and various upper extremity support prompts, allow our clients to practice more efficient ambulation. The trainer assisting with ambulation is also able to focus on step progression without providing additional support at the client’s hips.The Pacer XL and Dynamic Pacer offers the ability to train the client to ambulate with a consistent gait pattern — with improved temporal components and rhythm to facilitate central and spinal pattern generators. It also offers the ability to train for increasing motor control below the spinal cord lesion level.
The client is placed in a load-bearing position with as-needed upper body and trunk support provided by accessory prompts. The load bearing position assists with improving propriospinal pathways in the areas below the spinal cord lesion level.The Pacer XL provides the ability to position the client in an upright and weight-bearing position appropriately so that the above pathways mentioned are better facilitated.
Secondary effects of using Rifton Pacer Gait trainer and Rifton Dynamic Pacer:
- Improves bone density
- Improves joint range of motion
- Increases cardiovascular response to areas below spinal cord lesion level
- Allows for regulation of digestive system
- Improves respiratory endurance
- Stimulates central and spinal pattern generators, as well as additional neural pathways
- Facilitates integumentary and lymphatic system function
- Pressure relief
The Bioness L300 plus system
The Bioness L300 plus system has been designed specifically to aid in foot drop as well as offering help with dorsiflexion and knee flexion or extension together. If positioned properly, the thigh cuff has the capability to stimulate hip extension as well.
The L300 Plus system offers three different operating modes:
- Gait mode is used when walking. Gait mode uses a pressure sensor that’s positioned in the shoe to sense body weight and in turn, trigger the electrical stimulation in either the L300 and/or the L300 Plus thigh cuff. The two systems are not confined to working at any specific point of the gait cycle. With the device’s PDA, timing for the electrical impulses can be changed to meet each individual’s needs. Stimulation in the L300 and thigh stimulation units respond as programmed by the clinician.
- Training mode is used to train the muscles when not walking. Training mode delivers pre-set electrical stimulation parameters for a predetermined amount of time when the client is in any position. The training mode parameters will need to be set using the PDA as well. Training mode will work independently of the Intelli-Sense Gait Sensor.
- Clinician mode allows the clinician to use the control unit as a wireless trigger to start and stop simulation to enhance exercises. The stimulation parameters set in gait mode will be applied when pressing the trigger.