Walk-Aid, Bioness inquiry

Walk-Aid, Bioness inquiry

9/12/2008

I had a patient in my office for a diagnostic fitting of one of the dorsiflexion assist E-Stim systems that is presently available. The patient is a gentleman in his 60's, who was quite active prior to an onset of idiopathic hemiparesis. They have ruled out both the original suspected Dx's of CVA and MS. They are still running tests to try to Dx the causation. He manifests symptoms classic of a moderate CVA. He does exhibit some tone, as well as mild intermittent spasticity. He is taking medication to control the tone and spasticity. He has mild to moderate dorsiflexors, which diminish as he tires. He is capable of mild to moderate hip and knee flexion during swing phase, but tends to minimize these for fear of his knee buckling at the initial heel contact of stance. He has weak quads/hamstrings, and he presents a genu recurvatum during stance. He ambulates with one forearm crutch, and does reasonably well all things considered. The major hurdle we are trying to overcome is a toe drag on the ipsilateral side at the initiation of swing phase, partially due to a weak gluteus medius on the ipsilateral side and his fear and/or diminished ability to flex his hip and knee. He compensates for this by vaulting during stance on the contralateral limb. Now to my question...

When the patient was fit with the e-stim system we were able to achieve positive outcomes. Much better than we have been able to achieve using various OTS AFO's. (He had tried a custom AFO made elsewhere with negative outcomes due to size, weight, etc...)The patient, his wife, and I were very encouraged by the results. He was able to initiate swing phase without the toe drag, and the vaulting gait pattern was significantly decreased. He was on his way to his neurologists after his appointment with us, so we sent along a packet of information on the system for the neurologist to review. The neurologists response to the patient was that he considered this a waste of time, a waist of money, and he does not think these systems are safe or effective. He told the patient that if he used one of these systems, he would burn up his nerves and they would be fryed within 6 months to a year.

I have no intention of arguing with the neurologist, but for my, and my patients information, is anyone aware of any studies and/or information (clinical not anecdotal) of the long term effects of e-stim in general and/or the walk aid or bioness systems specifically? I have to admit this is the first time I've heard of frying a nerve via e-stim. Has anyone heard of this as a long term complication of these systems? Any info would be greatly appreciated.

Thanks in advance,

Mike Madden, CPO

       

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