Webinar On Demand: Improving Upper Extremity Motor Recovery with Saebo

Webinar On Demand: Improving Upper Extremity Motor Recovery with Saebo



afternoon everyone my name is Chris I'm Holly I'll be conducting today's webinar it won't get started in one minute I'll just give it one a few more minutes to let folks join on and we'll start promptly at noon alright guys I think we'll might as well we'll get started thanks for joining I really appreciate you guys and everyone spending the Friday afternoon listening to the webinar today allow me to introduce myself my name is Rahsaan Hawley I'm an occupational therapist at the MedStar national rehab hospital in Washington DC and I'll be conducting today's webinar discussing some of the stable products and how you can incorporate it into your treatment to help facilitate or encourage armed recovery after stroke or brain injury as well as lower extremity return as well just a few housekeeping issues we're going to save all questions to the end of the webinar and if you can if you like you could type your questions in the display box and at the end we'll have about five minutes to ten minutes where we'll discuss and we can try to answer some of the questions that you pose so if you do have questions please write them down write them down and put them into the chat box and myself and our panelists from sabo will answer any questions that you might have so let's get started Sabo is a neuro rehab company that started about in 2001 basically looking for some rehabilitation options for individuals who had particular shown some shoulder movement and elbow elbow movement after a stroke but they lacked the ability to include the hand and functional tasks so they were really interested in inter providing some type of treatment option for individuals who had some return in the arm after some neurological injury but they didn't have full functioning of the hand so at the time they developed a device that they could a stroke survivor or a patient could we err on the hand to help with training to hand on functional use and incorporating in it into the hand into functional activities it was called disable flex and we'll discuss it in a in a second here um so they've developed disable flex back in 2001 and that's when I got my or received my exposure to the device so I'm as I mentioned earlier occupational therapist and I spent my most most of my career here at the National Rehabilitation Hospital I've been treating an inpatient rehab so immediately after an individual would suffer a stroke or brain injury I've worked in the outpatient setting I work in a home care environment I participated research so I have really a lot of exposure to seeing the full course of an individual post injury and I got my exposure to Sabo was during the inpatient rehab so immediately after a stroke or a brain authorial injury and what I used at what I was trained on with uh during those inpatient years was on disable flex and as we'll see in a sec it's a really real innovative device that helps encourage ham recovery after stroke and you could actually put the hand in a functional position that allows the hand to engage in functional activities so that would stables first device and it's probably one of its most popular products that they sell but since then so fast-forward 17 years sable is now offering many different products for the neuro patient who has limitations in upper extremity as well as leg movement and the goal of the webinar today this is just give you a taste of a lot of products that sable offers and how you can incorporate it into your home exercise program or your therapy session and when certain products are appropriate and when certain products aren't appropriate this is really just a general overview of the product I highly encourage you after you care today's webinar there will be a representative from Sabo who will follow up with you if you were able to get your hand on some of the products just to play around and get some exposure to the devices that will really help compliment now are the information that I will be sharing today so it's one thing to listen on a webinar it's another thing to actually get your hands on some of the products and see how they actually work in real life so again someone from Sabo will be following up with you after today's webinar and if you can ask for a demo of some of the devices and products that we'll discuss they'll be more than happy to discuss it to you how to do that ok so with the introduction and giving you a little background of Sabo and my exposure to the sable product let's discuss some of the products that they offer just real quickly the slide just gives you a general picture of all the products that sable offers and we'll just go a little bit more in depth as the webinar goes on but the device here this picture here this is of the sable Fleck so this is the device I was discussing earlier so is a functional dynamic or Co C's that puts the hand or the affected hand in the functional position to allow to engage the patient and more home-based and therapy based activities there's another elbow component to it which is cold that allows the individual to extend their elbow and it facilitates that only elbow extension but also finger extension and when you combine the above elbow component with the distal component the entire device is called the stable reach and we'll discuss that in a second as well this product here is the next product down is called the stable stretch so it's a dynamic hand splint designed to prevent joint damage in the fingers if tone kicks in so it keeps the hand the fingers and the drink to the hand in the proper position once tones once the tone kicks in and the fingers winter curl and it helps repo put the position fingers back in the proper position so it avoids joint deformity we have the stable mod which is here which is a zero gravity mobile arm support system designed to help clients with a weakened shoulder and allows the patient to engage in more activities without the weak shoulder and allows them more mass repetition task oriented treatment then which we look at some of the electrical stimulation devices we have a stable of eve of sim this is a tool to channel electrical stimulation device that has 13 different programs so it's a unique simple Eastham device that you could provide if you are a therapist to your clients or if you're a patient you can use at home a little bit more involved in disable minor track of journey which is a biofeedback triggered electrical stimulation device okay and this the reason why it's biofeedback because the patient would receive visual and auditory cues on how much they're contracting or attempting to activate a muscle and once they read a certain threshold that the therapists set of stimulation is provided so it's more driven by the patient as and it's more involved active patient as opposed to more be a passive Eastham devices we have the sable rejoice which is an upper extremity virtual reality system where the patient we gauge in different movements of the arm while they're playing different games that are displayed on the computer screen we have the stable gross motor equipment as well as the stable glove which is a advice for those patients with ortho or orthopedic or neurological condition where they have some finger extension but they need assistance with composite finger extension so it allows the patient to in Susanna involved a hand and more functional and therapeutic activities devices that are in picture here are some of our newest devices that we'll discuss such as disabled VR which is a virtual reality system as well as disabled step which is a first entry into the lower extremity market as well as well as the say both sim micro which is a low sub sensory electrical stimulation to the arm and the hand so what are the goals of Sabo's basically to allow patients to use that arms more functionally decreased non-news increase learn use reduce spasticity improve range of motion strength and control improve occupational performance and of course improve quality of life so jumping right in if we talk about the different products we're looking at disable flex build a stable flex like I mentioned earlier this is what's tables first device okay so the dynamic custom fabricated wrist hand finger associates that we choose a spring-loaded finger and some extension system the extensor spring system assists with reopening the fingers after functional brass so Clues appropriate foot a flex so pretty much any individual unable to use again functionally or they cannot extend a hand due to tone of the wrist and finger flexors so if there's a lot of tone and the wrist and finger flexors the patient lacks that ability to fully extend the fingers so why was disabled flex developed I alluded to this a little bit earlier but at the time when the Sabre flex was designed by the creators of Sabo um they at the time there weren't that many treatment options for individuals that had some shoulder or some elbow but they left hand moved it so the only real effective treatment at the time let's go straight into smoothness so there was a need for something different something a little bit more intense to help include the hand in functional training so here's the video of how it works so pretty much the patient activates the long finger flexors so the flexor digitorum superficialis so the movements coming from this joint your PID joints in the fingers and then UMP joint in the thumb so that's the flexor pollicis presence is a particular muscle and what we're doing is we're having the patient's contract that muscle and then focus on relaxing the muscles to allow the fingers to extend so you're retraining the hands flexing muscles to activate and then relaxed to allow the spring to extend the fingers into extension okay so it's really meant to retrain the patient on how to activate a muscle and then relax it to allow the extensors to open up so this light here pretty much describes what I just mentioned so the patient would grab an object using the volitional flexors control so the muscles of the wrists and the fingers to pick up an object they carry the object to a desired location and then they relaxed the flexor tone to allow the extensive spring to open up the fingers and it's um okay so who is the candidate so any patients with limited shoulder and elbow movement and limited wrist and finger extension so specifically 15 degrees of shoulder elevation so that's 15 degrees of movement anywhere in the shoulder so just movements anywhere at the shoulder 15 degrees of elbow flexion or bending the elbow up to about 15 degrees and a quarter range of finger flexion so we like to call it 15 15 and a quarter so 15 degrees at the shoulder moving the shoulder in any directions 15 degrees at the elbow and a quarter range of finger flexion so here's the few slides of what take location will look like the patient tries to pick up the cup hair he lacks the finger extension wrist extension to get his hand around the cup ok we then put them into the saber flex and he can activate the finger flexors pick up the cup and complete the task ok we have a spoon alright able to scoop with the spoon as well as if we put his hand into the stable flex he's able to scoop it no problem so we can see she's trying to pick up the bowl and she lacks that finger extension to get her hand around the ball ok we then put her into the stable flex and we could see she's able to pick up the ball no problem and drop it over okay so pretty much disabled flex puts the hand in that focal position to grab the little ball or the object and then work to release it so if we look at a particular case study so this is a patient a two stroke survivor through three weeks post strokes he came in to see us three times per week for 12 visits each session lasted 45 minutes and we recommended a home exercise program for 40 minutes per day so the task that we had them do was using disable flex and some of the gross motor equipment that you'll see in a sec so looking at the baseline movement so what we wanted was again quarter or 15 degrees at the shoulder okay and he's able to get about maybe 15 degrees of shoulder abduction so he definitely meets the criteria at the shoulder we then went 15 degrees of elbow flexion okay and he's able to get about 90 degrees of elbow flexion so he definitely meets the criteria at the shoulder and at the elbow we don't stand them up and we want to see if we have a quarter range or finger flexion and we get about that quota range of finger flexion so he's definitely can eight for disabled Fleck this is his first attempt with disable flex visit – he's able to grasp and then relax the flexors to release the ball into the crate so he picks it up he's able to pick up the object and relaxes and drops the ball into the crate we then move over to another activity the fireball peg activity where he's able to pick up the peg but he lacks the strength to put the peg into the target so he doesn't have enough strength to complete the task but he does have enough strength to lift up the object and carried it over now step forward visit 10 and here is doing that same 5 wall peg activity but now he's able to release the object into the target you can see also that the therapist made to task a little bit harder by moving the target on to the other side so requiring a little bit more trunk rotation as well as requiring the patient to bear weight on his weaker leg okay this is hid to 12 without the same reflects and you can see now his hand is nice and loose he's able to pick up the object carried it over not dealing with that flexor channel that he was dealing with before in the hand five months post here he is using the left hand to sort change off of the table okay working on dicks dexterity type of task the next video here he's setting up his Eastham unit so you probably noticed that he lacks a little bit of the wrist extension so bringing the wrist up so here he's using the left hand as to engage in more bilateral activities so setting up as you sim unit and then in the video on the bottom he is sorting change out of his hands alright so not saying that every patient is going to see the same returns but this is just gives you a general idea of how you could incorporate disable flex into treatment now the Sable reach as I mentioned before this is a dynamic custom-fabricated elbow wrist hand finger of ptosis so this includes that above elbow component which is this here and combined with disable flex which is just the component and the above elbow component is connected to the disco component to a stable flex via these tension bungee cords so basically what would work the works the same way that disable flex works so the patient would activate the bicep and then focus on relaxing the biceps to allow the bungee cord to extend to elbow okay so again the patient activates the bicep relaxes the biceps – well the bungee cord or this extension system to extend the elbow so this slide just reiterates that so the reach consists of the stable flex which is here and the custom-fabricated above elbow components the main feature of the reach Ysabel bow extension system the an extension system helps with straightening the elbow after functional reaching so the best way to show the stable reach is to show it in action so here's another case study this is a patient who was sober in a stroke survivor subacute phase so just immediately after his stroke he came in to see the folks at say both three times a week for nine visits each session lasted 45 minutes and a whole nexus a home exercise program we recommended or was to 45-minute exercise programs per day the treatment was repetitive task oriented training this time using the sable reach and some of the gross motor equipment okay so here is the patient trying to pick up the ball and again you can see he lacks that volitional finger extension just due to the increased flexor tone right so then we put them into the stable flex and you can see his hand is in a better position he could come down around the ball pick up the ball carry it over to the crate again so he's activating the flexors relaxing the flexors to drop the ball into the crate okay and then he was able to continue to engage in the task with the hand in at from jill's position so really addressing the flexor tone in the wrist enhance a visit eight we then put it up on both elbow components and you can see the tensioner is FD he picks up the ball he has to push it through this hoop and drop it into the crate once he picked it up he reaches over extends and then drops the ball into the crate you can imagine if we didn't have the bungee cords he would be more in elbow flexion so in order to complete the task he would have to compensate so trunk flexion to get his hands through the hoop hair so here by adding the above elbow component you're decreasing any trunk compensations or body conversations that might emanate now this is without disable reach they can see his hand is nice and relaxed it's really nice finger extension to get his hand around the ball and he is engaging in the task a lot easier okay six months later so here he is doing some timing drills so bouncing a ball or a trampoline and catching okay again this is not every patient that we see is not going to see these type of returns but it just gives you a general idea of the type of results that we could potentially see if you engage the patient with the appropriate tab with the appropriate activity as well as the appropriate tools moving on so I'm going along the same principles as both disabled flex and Sabo Reach is disabled glove so this is on a table of newer devices and what it is it's a cutting edge row profile globe that is appropriate for both the neural patient as well as the orthopedic patient and it's really ideal for those patients who have some finger extensions but they lack composite or full finger extensions so with it it allows the patient to engage in functional grasping a lease or tasks training or tasks activities at home or in the gym so how does the work pretty much the same way as you see here so the patient activates the flexors and then tries to relax and Unwin to have stable flex we had this spring with opus helped with opening the fingers but as you can see with the Sabre glove you have these tensioners or rubber bands that are connected to the store sole base splint to the glove you have these little hooks that are on the individual joints of the fingers so the patient activates the flexors tries to extend they can't get full extensions and the Vikes would move them into full extension why use the same as well basically to help patients to include or incorporate the hand more functionally at home and in therapy increased motor control strength range of motion increased function with and without the globe allow patients to engage in functional activities immediately so if they don't like if they don't have the finger extension allows patients to engage in folktale activities immediately and not have an excuse of not engaging and tasks because you lack full finger extension and you can combine it with electrical stimulation devices as well so who is appropriate for disable glove stroke survivors individuals with brain injury spinal cord injury MS Gyan beret other neuro conditions raised by radial North palsy brachial plexus and any individuals with limited risk of finger extension but the major issue is the patient's must have low tails so you can imagine if they have low if they have severe tone which is real difficult to extend the wrists or extend two fingers they might be more appropriate for the stable flex what if they were stable flex once they will reach because this device is really ideal for those patients who have some finger extension but they need some assistance to get full composite finger extensions still some video examples so here's a individual with radial nerve palsy without the glove here he's trying to move the cup from one side to the table to another but he lacks that finger extension to able to do it so we then put them into the glove and it's able to do the task pretty easily here's the same patient trying to you open up the cabinet without the gloves then if we include the globe he's able to open it no problem here's a spinal cord patient without the glove have some finger extension but not full then and then we have them try the dowel velcro activity to see he's having difficulties moving to dowel down the board we then put them into the glove and you can see we get more of a full composite finger extension as as opposed to before and then if we try the velcro dowel pass is able to perform it a lot easier is a stroke survivor as some finger extension okay Garcia we have CS finger flexion and then some volitional finger extension we put them in the gloves is able to get more of that finger extension that we're looking for and then with that then we can do grass release and engage in a more of a functional activities including the hand now just moving and discussing another device that sable offers is called the sable stretch so this is a resting can splint that's unlike other splint up there so typically with the other static splint on the market once a patient activates their or app moves or try to move their arm or walks or sneezes or laughs tone usually increases in the hand and with your traditional static splints once that happens the fingers curl into in the init splint basically resulting in a lot of joint – for me as you see here okay so what's really unique was the sable stretch is that dynamic arresting hand flip meaning once tone kicks in the patient walks they stand up they sneeze they laugh the device actually been with them so as you can see here the things are straight tone kicks in you have a bending action so that pastes a splint actually can accommodate their toes when the tone subsides or the patient relaxes the splint actually recoils back and properly positions the fingers back into the proper position okay so it bends then they relax and then it's went with positions two fingers back into the normal position unlike your static splints once the fingers Bend they don't get that recoil action back that just curled up in to into splint which causes major joint it for me um so here's just a slide that describes what about the splint it's a revolutionary dynamic campus that could really address the different toll tonal changes that a patient might go through in a typical day there reason why events we have interchangeable resistive hand plate that the therapist or the patient can change depending on the tone in the hand what's really unique about the splint as well has elastic non strip non slip straps that are sewn to the actual splint as you can see here it has zippered removable so the cover is actually a zippered so you can unzip it and wash it with normal cleaning methods you have a raised padding for the palm of the hand you have an adjustable thumb as well so depending on the phone patients thumb position and you have stabilizing wings for the forearm as well so the splint does it move on the patient's hand okay these are just pictures of the interchangeable hand pieces that come with the splint so you can see here you have a yellow which is the lightest hem resistive plate and then the blue which is the strongest resistive plate the device is actually shipped to the patient with a red which is the medium resistance so depending on the patient's tone and what their needs you would or the therapist or the patient would change out the actual hand plate to depending on the patient's need and the best one or the best plate to provide the most amount of assistance to move back into extension once the fingers curl device disable offers is called disable sim micro okay disable system micro provides a low sensory East electrical stimulation to the arm and hand utilized utilizing the specialized electro garment that's on the glove and at the elbow this unique electro garment is comfortable is easy to wear and you can actually use it during activities as well inside the garment it's made of nylon fibers or depron that has silver threads in them and the silver threads it helps with conducting the electrical charge or the electrical stimulation from this unit to both the elbow and at the hand why use a stable skin micro so the research shows as you can see here individuals after with hemiparesis after some type of neurological injury they're not using their effective arm as frequently as they should so some studies show that individuals only use their effective upper extremity for only three hours per day other studies show that the effective arm is used only 30 minutes during a nine hour day so research shows if we want to have our best chance for functional recovery of the upper extremity we really need to engage in repetitive tasks that needs to be used repeatedly or it's a repeated list throughout the day it can't just be used three hours a day and by doing that and by encouraging more use we have a better chance of prolong and sustain recovery so we need different ways of trying to stimulate the affected side so the sable sim micro shows is basically providing a sub sensory so undetectable to the patient stimulation to the effective limb and research shows that sensory electrical stimulation can be an effective treatment for improving not only sensory recovery but also motor function as well the main goal of the stable stim micro is to maximize input by providing stimulation at very low levels without producing a muscle contraction so we're providing stem without producing a muscle contraction just to stimulate the add to century level studies show that providing that sensory sensory level stimulation to an impaired nervous system can help Prime the motor cortex – and be more susceptible for neural plasticity which then would help with motor recovery so pretty much with the sub sensory stimulation you're priming the motor cortex to help with neuroplasticity which then would help with motor return the recommended protocol typically during the day you can exercise or do that home or in therapy two times per day for 30 minutes is really ideal clients with some hand function are could encourage to combine it with such a century combined sensory East them with hand training so typical therapy exercises you can wear it at night as well but it's not is not mandatory and benefits decrease specificity improved motor function increased sensation improve inattention or neglect so definitely if the patient has an attention or it's neglecting one side so great way to stimulate that side of the body it may potentially help with decrease swelling pain and potentially normalize hand temperature now something that's a bow for the therapy clinics out there something that communitas a bow is offering is a sable hand treatment kit so basically what it is designed for it's for hospitals and clinics and it's the only one kit that addresses all the upper extremity motor return needs for the patient so it includes a stable glove a stable flex a stable stretch stable sim micro and there's either sip so if the patient would need electrical stimulation there's a product for us if it patient has some volitional finger extension but they need a more complete or composite finger extension you have disabled stable glove if someone's it has a little bit more tone you have the stable flex you have disable stretch for proper finger positioning so it would all come in one kit so this is something that's really unique that's new that stables offering so I definitely recommend you fought one you have disabled representative who will contact you after the seminar that you ask them about this sable hand treatment kit one of Sables newer devices that they came out with is a first device for the lower extremity it was called disabled step it consists of a lightweight uniquely designed foot drop rate which is here that provides convenience while performing optimal foot clearance and supporting and support during walking the sable step is designed to replace those uncomfortable AFOs that are out there that a lot of stroke survivors use and what it does what's really unique you have the ankle brace okay and it's connected to hooks that are in the shoe okay and the hooks are connected to the brace via these this spectral cord or a cord Accord design and what you would do you have the brace on at the ankle you attach the cord to the hooks that are in the shoe and then you adjust via the BOA dial technology or a boa dial the tension that on to on the cord and basically the more assistance the patient needs in Dorothy flexion you would tighten up the dial and basically it helps the patient with swing during the gates and then when the patients finish you just pull the dial out and it would release the tension to allow us to allow you to take the device off here's the general makeup of the device okay it's really unique I have a lot of PT colleagues who use it and it's a really good way of helping with the swing phase in ankle and really addressing that dorsiflexion and patients who lack it and it's more comfortable for patients as well because they don't have the bulky afo that they need to use who is appropriate for the table steps so neuro patients so you stroke ms spinal cord injury Parkinson's ortho patients as well okay it's the only contradictions the patient has if the patient has high tone they probably wouldn't be a candidate because you probably couldn't put that much tension on to the device two chords that dorsiflexion at ankle and clients with only one handed function require tear get work or putting in on ok these are the type of shoes that you can use it on and then also if you have shoes that don't have shoelaces or don't have the holes for the shoelaces the there's a tool that stable wood could provide that actually could make holes in the shoes that you can attach the velcro to I mean the hook too so there's an option even for those shoeless she is out there alright the leafless shoes of the excuse me another device that sable offers this is more for the clinic but it's called disabled Mott and the stable masses are dynamic mobile armed support system um so mobile our support systems have been out in rehab or in the rehabilitation field for years only back in the 1950s but one of the most common complaints about the older type or old traditional forms of mobile armed support systems were that they're uncomfortable they're difficult to to attach to wheelchairs they're cumbersome they're hard to incorporate in functional activities and they weren't used as often so stable heard of the need for a newer device that could help with um help with the weakened arm and would be appropriate for individuals who need to really address the we connect upper extremity and would benefit from mobile our support system and they came out with a device called disabled month so disabled mas is a zero gravity dynamic mobile arm support system specifically designed for the individuals with the challenge shoulder to really engage the patient and high repetition activities so the month is pretty much made up of spring-loaded parallelogram which is here okay and a therapist would tighten or increase the assistance or increased attention on the spring depending on the patient's weakness so as the patient needs more assistance let's say it's difficult for them to move their arm at from at the shoulder at the shoulder the Papists would adjust the tension on the spring to allow the spring to take more of the weight of the arm but as the patient improves the strength and they get stronger you would decrease the spring and allow the patient to engage more on their own okay so the least amount of tension is set at a1 most about attention is out of 15 so a couple a case examples so here's a stroke survivor using disabled flex and we're trying to have a move it to the yellow tube he's able to do it but he has a real hard time putting his hand into tube and also getting it out of the tube you um then we have we then add them continue to task which disable mas and you can see he's able to do it a little bit easier so similar situation have a patient used in disable flex trying to move their arm into the crate we then put them into the stable month and you can see she is able to move the arm a little bit easier and to complete the task and then this last video here this is a patient using the Flex going up a little bit higher to the red tube so requiring a little bit more assistance to lift up the arm into the red tube we put them into the MAS and he's able to lift up there and drop it into the yellow tube and then lift the arm out of the tube and then complete the task here's the spinal cord patient using the same task more for proximal strengthening okay so it's targeting type of exercises okay you can also use it for functional activities so at our facility we have a few of them as in our clinics we use them for our feeding groups or an inpatient rehab for our ADL or cooking activities that patients need assistance I have a weak shoulder and they need to engage in more functional tasks they use it for ADL's or cooking activities so you can use it for functional activities as well it does come with a base if you need to if you want to roll it around the gym or use it in your dining clinic or dining room or you can move it to you ADL kitchen so you do have captures that sable sails with it as well now for the pediatric population or home care or maybe outpatient gym if need be disabled made disabled mocks mini which is the smaller version of a sabre ma this is a quick video of what the mas mini would do and pretty much is the same idea it provides that proximal support it allows the patient to engage in mass repetition but the only different with amongst many as you can see obviously is smaller it doesn't provide as much assistance so the weight capacity is a little bit less than that muffin de menthe but it's really ideal for those homecare patients or pediatric patients that you might see so here's another video example of a patient using the MAS mini she's trying to pick up the ball put it into the yellow tube to see he lacks that proximal strength so much you have to use this other hand to lift up the ball and drop it into the tube then put them into the last mini and you can see he's able to do the test a little bit easier and he's able to engage and more match repetition as opposed to before where he couldn't lift up the arm so prior if we didn't have the last mini or the mas where that matter it would be the therapist trying to facilitate or do a hand over hand techniques to complete the activity so when we compared it to devices the monsters 11 pounds compared to seven half pounds for the MAS mini but monsters 40 is six inches long compared to two and twenty nine and a half inches long in the mini monster 21 inches high compared to 21 inches high for a mini and as I mentioned before the weight capacity for the monsters 15 pounds as opposed to the max capacity weight capacity afforded monster mini is eight and a half pounds looking at some of the electrical stimulation devices so we have the stable mind track affinity so this is an advanced biofeedback electrical stimulation unit so it's unique because it offers an EMG biofeedback electrical stimulation EMG triggers electrical stimulus the reciprocal ent triggers stimulates and also into each in effect pretty much EMT is a 2 to channel high resolution surface electromyography so basically electrodes go over a muscle and it hit detect how much a particular muscle is activating so it's pretty when you have EMG you can use it as a biofeedback technique where the patient can get visual cues and auditory cues on how much a particular muscle is contracting and relaxing well what's unique about the mind track if any it also features electrical stimulation so those electrodes can also serve to provide electrical stimulation also is the EMG control trigger EMT controlled electrical stimulation which would be the therapist would set a threshold that the patient would need to detract a muscle once they contract the muscle at depth or Institute a certain threshold the patient is rewarded with electrical stimulation so unlike other electrical simulations where the patient's more passive the patient doesn't need to do as much with this device the patient needs to activate the muscle first to get the stimulation okay and that's really unique and unlike any device that's on the market right now the benefits of stimulation helps us muscle reeducation muscle pump contraction and increased local blood circulation helps address muscle atrophy helpless strengthening muscles maintain and increase range of motion address the specificity and works on acute and chronic pain control so here's this slide here just reiterates where I said I get up before those EMG triggered stimulation this is when you put those electrodes on the muscle to detect a muscle activity once the patient contracts volitionally to track the muscle to a certain threshold electrical stimulation is provided again it's more volitional based the patient describing this right as opposed to more of a passive device we just put a simulation on the patient and nothing is that patient does it do any active movement and it's more passive so this here diagram just describes the method so we put the electrodes on the muscle a therapist sets the threshold that the patient needs to activate the patient activates the muscle to that threshold and stimulation is triggered what's unique about to my track affinity as well it also features a reciprocal EMG trigger stimulation and this is really ideal for those patients who are working on that balance between the flexors and extensors and with this you have electrodes on the flexors you have electrodes on the extensors the patient would activate the flexors to a certain threshold then they relaxed the flexors to to the point where the therapists would set and then once they relaxed if the rushed out of their flexors stimulation is provided to the extensors so again the patient activates the flexors then they relax the flexors to a certain commercial that the therapist would set then stimulation is provided today extensors this is really appropriate and really ideal for those patients who are working on that balance between the flexors and extensor muscles by teaching the patient on shutting off the flexors it then provides that stimulation to help the patient understand ok I need to shut off the flexors to this point to get them to the extensors so there's not a lot of devices on the market actually does that has that feature and you could also do use that same protocol for the lower extremities as well so put electrodes on the plantar flexes and dorsi flexors the patient would need to shut off the planet flexors to a certain threshold to allow stimulation to be provided to the dorsi flexors that's one is stable newer devices called a save OVR so this is a virtual reality systems are sable offers that's designed for the rear of the design for individuals to engage the patient and more ABL based activities using the upper extremity while engaged in a VR environment the patient would have a virtual assistant or avatar called Claire that would guide the patient and through various protocols and would be able to buy the patient with real-time feedback as well it really helps patients to incorporate their upper extremity in real life activities I like to disable VR because yes of course we can engage in real-life activities but it is what the research shows is when we offer unique and innovative techniques for our approaches to patients it helps facilitate cortical plasticity so here using VR or virtual environment you can engage the patient is something unique and different while also following it up with real functional real-life activities because it's I think it's something different that helps stimulate that cortical plasticity which is so near those which is so needed so some of the virtual ADL tests as you can see here is a list so grocery shopping put away groceries what have you and why do we need to use it I think the slide is emphasizes the point enough and we brought it up earlier that individuals aren't including or engaging their Fricks show me as often as they should be after a neurological injury so this is just another way of stimulating the upper extremity and this lies research to shows the effectiveness of the stable VR okay and these are just some other benefits of the stable VR and we highlight function so the functional aspect function function function is important I like it too because you might be in a clinic where you might not have enough you need to do gardening so like in the photo here so here it gives you an opportunity to engage in tasks that might be interesting to the patient or engaging for the patient if specifically if you don't have an opportunity to go to a grocery store or to do gardening of some sort so just opens up a lot more possibilities so who are attending patients with cogsa who lose the canning patients with cognitive or upper limb impairment that could be neurological or orthopedic to address the physical limitations with disabled VR you can incorporate other modalities like the stable montt or maybe electrical stimulation options like my track affinity or the V the stem or potentially use disabled glove as well now here are some pictures of some of the other devices being used with disabled VR and lastly we have the sable rejoyce which is upper extremity workstation for the orthopedic and neurological population so basically is the workstation that the patient would engage in different tasks challenging gross motor movement as well as grid patterns and it's all correlated or related to as a patient and engaging and different games that are displayed on the computer screen it works a workstation consists of a tabletop mount this is a spring-loaded system as you can see here and you have handles so the patient would use the gripper to grab different objects or you can work on different graphs patterns as well and that's all at the same time while the patient has engaged in various games are displayed on the computer monitor while user rejoice again I think it goes back to trying to encourage tasks going into treatment and well as well as offering something something innovative different to keep the patient's interest and to help with the cortical plasticity here are some of the grip patterns that are are available that's a patient to work on and this is a slide that just shows some of the gross motor movements that the patient would engage in so at this time the patient is engaging in a game okay so you can really highlight and emphasize individual movements while they're using or playing the different games displayed on the computer screen some of the games really work on speed endurance coordination range of motion there are some simple games that the patient would engage in all right certainly has a functional harm test as well so it can assess the patient's motor ability if need be and can track the patient's progress so if that's if you need an outcome measure it can give you an outcome score of how the patient is progressing throughout their treatment and each patient gets a profile of how they're progressing with the program so the component that comes with a computer the manipulandum which is a handpiece the arm piece that attaches to the table as well as an instruction manual as well as a quick reference guide so as a follow up to the webinar as I mentioned earlier representative from stable will be calling you just to see how the webinar are when and if you have any questions but also stable offers for the facility based products they offer a 10-day trial where is just your opportunity to explore and play with get some hands-on experience with disabled products so that includes a stable VR the stable ma the stable my track of fitting and disabled rejoice so that's a ten day free demo in clinic demo that sable offers so please ask about that and then for the patient based products they will offers a free 30 day free shipping free returns trial so a 30 day risk-free trial and that's of the sable reflects the Sabo disabled stretch disabled step the vive stem the sable stem micro and thus a book club so again it's really offers a really good way to have the Papio patient trial out some of the products that we discuss today in the Royal M&R you

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