Transcript Bioness L300+ Boot Camp - Spalding Rehabilitation Hospital

Adam M Hoyle, PT, DPT, MSPT
Spalding Rehabilitation Hospital
Aurora, CO

Participants will be able to describe the main
components of the L300 Plus system.

Participants will be able to describe the patient
population for whom the L300 Plus system is
indicated.

Participants will be able to describe how the L300
Plus system works and which anatomy and specific
motor points are involved.

Participants will be able to describe types of
treatments that can be implemented apart from gait
training with the L300 Plus system.
•
What is the L300 Plus System?
•
The Latest Technology to Help Patients Walk More
Naturally.
•
The L300 Plus System builds on the success of the L300
Foot Drop System by adding a thigh cuff to give greater
control over bending and straightening the knee, which
may help normalize gait.
•
The L300 Plus System’s wireless components adapt to
changes in walking speed and terrain, allowing patients
to walk more easily on stairs, grass and carpet.
Comfortably worn under most clothing, the system’s
unique design may help eliminate the need for a rigid
knee-ankle-foot orthosis (KAFO), or braces, and may
reduce the risk of falls and injuries.

The NESS L300 Plus System is intended to provide ankle
dorsiflexion and knee flexion or extension in individuals
with foot drop and thigh muscle weakness following an
upper motor neuron injury or disease.

During gait, the NESS L300 Plus System electrically
stimulates muscles in the affected leg to provide
dorsiflexion of the foot and knee flexion or extension;
thus, it may improve the individual’s gait.

The NESS L300 Plus
System may also:

Facilitate muscle reeducation.

Prevent or retard disuse
atrophy.

Maintain or increase joint
range of motion.

Increase local blood flow.

Patients with a demand-type cardiac pacemaker,
defibrillator, or any electrical or metallic
implant should not use the NESS L300 Plus
System.

The NESS L300 Plus System should not be used on
a leg where a cancerous lesion is present or
suspected.

The NESS L300 Plus System should not be used on
a leg with a regional disorder, such as a fracture
or dislocation, which could be adversely affected
by motion from the stimulation.
 Multiple
Sclerosis (MS)
 Stroke (CVA)
 Traumatic Brain Injury (TBI)
 Spinal Cord Injury (Incomplete)
 Cerebral Palsy (CP)
 Many others are being trialed
1.
2.
3.
4.
Functional
Stimulation Leg
Cuff
Functional
Stimulation Thigh
Cuff
Intelli-Sense Gait
Sensor
Wireless Control
Unit

Dorsiflexor
◦ Anterior Tibialis

Quadricepts
◦ Rectus Femoris
◦ Vastus intermedius
lateralis, and medialis

Hamstrings
◦ Bicep femoris
◦ Semitendinosus
◦ Semimembranosus
Anterior Tibialis
1.
Femoral Nerve and
branches
2.
Tibial portion of the
Sciatic Nerve and
common Fibular
potion of the Sciatic
Nerve
3.
Deep peroneal
nerve
Nerve(s)
1.
Quadriceps
2.
Hamstrings
3.
Tibialis Anterior
Muscle(s)

In Upper Motor Neuron Pathologies, muscle
activity can:





Be absent
Display insufficient magnitude
Display excessive magnitude
Display incorrect timing
 Delayed onset
 Prolonged
 Constant
Any combination of the above

Why do we need the Hamstrings to be active during
swing?


To control/decelerate the knee extension moment before
Initial Contact
Why do we need the Hamstings to be active during
stance?

To help control the knee position during Loading Response

Why do we need the Quadriceps during swing?


Why are the Quadriceps needed during stance?


To ensure full knee extension at the end of swing
To control and stabilize the knee through Mid-Stance
Why do the Quadriceps go quiet during Mid-Stance?

Due to the ground reaction forces moving anterior to the
knee joint.

For stimulating the Quadriceps, think KAFO
or weak stance force production.

For stimulating the Hamstrings, think Genu
Recurvatum or poor timing and or poor
stance control.

This is not all inclusive, but helps in the
early assessment phase when learning to
use the unit in practice.
 Forced
use
 Exercise
equipment
 Early
start for proprioception and
neuromuscular feedback
 Using
Clinician Mode

Select System
Configuration. Select
L300 Only, L300 and
Thigh Hamstrings, or
L300 and Thigh
Quadriceps.

Program Stim Settings.
Press Stim and the L300
tab. Adjust stim settings.
Press Test to turn on
stimulation. Press Stop to
stop stimulation.

Program Gait Settings.
Press Gait and the L300
tab. Adjust gait settings.
Press Test to turn on
stimulation in the L300
only. Press Stop to stop
stimulation.

Program Stim Settings.
Press Stim and the Thigh
tab. Adjust stim settings.
Press Test to turn on
stimulation. Press Stop to
stop stimulation.

Program Gait Settings.
Press Gait and the Thigh
tab. Adjust gait settings.
Press Start to turn on
stimulation in both FS
Cuffs. Press Stop to stop
stimulation.
 49
year old male.
 Fairly healthy, only being treated medically
for HTN prior to a severe Right Basal
Ganglion hemorrhage back in 2011.
 Acute hospital stay was complicated with
hemorrhage extension and shift, which
required craniotomy and intraventricular
catheter and burr hole placement.
 Subsequent respiratory failure with
prolonged period of ventilation.
 Once
stabilized after a lengthy stay in Long
Term Acute Care he presented for Acute
Rehabilitation at Spalding Rehabilitation
Hospital.
 Prior to his stroke he was completely
Independent and working fulltime as a
Realtor.
 Lives with his wife and two teenage
daughters in a single story home with 4 steps
to enter
 Dependent
for bed mobility, transfers, gait
and stair mobility.
 Dense L hemiparesis with impaired sensation
and proprioception.
 Midline deficit with L inattention
 L flexion synergy both in upper and lower
extremities.
 Significant cognitive involvement with
difficulty speaking and swallowing.
 Neuromuscular
reeducation utilizing an
integrated approach of forced use, PNF, NDT
and motor control/learning paradigms.
 Primary focus was on midline reorientation
and improved stance control on the LLE.
 Pre-gait training in conjunction with the
Bioness L300 plus was completed along with
BID training sessions.
 Followed by extensive progressive gait
training with Bioness L300
 60 days of acute rehabilitation
Functional
Status
Initial
Evaluation
Discharge w/o
L300+
Discharge w/
L300+
Bed mobility
Dependent
SBA
SBA
Transfers
Dependent
SBA w/
hemiwalker
SBA w/
hemiwalker
Gait
Dependent
CGA ,
hemiwalker,
L KAFO x 50 ft
at a time
CGA,
hemiwalker,
L300+ x500’ at
a time
Stairs
Dependent
Up/down curbs
and 10 steps
w/ rail and
hemiwalker
and KAFO, MinA
Up/down curbs
and 20 steps
w/ rail and
L300+, CGA
 Patient
went on to complete 20 more visits
of both day treatment program and
outpatient Physical Therapy over
approximately 6 months.
 Now with the Bioness L300+ he is able to
ambulate up to 2500’ at a time with a quad
cane and Supervision.
Efficacy
 Cost ~$10,000.00 for whole system
 In Colorado, per Bioness they are averaging
about a 42% approval rating through private
insurance.
 Medicare will cover the L300 only for an
incomplete SCI diagnosis.
 The VA covers 100%.
 Vocational Rehabilitation covers nicely as well.
