On the move again; New Prosthesis Aids Those With MS
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Written by Autumn Cruz/Sacramento Bee/MCT
Published in Hamodia, Section: Science & Technology on 15 AV 5769
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Sacramento, Calif (MCT) – Talk about a troubling midlife crisis. Pushing 50, Linda Barnard noticed subtle yet progressive bodily changes she knew weren’t simply the inevitable result of time’s ravages.
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She’d squat to pick up something and find she had no strength in her quadriceps to get back up. She’d walk on the street and suddenly get so fatigued she’d have to stop. Strange, too, because the Sacramento, Calif., resident had always been athletic. The diagnosis, multiple sclerosis, hit Barnard hard.
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As central nervous system damage brought on by the disease worsened over the past decade, walking became increasingly difficult. She saw her fitness level drop and her weight rise. The nerve controlling her right leg ceased to function, which resulted in a condition called drop foot.
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She fell – often – breaking her ribs “too many times to mention” because she lacked proprioception – the sense of the position of her body in relation to the space around her. She had taken to using a cane.
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In the past four months, however, the falls have stopped and Barnard’s halting gait has vanished. It’s all because of a wireless device strapped to her right calf, just below the knee, and another in the sole of her shoe, which send an electrical pulse to her peroneal nerve and stimulate muscles to properly lift the foot.
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Her device is called the NESS L300, one of two wireless prosthetic stimulation aids on the market. The other is WalkAide, which uses similar technology with a few mechanical differences.
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Both products received Food and Drug Administration approval in 2006 for us by patients with motor neuron injuries such as stroke, some spinal cord injuries and central nervous system diseases such as MS and cerebral palsy. It does not work with patients who have complete paralysis or severed nerves.
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Though both devices have been on the market for more than two years, the $5,000 to $6,000 price tag and lack of most insurance companies’ (including Medicare) coverage for the cost so far has limited widespread use.
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Indeed, to many, cost can be prohibitive. But, says Barnard, her literal stimulus package is worth every penny. “How can you put a price tag on being able to live your life the way you want to?” she asks.
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Though the FDA has given the devices full approval, acceptance by the medical community at large has been slow. So what might be considered a giant leap forward in technology still is at baby steps in implementation.
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Physical therapist Linda Muhlenkamp said she and her colleagues were initially skeptical about the efficacy of the device. “When we first saw it, we thought, ‘This is pretty cool, but does it work?’” she says. “But we’ve found it works not only for patients with some ability to walk, but we’re using it with patients who don’t walk at all to try to retrain the muscles in hopes of resuming walking.”
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Barnard also admits being skeptical. But when she first tried the device, she was taken aback by its effectiveness.
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“It was immediate change,” she says. “I was so used to overcompensating (with her leg) that I almost fell over when I could actually pick it up. It’s a muscle I hadn’t used for a long time, so there was a learning curve. You’ve got to gradually build yourself up with it.”
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The FDA lists no major side effects from long-term use of electrical stimulation of the nerves. Phil Astrachan, a San Francisco physical therapist who helps test patients for WalkAide devices, says, “The biggest side effect is skin irritation in some, but the incidence is low.
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“Some people worry that it’ll ‘kill’ their nerve or wear it out by zapping it. It actually has the opposite effect. The motor response that takes place over time usually gets more and more robust.”
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