Diane Rowles

The Tongue Enables Computer and Wheelchair Control for People with Spinal Cord Injury

Individuals with severe spinal cord injury control a computer and powered wheelchair by using a wireless tongue-operated assistive technology called the Tongue Drive System. Tying the Tongue to Motor Control Voluntary tongue motion may help people with limited upper limb mobility, such as those with high-level spinal cord injury, to access computers and to drive wheelchairs. The Tongue Drive System (TDS) is a wireless and wearable assistive technology that allows individuals with severe motor impairments to access their environments using voluntary tongue motion. Kim et al. report on a new study of TDS efficacy in patients with severe spinal cord injury. Two groups of able-bodied participants and a group of patients with spinal cord injury received a magnetic tongue barbell. Participants used the TDS during five to six testing sessions. Comparisons between the TDS and the keypad for the able-bodied groups and a sip-and-puff device (a traditional assistive technology) for those with tetraplegia were based on widely accepted measures of speed and accuracy. A combination of TDS flexibility and inherent human tongue abilities enabled individuals with severe motor impairments to access computers and drive wheelchairs more quickly but just as accurately as when using traditional assistive technologies. The Tongue Drive System (TDS) is a wireless and wearable assistive technology, designed to allow individuals with severe motor impairments such as tetraplegia to access their environment using voluntary tongue motion. Previous TDS trials used a magnetic tracer temporarily attached to the top surface of the tongue with tissue adhesive. We investigated TDS efficacy for controlling a computer and driving a powered wheelchair in two groups of able-bodied subjects and a group of volunteers with spinal cord injury (SCI) at C6 or above. All participants received a magnetic tongue barbell and used the TDS for five to six consecutive sessions. The performance of the group was compared for TDS versus keypad and TDS versus a sip-and-puff device (SnP) using accepted measures of speed and accuracy. All performance measures improved over the course of the trial. The gap between keypad and TDS performance narrowed for able-bodied subjects. Despite participants with SCI already having familiarity with the SnP, their performance measures were up to three times better with the TDS than with the SnP and continued to improve. TDS flexibility and the inherent characteristics of the human tongue enabled individuals with high-level motor impairments to access computers and drive wheelchairs at speeds that were faster than traditional assistive technologies but with comparable accuracy.

Effects of Etiology on Inpatient Rehabilitation Outcomes in 65- to 74-Year-Old Patients With Incomplete Paraplegia From a Nontraumatic Spinal Cord Injury

To examine differences in rehabilitation outcomes for older patients with a nontraumatic spinal cord injury (NT‐SCI) for 5 etiologic diagnoses: degenerative spinal disease (DSD), malignant spinal tumor, benign spinal tumor, vascular ischemia, and spinal abscess.

Effects of Gender on Inpatient Rehabilitation Outcomes in the Elderly With Incomplete Paraplegia From Nontraumatic Spinal Cord Injury

Abstract Objective: To examine gender differences in rehabilitation outcomes for patients with nontraumatic spinal cord injury. Research Design: Secondary analysis was conducted on Medicare beneficiary data from 65 to 74 year olds with incomplete paraplegia discharged from inpatient rehabilitation facilities in 2002 through 2005. Main Outcome Measures: Length of stay, Functional Independence Measure instrument motor item and subscale scores on discharge, and discharge destination. Results: Among patients with degenerative spinal disease, men had significantly longer rehabilitation stays than women (P < 0.001). Men with degenerative spinal disease had significantly lower discharge Functional Independence Measure scores than women, indicating more dependence in self-care (P < 0.001) and mobility (P < 0.001). Among patients with degenerative spinal disease, men were less likely to walk (odds ratio = 0.58; 95% Cl = 0.38−0.87) and less likely to be independent with bladder management (odds ratio = 0.44; 95% Cl = 0.31−0.62). Among patients with vascular ischemia, men were more independent (B = 2.59; 99% Cl= 0.42−4.76) in mobility than women. There were no gender differences in the malignant spinal tumors group. There were no gender differences in being discharged to a community-based residence. Conclusions: Gender distributions varied by etiology. Gender differences were found in demographics, length of stay, and functional outcomes but not discharge destination. Men were more dependent than women at discharge in the etiology group with the least overall disability (degenerative spinal disease) and more independent in mobility than women at discharge in the etiology group with the most overall disability (vascular ischemia).

Safety and efficacy of medically performed tongue piercing in people with tetraplegia for use with tongue-operated assistive technology

BACKGROUND Individuals with high-level spinal cord injuries need effective ways to perform activities. OBJECTIVES To develop and test a medically supervised tongue-piercing protocol and the wearing of a magnet-containing tongue barbell for use with the Tongue Drive System (TDS) in persons with tetraplegia. METHODS Volunteers with tetraplegia underwent initial screening sessions using a magnet glued on the tongue to activate and use the TDS. This was followed by tongue piercing, insertion of a standard barbell, a 4-week healing period, and an exchange of the standard barbell for a magnet-containing barbell. This was then used twice weekly for 6 to 8 weeks to perform computer tasks, drive a powered wheelchair, accomplish in-chair weight shifts, and dial a phone. Symptoms of intraoral dysfunction, change in tongue size following piercing, and subjective assessment of receiving and wearing a magnet-containing tongue barbell and its usability with the TDS were evaluated. RESULTS Twenty-one volunteers underwent initial trial sessions. Thirteen had their tongues pierced. One individuals barbell dislodged during healing resulting in tongue-tract closure. Twelve had the barbell exchanged for a magnet-containing barbell. One subject withdrew for unrelated issues. Eleven completed the TDS testing sessions and were able to complete the assigned tasks. No serious adverse events occurred related to wearing or using a tongue barbell to operate the TDS. CONCLUSIONS Using careful selection criteria and a medically supervised piercing protocol, no excess risk was associated with tongue piercing and wearing a tongue barbell in people with tetraplegia. Participants were able to operate the TDS.

Poster 297 Long-Term Safety, Efficacy, and Satisfaction of Intrathecal Baclofen Pumps

Disclosures: S. R. Khurana, Research grants: Teva. Objective: The objective of this study is to determine the effect of exercise on walking ability in subjects with multiple sclerosis (MS). Design: MS is characterized by demyelination in the central nervous system which often leads to limitations in walking ability. The Six Minute Walk Test (6MWT) is a submaximal exercise test used to measure functional exercise capacity and response to an intervention. This one-year study is a prospective, investigator-blinded, open-label, randomized pilot trial using performance-based tools to evaluate 18 individuals (n 6 per group) with relapsing-remitting disease with self-reported balance dysfunction. Setting: Lois Pope Life Center Research Laboratory, University of Miami Miller School of Medicine. Participants: Eighteen individuals with relapsing-remitting MS with self-reported balance dysfunction. Interventions: Qualified subjects were randomized to one of three groups: 1. Copaxone (CO) alone. 2. Copaxone and Physical Therapy (PT): three, 60-minute sessions weekly for 12 weeks. 3. Copaxone and Virtual Exercise (VE) (IREX Virtual Reality System): three, 60-minute sessions weekly for 12 weeks. Main Outcome Measures: The outcome measure was the 6MWT. Testing was completed at baseline, 6 weeks, 12 weeks (during intervention), and 12 weeks after intervention was completed. ANOVA was used to examine percent change between groups. To compensate for the small sample size, the two active intervention groups (PT and VE) were combined and compared to the control group. Results: Improvement between baseline and post-intervention 6MWT scores were seen in all groups: CO 5%, PT 64%, and VE 32%. Although differences were observed, they did not reach significance (6 weeks P .099, 12 weeks P .131 and at 6 months P .134). Significant differences were present when the intervention groups were combined (PT and VE) and compared to no intervention (CO) (6 weeks P .030, 12 weeks P .027 and at 6 months P .019). Conclusions: Participants made improvements in the 6MWT when Copaxone was administered along with an exercise intervention compared to Copaxone alone. This study has shown that an intervention, whether PT or VE, has a role as an adjunct to disease modifying therapy.

The Tongue Drive System: Testing Novel Assistive Technology that Uses Magnetic Signals Derived from Tongue Movements

A Randomized Controlled Trial on the Efficacy of Body Weight Support Overground Ambulation Versus Body Weight Support Treadmill Training Among Post-stroke Patients of a Tertiary Hospital. Sherwin W. Gan, MD (Veterans Memorial Medical Center, Quezon City, Philippines); Alfredo C. Azarcon, MD; Ma Jullita J. Cadiao, MD; Ma. Antonette M. Gabua, MD; Rafaelita S. Javier, MD; Edwin M. Orayle, MD; Edgardo D. Uyehara, MD.