Nerve stimulation prosthesis helps those with MS

From The Desert Sun:

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.

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 beach and suddenly get so fatigued she'd have to stop.

Strange, too, because the Sacramento resident had always been athletic, playing basketball as a youth and being a lifelong golfer.

The diagnosis, multiple sclerosis, hit Barnard hard.

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.

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.

“Just walking from the car to my house was a struggle,” said Barnard, a family therapist. “I'm going to be 60 in October, so falling is starting to be a real health issue.”

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.

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.

Both products received Food and Drug Administration approval in 2006 for use 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.

Both devices have been on the market for more than two years, but 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.

Barnard found the closest rehabilitation center to Sacramento offering the product by Bioness Inc. was at Lodi Memorial Hospital.

Despite the cost, Barnard says 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 asked. “For me, it was a no-brainer, even though my insurance wouldn't cover it and my neurologist wouldn't even write a prescription for it.”

Though the FDA has given the devices full approval, acceptance by the medical community at large has been slow.

Physical therapist Linda Muhlenkamp, Lodi Memorial's clinical coordinator, 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 said. “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.”

Barnard also admits being skeptical. She had viewed promotional videos about the devices but wondered whether they “exaggerated claims and overdramatized it.” When she first tried the device, she was taken aback by its effectiveness.