Faye Pitt BSc(Hons) MSc Senior Orthotist Trulife 1

The WalkAide is a battery-operated, single channel, functional electrical stimulation device used to address Foot Drop. - Functional - Therapeutic

Dorsiflexion of the ankle at the optimal time during the gait cycle to normalise walking.

One piece & self-aligning Built-in sensors One-hand donning/doffing Universal R/L cuff Electrode markers for placement Light-weight & comfortable Adaptations for visual & hearing impaired

Facilitates sagittal plane swing Works with any initial foot position No heel strike needed Minimises skin irritation via balanced charge recovery circuitry Collects & analyses patient data via wireless Bluetooth technology Walking Mode and Exercise mode

Upper Motor Neuron Lesions Candidates Upper Motor Neuron Lesions CVA or stroke Incomplete SCI Traumatic brain injury Cerebral palsy Multiple sclerosis Familial hereditary spastic paraplegia (FSP) Here is a list of patient populations who are indicated for consideration of the WalkAide system. There are 750,000 new stroke patients each year and walking is a primary goal. Spinal cord injuries must be thoroughly evaluated by the medical team. Injuries above T6 may risk autonomic dysreflexia and injuries below T12 involve peripheral nerve structures. Each person must be individually evaluated in terms of their walking profile, reaction to electrical stimulation, functional movement produced, and ability to operate the WalkAide system. 10

Considerations Contraindications Severe sensory/proprioception deficit Lower Motor Neuron History of skin sensitivity Pacemaker Limited walking potential Pregnancy Morbid obesity <35%> History of Seizure Disorder Cognitive Status Thrombosis in area of the device Peripheral Nerve Damage Surgical Trauma; lumbar or hip Lumbar spinal stenosis Poliomyelitis Guillain-Barre Syndrome Sciatica

Paediatrics Well tolerated Prevent Deformity Delay or Prevent Surgery

Cerebral Palsy: Left Hemiparesis

HOW ?

An intact peroneal nerve pathway is required. 4/21/2017 Peripheral Nerve Stimulation An intact peroneal nerve pathway is required. Controlled amounts of electrical currents are applied to the peroneal nerve in order to promote functional dorsiflexion. Common peroneal nerve Superficial peroneal nerve Peroneus longus Peroneus brevis Plantar flexion Eversion Deep peroneal nerve Tibialis anterior Ext. digitorum longus Ext. digitorum brevis Ext. hallucis longus Dorsiflexion Inversion WalkAide_ISPO-NL2008 15 15

Measures angular changes from vertical Inclinometer ‘Tilt’ Sensor Measures angular changes from vertical Tilt ON Threshold Tilt OFF Threshold

Tilt Sensor Input Anterior angle: OFF Posterior angle: ON Swing: ON

Measures changes in acceleration. Accelerometer Measures changes in acceleration. Measures time between the angular changes; (The force exerted by restraints in an accelerating body).

WalkAide® System Equipment WALKAIDE SYSTEM Product Development

Patient Set-up Pre-screening: Ministim

Electrode Location

Patient Kit

Clinician Kit-Programming Tools * WalkAnalyst Software

Heel Sensor Input Unload: ON Swing: ON Load: OFF

Data Collection and Programming

Clinician Input WalkLink

System Data Collection 4/21/2017 System Data Collection WalkAide_ISPO-NL2008 27 27

3.0 WalkAnalyst Normalise Gait 3.0 Version Upgrades Initiation of swing Duration of swing Termination of swing 3.0 Version Upgrades Rapid Programming Walking Speed Calculation Comparative Reporting

Quantification of Outcomes Walking Speed: Quantify changes over time With and without device Usage Log: Hours per day Stims per day Printed Reports: Back-up data Prescriber Communication

Stimulus Adjustability Total stimulation CHARGE is regulated by pulse duration, time in between and intensity Patient Comfort Quality of the stimulation Preserves skin integrity and muscle endurance Body is dynamic-changes 30

Parameter Adjustability Pulse duration Frequency Ramp On/Ramp Off Extra stimulations Filter Exercise settings Traceability Troubleshooting Diagnostic Codes 31

WHY ?

Augmentation Maximize Recovery Regain voluntary control, restore reflex responses and complex functional movement Precise and timely feedback from the periphery allows for quality control of movement Task Oriented Biofeedback Repetition Sensory feedback Audible feedback Augmentation

Research from the University of Alberta “A Multicenter Trial of a Footdrop Stimulator Controlled by a Tilt Sensor” Stein et al, Neurorehabilitation and Neural Repair 2006

WalkAide® System Evidence: Increase in velocity with and without the WalkAide System (Carry-over effect) 3 mo 16% 6 mo 27% 12 mo 51% PCI index decreased 25% Voluntary drive and muscle strength

MEP Mapping by TMS Normal subject (age 27) Motor Evoked Potential mapping by Transmagnetic stimulation. Record MEPs by stimulating the motor cortex. There is a best point for evoking EMG potential of tib anterior.

Long-Term Effects of FES in a Head-Injured Patient (10+ years post-injury) After 6 months of FES use Before FES use 43 yr old male. Head injury 19 years earlier. No reports of changes in walking speed before entering the trial. Decided he didn’t need WA after 12 months. 2 years later returned feeling no progress was being made and PCI & velocity measures indicated this – so he returned to WA. Shows potential for re-educating brain and compensation for brain damage.

Both groups had an orthotic benefit from FES. Does Functional Electrical stimulation for Foot Drop Strengthen Corticospinal Connections? Everaert et al Neurorehab. Neural Repair 2010 regular use of a foot drop stimulator strengthens activation of motor cortical areas and their residual descending connections Long-Term Therapeutic and Orthotic Effects of a Foot Drop Stimulator on Walking Performance in Progressive and Nonprogressive Neurological Disorders – Stein et al, Neurorehab. Neural Repair 2010 Both groups had an orthotic benefit from FES. Therapeutic effect increased for 11 months on nonprogressive disor up to 3 months in the progressive disorders.

Who do we work with? Trulife clinicians Private clinicians NHS units

Global Presence 23 Countries

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