NeuromoveNeuromove

What is the What is the NeuroMoveNeuroMove??

It is an EMG Triggered It is an EMG Triggered Neurological Relearning tool for Neurological Relearning tool for

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Neurological Relearning tool for Neurological Relearning tool for Stroke and Brain Injury ParalysisStroke and Brain Injury Paralysis

Stroke and TBI Rehabilitation CentersSpinal Cord Rehabilitation Centers

Where are you going to sell the NeuroMove?

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Spinal Cord Rehabilitation Centers

Why do Rehab Clinics need such a product?

�Shortens patients time spent in Rehab�Motivates patients to work at their own therapy�Works when there is total paralysis or no voluntary movement.

What Neuro-rehabilitation devices do you use for

Opening Lines

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What Neuro-rehabilitation devices do you use for stroke patients?

Do you have a Neuro Re-learning Tool?

�The NeuroMove retrains the brain to regain voluntary movement.

Who Benefits from the Who Benefits from the NeuroMoveNeuroMove??

StrokeStroke Patients Patients

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StrokeStroke Patients Patients

The number One cause of treatable The number One cause of treatable paralysisparalysis

••Traumatic Brain InjuryTraumatic Brain Injury

••Palsy and other congenital paralysisPalsy and other congenital paralysis

••Spinal Cord InjurySpinal Cord Injury

Sales Tools:Sales Tools:

�� Establish an invite to Establish an invite to on our websiteon our website

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�� Establish an invite to Establish an invite to on our websiteon our website

I will send it to your email addressI will send it to your email address

All documents can be modified and saved. All documents can be modified and saved.

Power pointsPower points

Marketing itemsMarketing items

Clinical StudiesClinical Studies

PicturesPictures

U.S. FDA U.S. FDA --For Stroke, TBI and SCI RehabilitationFor Stroke, TBI and SCI Rehabilitation--Relaxation of Muscle Spasms & Muscle ReRelaxation of Muscle Spasms & Muscle Re--educationeducation--Prevention of Retardation of disuse atrophyPrevention of Retardation of disuse atrophy--Increase Local Blood CirculationIncrease Local Blood Circulation--Maintaining or Increasing Range of MotionMaintaining or Increasing Range of Motion

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--Maintaining or Increasing Range of MotionMaintaining or Increasing Range of Motion

European Heath StandardsEuropean Heath StandardsCConformitéonformité EEuropéeneuropéene -- CE CE

--Approved for Approved for –– Stroke RecoveryStroke Recovery

--class II deviceclass II device

ZynexZynex is an ISOis an ISO--13485 Company13485 Company

The NeuroMove is manufactured in the U.S.The NeuroMove is manufactured in the U.S.SFDA PendingSFDA Pending

Evidenced Based Success

--Peer Reviewed Clinical TrialsPeer Reviewed Clinical Trials

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--Peer Reviewed Clinical TrialsPeer Reviewed Clinical Trials

Direct clinicians to Direct clinicians to

www.neuromove.comwww.neuromove.com

--Patient TestimonialsPatient Testimonials

--Rehab Hospitals usage protocolRehab Hospitals usage protocol

Show hospital listShow hospital list

Clinical StudiesClinical Studies

Chronic Motor Dysfunction After Chronic Motor Dysfunction After StrokeStroke

ConclusionConclusion: “Two lines of evidence clearly : “Two lines of evidence clearly support the use of EMG triggered NMES support the use of EMG triggered NMES treatment to rehabilitate wrist and fingers treatment to rehabilitate wrist and fingers

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support the use of EMG triggered NMES support the use of EMG triggered NMES treatment to rehabilitate wrist and fingers treatment to rehabilitate wrist and fingers extension movements of extension movements of hemiparetichemipareticindividuals > 1 year after stroke…individuals > 1 year after stroke…

Recovering Wrist and Finger Extension by EMG Recovering Wrist and Finger Extension by EMG TriggereTriggereNeuromuscular stimulation. Neuromuscular stimulation. By James By James CaraughCaraugh, , Ph.DPh.D

See all clinical studies at See all clinical studies at www.neuromove.comwww.neuromove.com

Clinical StudiesClinical Studies

““Progress often far exceeded that of Progress often far exceeded that of

previous conventional therapy. Regarding previous conventional therapy. Regarding mechanisms, impaired proprioceptive mechanisms, impaired proprioceptive feedback is considered central to strokefeedback is considered central to stroke--disrupted sensorimotor control. EMGdisrupted sensorimotor control. EMG--

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disrupted sensorimotor control. EMGdisrupted sensorimotor control. EMG--triggered EMS is intended to improve brain triggered EMS is intended to improve brain relearning by reinstating proprioceptive relearning by reinstating proprioceptive feedback timefeedback time--locked to each attempted locked to each attempted movement. Clinical results were consistent movement. Clinical results were consistent with this theorywith this theory.” ”

See all clinical studies at www.neuromove.com

NeuroMoveNeuroMovePrescribed by Leading Rehab HospitalsPrescribed by Leading Rehab Hospitals��Johns Hopkins, MDJohns Hopkins, MD��TawamTawam Hospital, UAE Hospital, UAE ��Cleveland Clinic Cleveland Clinic ��Kennedy Krieger Intl. Kennedy Krieger Intl.

St. John’s Mercy, St. LouisSt. John’s Mercy, St. Louis��Mt. Sinai, NYMt. Sinai, NY��Marlton Rehab, NJMarlton Rehab, NJ��Montefiore, Bronx, NYMontefiore, Bronx, NY

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��Kennedy Krieger Intl. Kennedy Krieger Intl. Spine Institute Spine Institute ��Rehab Institute of Rehab Institute of ChicagoChicago��Mayo Clinic, MNMayo Clinic, MN��Kessler, NJKessler, NJ��Moss Magee Rehab, PAMoss Magee Rehab, PA��Queen Elizabeth, H.K.Queen Elizabeth, H.K.

��Montefiore, Bronx, NYMontefiore, Bronx, NY��Lutheran Hospital, Lutheran Hospital, Brooklyn, NYBrooklyn, NY��TIRR of HoustonTIRR of Houston��Mission Hospital, CAMission Hospital, CA��LethbridgeLethbridge Hosp. CanadaHosp. Canada��Tan Tan TokTok SengSeng, Singapore, Singapore

What Hospitals Say What Hospitals Say

about the about the NeuroMoveNeuroMove

““……treatmentstreatments areare focusedfocused onon patientspatients whowho havehavehadhad aa recentrecent strokestroke asas wellwell asas thosethose whowho havehavesufferedsuffered fromfrom strokestroke--relatedrelated disabilitiesdisabilities forfor yearsyears..

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sufferedsuffered fromfrom strokestroke--relatedrelated disabilitiesdisabilities forfor yearsyears..Lutheran'sLutheran's "Re"Re--traintrain thethe Brain"Brain" strokestroke recoveryrecoveryprogramprogram manymany longlong--sufferingsuffering patientspatients cancanregainregain longlong lostlost mobilitymobility andand functionfunction..””

RR.. Ahmad,Ahmad, OTR,OTR, DirectorDirector

LutheranLutheran RehabRehab Network,Network, Brooklyn,Brooklyn, NYNY

TalkTalk toto thethe leadlead therapisttherapist aboutabout adoptingadopting aa NeuroNeuro

RehabilitationRehabilitation programprogram..

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85% of strokes are Ischemic85% of strokes are IschemicRestriction of Blood to the BrainRestriction of Blood to the Brain

Hemorrhagic StrokeHemorrhagic StrokeBleeding into the brainBleeding into the brain

What HappenedWhat Happened

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��What HappenedWhat Happened��Loss of Brain Cells and the Loss of Brain Cells and the functions they controlfunctions they control

��Causing HemiplegiaCausing Hemiplegia

Be aware of what is done in thestroke rehab clinics

-Find lead Occupational Therapist

-Private and Gov’t programs

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Treatment of Stroke ParalysisTreatment of Stroke Paralysis

Physical training including:Physical training including:

�� Therapeutic exercisesTherapeutic exercises�� Movement modification Movement modification �� Special equipment Special equipment -- FES FES �� Assistive devices Assistive devices �� OrthoticsOrthotics

Treatment ApplicationTreatment Application

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Treatment ApplicationTreatment Application��Acute RehabAcute Rehab

OnceOnce stabilizedstabilized

��Out patient RehabOut patient Rehab

��Home Care TherapyHome Care Therapy�� This is the goalThis is the goal

Re Train the Brain ToolRe Train the Brain Tool

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NeuroplasticityNeuroplasticity�� ReRe--Mapping the brain pathways by Mapping the brain pathways by driving the driving the healthy neurons to take over for damaged healthy neurons to take over for damaged neurons thus regaining voluntary contractionsneurons thus regaining voluntary contractions

�� The The NeuroMoveNeuroMove: Not just FES!: Not just FES!

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�� The The NeuroMoveNeuroMove: Not just FES!: Not just FES!

PPatient imagines movement and is rewarded atient imagines movement and is rewarded through stimulated muscle contraction… through stimulated muscle contraction…

MOVEMENT!MOVEMENT!

What makes a Successful What makes a Successful

Brain Relearning Tool?Brain Relearning Tool?

Patient must be CognitivePatient must be Cognitive

��Engages the BrainEngages the Brain

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IntensiveIntensive

��Concentrated EffortConcentrated Effort

FrequencyFrequency

��Focused RepetitionFocused Repetition

The Re-learning Tool - NeuroMove

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�EMG detects targeted neurological attempts to move the muscle

�Utilizing Repetitive attempts and reward to stimulate Neural re-mapping

��Patients can experience Patients can experience

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��Patients can experience Patients can experience immediate results. immediate results.

��Gives Stroke patients Gives Stroke patients real real hopehope and motivationand motivation

Contraindications/PrecautionsContraindications/Precautions

�� Implanted electrical devicesImplanted electrical devices

��Cardiologist approval for use with Cardiologist approval for use with pacemakers.pacemakers.

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pacemakers.pacemakers.

�� EpilepsyEpilepsy

�� Cancer LesionsCancer Lesions

�� Use on Muscles onlyUse on Muscles only

In the KitIn the Kit

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Electrode Placement Guide BookInstructional CDAC Cord for recharging3-Packs of 3-ElectrodesConnecting lead wireProgram Manual

Therapy Therapy

SessionSession

SetSet--upup

Attach electrodesAttach electrodes muscle muscle

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�� Attach electrodesAttach electrodes muscle muscle group group

�� Turn on Unit. Turn on Unit.

�� Set eSet e--stimstim to visible yet to visible yet comfortable contractioncomfortable contraction

Start onStart on

Any Group of MusclesAny Group of Muscles�� Wrist & Finger Extension Wrist & Finger Extension -- FlexionFlexion

�� Front & Back Elbow FlexionFront & Back Elbow Flexion

�� Shoulder Subluxation/AbductionShoulder Subluxation/Abduction

Ankle DorsiflexionAnkle Dorsiflexion

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�� Ankle DorsiflexionAnkle Dorsiflexion

�� Knee ExtensionKnee Extension

�� Starting pointsStarting points

��upper or lower extremitiesupper or lower extremities

��distally or proximallydistally or proximally

Ankle Dorsiflexion (Drop Foot)/Flexion

Red

Black

Red

Knee Extension - Front

Red

Red

Black

Shoulder Subluxation/Abduction

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Knee Extension - Front

Red

Red

Black

Flexible: Use on anyMuscle Group

Refer to the Guide

Therapy Session OverviewTherapy Session Overview

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Cycle of TherapyRELAX: NM is Setting ThresholdREADY: Patient makes ATTEMPTGOOD: Stimulation or RewardRELAX: Deliberate rest

RELAXRELAX

The processor begins to detect EMG and set the threshold

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�Threshold is adjusted up or down every 15 seconds Automatically

READYREADY�� Patient makes concentrated attempts Patient makes concentrated attempts to make muscle exertion sensors to make muscle exertion sensors detect real attempts.detect real attempts.

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Encourage the patient to imagine or visualize movement, have them close their eyes. Engage the brain!

RewardReward

Imagination or attempt “strikes” the threshold and triggers physical movement…the reward.

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Cycle is RepeatedCycle is Repeated

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The threshold is re-set every cycle and moves up or down to continually challenge or encourage the patient.

NeuroMoveNeuroMove Hands On!Hands On!

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Other ApplicationsOther Applications��Spinal Cord InjurySpinal Cord Injury

�� *Set SCI Mode*Set SCI Mode

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Other ReliefOther Relief��Erb’sErb’s PalsyPalsy

��Bell’s Bell’s PalseyPalsey

��Cerebral PalsyCerebral Palsy

��Multiple SclerosisMultiple Sclerosis

Trouble ShootingTrouble Shooting

�� SignalsSignals

�� “check electrodes“check electrodes” ”

�� clean skin and wet electrodesclean skin and wet electrodes

�� “Poor or sporadic Signal on Screen”“Poor or sporadic Signal on Screen”

�� Restart NM between muscle groups changesRestart NM between muscle groups changes

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�� Make sure Full Battery ChargeMake sure Full Battery Charge

�� Set Default Set Default –– See Program GuideSee Program Guide

�� Check for Broken lead wiresCheck for Broken lead wires

�� EMG signal too low or too highEMG signal too low or too high

�� Set Defaults and restartSet Defaults and restart

�� See Trouble Shooting Guide on See Trouble Shooting Guide on dropboxdropbox

NeuroMove PatientsNeuroMove Patients

�� Post stroke and SCI treatment may begin:Post stroke and SCI treatment may begin:�� Once stabilizedOnce stabilized�� Out patient or home useOut patient or home use�� Must be cognitiveMust be cognitive�� Up to 30 years post strokeUp to 30 years post stroke

�� Treatment TimeTreatment Time

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�� Treatment TimeTreatment Time�� 1515--60 Minutes each session60 Minutes each session�� Once a day building to 2 or 3 times a dayOnce a day building to 2 or 3 times a day�� Expect 4 months to a year treatment planExpect 4 months to a year treatment plan

�� Can be used with:Can be used with:�� Botox Botox –– High Tone patientsHigh Tone patients�� Baclofen Pump Baclofen Pump –– Spinal Cord patientsSpinal Cord patients

Ancillary Benefits of NMAncillary Benefits of NM

�� High Quality NMESHigh Quality NMES

�� Programmable ParametersProgrammable Parameters

�� Treatment of Muscle Atrophy Treatment of Muscle Atrophy & Re& Re--educationeducation

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& Re& Re--educationeducation

��Muscle SpasmsMuscle Spasms

�� Pain ReliefPain Relief

Is this like regular biofeedback?Is this like regular biofeedback?

No - Regular EMG (electromyography) may also have a very sensitive input, but for most other applications the input signals are filtered and averaged.

Some stroke survivors have no EMG activity or a strong muscle tone

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Some stroke survivors have no EMG activity or a strong muscle tone with high background “noise” - regular EMG/biofeedback will not stand a chance of detecting the changes that indicate a real attempt from the brain. The NeuroMove measures peak values in the EMG and has very fast input circuitry. Instead of averaging the input it does the opposite – it looks for a pattern in the small changes that indicate a real attempt. A very effective demonstration of this is when a non-patient actually

triggers the NeuroMove just by thinking about it and imagining a

movement

Why only one channel?Why only one channel?

FES FES vsvs NeuroMoveNeuroMove

�It has one channel, patient must concentrate on one movement at a time

�Is it like FES – No, FES or an elaborate functional

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�Is it like FES – No, FES or an elaborate functional stimulation product does not engage the brain. The patient can be watching TV and doing FES, but the brain will not relearn new pathways

Is it complicated to set up?Is it complicated to set up?

No – Encourage Home-use.

Turn on the device and turn stimulation level up slowly for a comfortable contraction of the muscle

Think very hard about moving the fingers, wrist, shoulder,

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Think very hard about moving the fingers, wrist, shoulder, foot and other muscles

After relaxing, it returns to “Ready” and is ready for the next attempt, relaxing is as important as concentrating

Program SettingsProgram Settings

Set threshold Set threshold to increase to increase

or decrease challenge (can be set or decrease challenge (can be set

during session)during session)

Rest Period Rest Period

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��Rest Period Rest Period (default (default –– 15 sec. Set:60 15 sec. Set:60

seconds)seconds)

��Mode: Stroke & SCI Mode: Stroke & SCI SesitivitySesitivity

��Set Audio On or OffSet Audio On or Off

��Compliance Data Compliance Data (number of sessions (number of sessions

and total time used)and total time used)

Program SettingsProgram Settings

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Change ParametersChange Parametersoo Frequency and pulse width, ramp up/off timeFrequency and pulse width, ramp up/off timeoo stimstim period period (default at 5 sec.)(default at 5 sec.)

oo RangeRange: : Can only be set when SCI Mode is selectedCan only be set when SCI Mode is selected

SCI two sensitivity ranges:SCI two sensitivity ranges:oo 0.250.25--25 25 uVuV

oo 0.500.50--50 50 uVuV ((use if signal is off screen use if signal is off screen w stroke patients)w stroke patients)

Hands on Therapy SessionHands on Therapy Session

Email: info@painezee.com

Tel: +91 9030022402

Web: www.junopharm.com

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040 - 65522402

www.painezee.com