By Daniel Parkinson
Braintree Rehabilitation Hospital
In 2007, Myomo, Inc. of Cambridge, MA introduced a lightweight, portable upper extremity neuro-robotic device to clinical settings throughout the United States. Since then, it has been adopted across the healthcare continuum from inpatient, to outpatient, to skilled nursing facilities, to home health and personal home use. The technology has been successful with both acute patients and chronic patients up to 20+ years post-injury.
Braintree Rehabilitation Hospital in Braintree, MA was the first rehabilitation setting in the country to commercially utilize the device in both their inpatient and outpatient settings. This article will provide practitioners with an overview of what Myomo technology is, how it differs from other robotics devices, and what types of patients are benefiting most from this type of neuro-robotic technology.
What is neuro-robotics and Myomo? Neuro-robotics is the combination of neuroscience and robotic technology to treat the neurologically impaired individual. The Myomo (an acronym for “my own motion”) technology was the brainchild of Dr. Woodie Flowers, from MIT, and his graduate students John McBean and Kailas Narendran. Dr. Flowers is a visionary in the field of myoelectrically driven neuroprosthetics. The team’s goal was to apply the functionality of driving an artificial limb, into a functional robotic orthosis for patients who were too weak to utilize their partially paralyzed limbs successfully, and to incorporate the limb into functional tasks.
The robot is completely powered by electromyography (EMG) signals it receives from the proximal upper extremity. The device will work only when a patient is actively engaging the targeted muscle group. The sensor then reads the signal it receives from the muscle group and engages the neuro-robotic device to assist in moving the extremity. This provides a novel form of closed loop proprioceptive feedback to the involved limb as illustrated (see Figure 1).
Figure 1. How Myomo Works.
Many patients are benefiting from this exciting new technology. These patients may have moderate to severe impairments in upper extremity function, and may have little or no wrist or hand movement. Patients appropriate for using Myomo should exhibit at least trace muscle strength in the biceps and/or triceps and should be motivated to perform functional tasks with the impaired upper extremity. As researcher Dr. Stephen Page has been quoted as saying, “It acts as a gateway to future distal extremity training.”
The therapists at Braintree Rehabilitation Hospital have used Myomo successfully with both acute and chronic patients. The acute patients are activating their weak muscles earlier in their recovery, thus preventing learned disuse. Neuro-robotics affords the therapist an opportunity to create an environment in which the patient can successfully perform meaningful tasks at high dosages. Chronic patients are benefiting from the neuro-robotics’ unique ability to break up agonist/antagonist patterns that often prevent and impair important functional control.
When working with the acute patients at Braintree Rehabilitation Hospital, treatment plans focus on increasing the patient’s ability to activate targeted muscle groups and use the upper extremity in meaningful, task-specific activities. These activities may include weight bearing, reaching tasks and carrying items such as laundry baskets. Myomo has been used successfully with patients who have trouble coordinating shoulder and elbow motion with functional hand control. While the device is assisting with the elbow control, the patient can focus on grasp and release during reaching.
The treatment focus for chronic patients may be on more specific goals such as weight bearing while transitioning from sit to stand, keeping the arm down by the side while ambulating, and/or using the arm during bilateral tasks (e.g., carrying items, pushing a grocery cart or raking the lawn.
Regardless of the number of years post injury, Myomo teaches patients how to properly activate the targeted muscle groups without substitution. Treatment can consist of planar exercises or functional activities. The patient and/or family members can be easily trained on how to don and doff the device and how to operate the controls. The patient can then transition from using the device in the clinic to using it at home.
Robotics are no longer a novel treatment in the rehabilitation setting. On the contrary, robotics have become a standard of care in the last decade, and many different robotic products are available for gait training and upper extremity rehabilitation. These devices can greatly enhance outcomes in the clinical environment and can also provide an excellent vehicle for evidence-based practice techniques such as repetitive task training.
The Myomo system is distinctive from other rehabilitation robotic technologies because it is lightweight, portable, user-friendly, functional and available for home use. Many of the other technologies are available only in the clinical setting. Myomo also offers the unique advantage of being powered by the patient’s own muscle activity through EMG readings. This unique feature allows the Myomo device to benefit a variety of patients.
Ultimately, Myomo is a unique neuro-robotic device. From the beginning, the team of MIT engineers that invented this product recruited practicing clinicians and neurologically impaired individuals to collaborate on its design. The result of this collaboration is a portable neuro-robotic device that allows patients to complete functional activities in the clinic or home. The device is user-friendly and affordable, which makes for an easy transition from clinic use to home use.
ABOUT THE AUTHOR
Daniel Parkinson, PT, MBA, is Director of Clinical Services at Braintree Rehabilitation Hospital in Braintree, MA.
