Interface of Neuromodulation, Rehabilitation and Biomedical Engineering 1 Neuromodulation and Rehabilitation: Overview W. Jerry Mysiw, M.D. Bert C. Wiley Chair of Physical Medicine and Rehabilitation Chairman, Department of Physical Medicine and Rehabilitation The Ohio State University
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Interface of Neuromodulation, Rehabilitation and Biomedical Engineering 1 Neuromodulation and Rehabilitation: Overview W. Jerry Mysiw, M.D. Bert C. Wiley.
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Interface of Neuromodulation, Rehabilitation and Biomedical Engineering
1
Neuromodulation and Rehabilitation: Overview
W. Jerry Mysiw, M.D.Bert C. Wiley Chair of Physical Medicine and Rehabilitation
Chairman, Department of Physical Medicine and Rehabilitation
The Ohio State University
2
Health care reform TeleRehabilitation
Emerging technology Assistive technology
Advances in neurosciences
Advances in neuroimaging
Neuromodulation
Disability Statistics
Almost one-third of Americans entering the work force today (3 in 10) will become disabled before they retire.
Over 51 million Americans - 18% of the population - classify themselves as fully or partially disabled.
8 million disabled wage earners, over 5% of U.S. workers, were receiving Social Security Disability (SSDI) benefits at the conclusion of June, 2010.
In June of 2010, there were nearly 2.5 million disabled workers in their 20s, 30s, and 40s receiving SSDI benefits.
Common causes of disability
According to CDA’s 2010 Long-Term Disability Claims Review the following are the leading causes of new disability claims in 2009:
Musculoskeletal/connective tissue disorders caused 26.2% Nervous System-Related disorders caused 13.7% Cardiovascular/circulatory disorders caused 13.1%Cancer was the 4th leading cause of new disability claims at 8.4%.
Approximately 90% of disabilities are caused by illnesses
rather than accidents. Neurological disorders consume over one
third of the global chronic disease health burden
Stroke Related Disability Stroke is a leading cause of adult disability in the
US. Data from GCNKSS/NINDS studies show that
about 795,000 people suffer a new or recurrent stroke each year. About 610,000 of these are first attacks
About 6,400,000 stroke survivors are alive today In 2010, stroke will cost the US $73.7 billion in
health care services, medications, and lost productivity.
With timely treatment, the risk of death and disability from stroke can be lowered.
Early poststroke complications deprive patients of approximately 2 years of optimum health. Greater numbers of complications are associated with greater loss of healthy life-years.
CDC; AHA
Stroke Rehabilitation Outcomes
80% -Independent Mobility 70% -Independent Personal Care 40% -Independent Outside the Home 30%- Work
Sexuality Spirituality Driving Employment Education Recreation Family Involvement
January 2005Slide 12
TBI in the United States
An estimated 1.4 million people sustain a TBI annually; of these: 50,000 die 235,000 are hospitalized 1.1 million are treated and released from an ED
The number reported with TBI underestimates the magnitude of the problem because the following are not included: TBIs treated by private physicians Individuals who did not seek medical care
FACTThe annual
incidence of TBI is
more than that of MS, spinal cord
injury, HIV/AIDS, and breast
cancer
COMBINED.
TBI as Chronic Illness(the “Silent Epidemic”) 80,000-90,000 new TBI survivors experience onset of long-
term disability annually About 1 in 4 adults with TBI is unable to return to work 1 year
after injury 5.3 million Americans (2% of U.S. population) currently live
with TBI-related disabilities Based on hospitalized survivors only
65% of costs are accrued among TBI survivors Annual acute care and rehab costs of TBI = $9 - $10 billion * Estimated annual lifetime costs of TBI survivors in year 2000 =
$60 billion *** NIH Consensus Development Panel on Rehabilitation, 1999
** Finkelstein E, Corso P, Miller T, et al. The Incidence and Economic Burden of Injuries. New York,
Oxford Univ Press, 2006
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Sensorimotor
Impairm
ents
Pre-injury
Function Injury S
everit
y
Disability secondary to
Traumatic Brain Injury
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Modified Institute of Medicine Enabling – Disabling Process
Person – Environment Interaction
The Person
Environmental Lifestyle
Biology
The Environment
social
Disability
socialphysical
QOL
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Modified Institute of Medicine Model The Enabling – Disabling Process
Transitional Factors
Biology
Environmental Lifestyle
No Disabling Condition Pathology Impairment Functional Limitation
Quality of Life
The Goals of NeuroRehabilitation
Prevent and Manage Comorbid Conditions Decrease impairment Maximize Functional Independence Stabilize mood and self regulation
impairments Optimize Psychosocial Adaptation Facilitate Resumption of Prior Life Roles and
Community Reintegration Enhance Quality of Life Decrease costs and need for long term care
Exoskeleton Robotic Applications in Rehabilitation Populations ‘Forced Application of Technology’ EWJ
TeleRehabilitationThe provision of therapy at a distance Augmented communication Cognitive rehabilitation Motor/Mobility rehabilitation Vocational rehabilitation Prevention and management of complications