Stroke Rehab: Four Insights From PTJ

From a study of upper-limb approaches to interviews with PTs on how they motivate patients, PTJ sheds light on an important area of care.

Roundup

Rehabilitation for individuals who have experienced stroke may be a common part of the day-to-day work of many PTs and PTAs, but there's always more to learn. PTJ: Physical Therapy & Rehabilitation Journal remains a solid go-to for the profession to gain insights on opportunities — and possibilities.

And as with all other PTJ content, members have full-text access to this research for free as a member benefit.

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Paralyzed Man Walks Again Via Thought-Controlled Implants

By Isabelle Tourne

A paralyzed man has regained the ability to walk smoothly using only his thoughts for the first time, researchers said on Wednesday, thanks to two implants that restored communication between brain and spinal cord.

The patient Gert-Jan, who did not want to reveal his surname, said the breakthrough had given him "a freedom that I did not have" before.

The 40-year-old Dutchman has been paralyzed in his legs for more than a decade after suffering a spinal cord injury during a bicycle accident.

But using a new system he can now walk "naturally", take on difficult terrain and even climb stairs, according to a study published in the journal Nature.

The advance is the result of more than a decade of work by a team of researchers in France and Switzerland.

he advance is the result of more than a decade of work by a team of researchers in France and Switzerland.

Last year the team showed that a spinal cord implant—which sends electrical pulses to stimulate movement in leg muscles—had allowed three paralyzed patients to walk again.

But they needed to press a button to move their legs each time.

Gert-Jan, who also has the spinal implant, said this made it difficult to get into the rhythm of taking a "natural step".

'Digital Bridge'
The latest research combines the spinal implant with new technology called a brain-computer interface, which is implanted above the part of the brain that controls leg movement.

The interface uses algorithms based on artificial intelligence methods to decode brain recordings in real time, the researchers said.

This allows the interface, which was designed by researchers at France's Atomic Energy Commission (CEA), to work out how the patient wants to move their legs at any moment.

The data is transmitted to the spinal cord implant via a portable device that fits in a walker or small backpack, allowing patients to get around without help from others.

The two implants build what the researchers call a "digital bridge" to cross the disconnect between the spinal cord and brain that was created during Gert-Jan's accident.

"Now I can just do what I want—when I decide to make a step the stimulation will kick in as soon as I think about it," Gert-Jan said.

After undergoing invasive surgery twice to implant both devices, it has "been a long journey to get here," he told a press conference in the Swiss city of Lausanne.

But among other changes, he is now able to stand at a bar again with friends while having a beer.

"This simple pleasure represents a significant change in my life," he said in a statement.

'Radically Different'
Gregoire Courtine, a neuroscientist at Switzerland's Ecole Polytechnique Federale de Lausanne and a study co-author, said it was "radically different" from what had been accomplished before.

"Previous patients walked with a lot of effort—now one just needs to think about walking to take a step," he told a press conference in the Swiss city of Lausanne.

There was another positive sign: following six months of training, Gert-Jan recovered some sensory perception and motor skills that he had lost in the accident.

He was even able to walk with crutches when the "digital bridge" was turned off.

Guillaume Charvet, a researcher at France's CEA, told AFP this suggests "that the establishment of a link between the brain and spinal cord would promote a reorganization of the neuronal networks" at the site of the injury.

So when could this technology be available to paralyzed people around the world? Charvet cautioned it will take "many more years of research" to get to that point.

But the team are already preparing a trial to study whether this technology can restore function in arms and hands.

They also hope it could apply to other problems such as paralysis caused by stroke.

More information: Grégoire Courtine, Walking naturally after spinal cord injury using a brain–spine interface, Nature (2023). DOI: 10.1038/s41586-023-06094-5. www.nature.com/articles/s41586-023-06094-5

Journal information: Nature 

CMS Listens to APTA, Reverses Course, OKs Hospital Use of Telehealth Post-PHE

APTA

Though many questions still remain, the U.S. Centers for Medicare & Medicaid Services has offered one answer on the use of telehealth in facility settings now that the public health emergency has ended: For hospital-based facilities, it's a go. The announcement is a major reversal from CMS' earlier position against use of telehealth in that setting.

The clarification, provided late Friday afternoon, can be found in a CMS FAQ document available online (see question 21). Essentially, the agency responded to advocacy by APTA and other organizations and now says that hospitals can bill Medicare for services provided via telehealth until the end of 2023. Previously, CMS had suggested any setting that used a UBO4 claim form — the form used by most hospitals — was excluded from billing for telehealth after the end of the public health emergency.

While a welcome development, the reversal only addresses a portion of the settings in which the fate of telehealth remains unresolved: CMS has yet to address similar questions about skilled nursing facilities, home health agencies, and rehab agencies. APTA met with representatives from the U.S. Department of Health and Human Services last week to press for resolution, who indicated that not all guidance may be produced quickly.

APTA continues to monitor the issue and will provide updates as available. The association's call for a resolution to the problem has been reinforced through a statement signed by coalition of organizations.

Guidance for the Expiration of the COVID-19 Public Health Emergency (PHE) Staff Vaccination Requirements

On November 5, 2021, the U.S. Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) issued an interim final rule (CMS-3415-IFC) requiring Medicare and Medicaid-certified providers and suppliers to ensure that their staff were fully vaccinated for COVID-19 (i.e., obtain the primary vaccination series), which was a critical step to protect patients. On April 10, 2023, the President signed legislation that ended the COVID-19 national emergency. On May 11, 2023, the COVID-19 public health emergency is expected to expire. In light of these developments and comments received on the interim final rule, CMS will soon end the requirement that covered providers and suppliers establish policies and procedures for staff vaccination. CMS will share more details regarding ending this requirement at the anticipated end of the public health emergency. We continue to remind everyone that the strongest protection from COVID-19 is the vaccine. Therefore, CMS urges everyone to stay up to date with your COVID-19 vaccine.

Emergency Preparedness: Training and Testing Program Exemption

The following information supersedes the previously issued QSO-20-41-ALL-REVISED memo for all certified providers/suppliers. CMS regulations for Emergency Preparedness (EP) require the provider/supplier to conduct exercises to test their EP plan to ensure that it works and that staff are trained appropriately about their roles and the provider/supplier’s processes. During or after an actual emergency, the EP regulations allow for a one-year exemption from the requirement that the provider/supplier perform testing exercises. The exemption only applies to the next required full-scale exercise (not the exercise of choice), based on the 12-month exercise cycle. The cycle is determined by the provider/supplier (e.g., calendar, fiscal or another 12- month timeframe). The exemption only applies when a provider/supplier activates its emergency preparedness program for an emergency event.