HYPERMED MULTIPLE SCLEROSIS

‘HyperMED NeuroRecovery is committed to expanding the therapeutic window promoting worthwhile functional outcomes - gone are days of simply living and coping with disability!' Dr Mal Hooper _ HyperMED NeuroRecovery Australia

 

HyperMED UPDATE Progressive MS - excellent overview

HyperMED Protocols in the treatment and management of Multiple Sclerosis are unique - we provide saturative blocks of Hyperbaric Oxygenation combined with Lokomat (Gait Training) and other supportive modalities including Median Nerve Stimulation, Whole Body Vibration, immune stimulating supplements etc to impact the disease process and salvage back functionality.

Every MS patient is different and every case requires specific recommendation. Typically we recommend a current and full MRI of the brain and full spine to determine your exact current position. Typically most MS patients state that the last MRI was 'when first diagnosed' or 'many years ago'!

MS is a progressive disease - it does not remain static, damage progresses.

MRI brain and full spine provides opportunity to compare previous MRIs with current - comparing location, size and frequency of lesions. Invariably many chronic MS patients have not had previous spinal MRI investigation - this is a mystery! Unfortunately progressive MS sufferers have additional demylination effects throughout their spine and often directly correlated with underlying structural degeneration i.e. disc prolapse, canal stenosis, previous back surgery etc.

MS is also linked with underlying 'opportunistic infections'. When commencing at HyperMED you can expect apart from standard blood investigations; a range of additional tests including Mycoplasma profile, Chlamydia profile, Epstein Barr virus, Cytomegalovirus, Toxoplasmosis, Rickettsia profile, Herpes profile, Immunoglobulin profile etc.

What Happens When Demylination Progresses?

  • the initial damage is often multifactor - many underlying mechanisms have been identified including genetic and cytopathic causes. Evidence has even identified undetermined birth hypoxic events as a possible cause to late and adult MS onset

  • the immediate effects of nerve cell damage leads to microscopic vascular damage of nerve fibers and neural tracts. This 'leakage' results in chronic swelling and edema causing progressive destruction of the surrounding myelin nerve sheath and other immediate surrounding tissue structures

  • chronic swelling and progressive vascular leakage due to weakened cell membranes results in micro-hypoxia (inadequate tissue oxygen)

  • hypoxia becomes a 'magnet for circulating infections' - referred to as 'opportunistic infections'. Past lung and respiratory infections often lead to chronic circulating infections that thrive in low oxygenated environments. Hypoxic regions are energy poor environments and provide a fertile platform for 'bad bugs' to replicate and accelerate the underlying disease progression. This destructive cycle of events is often referred to as Hypoxic Induced Apoptosis

  • The difficulty in treating neurodegenerative disorders including MS is the fact that 'drugs' require oxygen as a catalyst to penetrate the target region. If in fact hypoxia exists the MS and chemotherapeutic drug is relatively ineffective given the fact hypoxia blocks delivery. This is not a problem in a laboratory controlled drug trial where the drug is 'delivered' into the target tissue. This is exactly how Hyperbaric Oxygenation provides benefit for patients suffering MS and related illness. We often describe the impact of Hyperbaric Oxygenation is like 'getting more fizz into a flat can of coke'! The objective of Hyperbaric Oxygenation is to get more oxygen (fizz) into the hypoxic damaged nerve cell and neural tracts accelerating recovery, fighting the underlying infection and preventing further destructive spread due to apoptosis

Why Does The Individual Progressively Lose Functionality?

  • Experiments conducted on neural impaired subjects demonstrate that neural circuitry slowly 'learn' to shut down.

  • Lack of appropriate and 'accurate' stimulation induces functional incapacity called the ‘learning non-use’. Simply stated if you teach the neural circuits to cease walking or to sit they will learn 'non-use disability'. Refer to the 'rat study  Do Wheel Chairs Inhibit Recovery?

  • Motor cortex centers in the brain and spinal cord show signs of 'global functional loss' due to localized demylination effects. It is imperative to keep this ‘window open’

  • Body Weight Support Treadmill Training (BWSTT) and more recent studies on Lokomat (Robotic Gait Assisted Walking) demonstrate the potential of functional neuroplasticity - the ability to re-learn and re-organize function. Functional BOLD MRI measures the capacity to retrain function in both the brain and spinal cord neural pathways. The injured brain and spinal cord has capacity to 'wake-up' - salvage back tissue damage, re-activate and re-train dormant neural pathways improving functionality

Lokomat (Robotic Gait Assisted Walking) Gait Training

For the past 15-years bodyweight supported treadmill training (BWSTT) has become a prominent gait rehabilitation method in leading rehabilitation centers throughout the world.  

Experiments conducted on spinalized cats demonstrate that spinal circuitry (reflex generators) below the level of injury remains active and functional neuronal properties can respond to peripheral input from below the level of injury. Treadmill cats can be ‘trained to sit, stand and walk’

Lack of appropriate stimulation induces functional incapacity called the ‘learning non-use’. Simply stated if you teach the remaining active spinal circuits to sit they will sit! Motor cortex centers in the brain re-allocate functional capacity lost through spinal cord injury – it is imperative to keep this ‘window open’. Body Weight Support Treadmill Training (BWSTT) and more recent studies on Lokomat (Robotic Gait Assisted Walking) demonstrate the potential of functional neuroplasticity - the ability to re-learn and re-organize function.  

This type of locomotor training has many functional benefits but the labor costs are considerable. To reduce therapist effort, Robotically Gait Assisted BWSTT (Lokomat) has been shown to be more accurate and financially feasible, compared to the other BWSTT modalities. Currently 45+ Lokomat systems are in use in large Neurorehabilitation hospitals in the USA and approximately 150 Lokomat systems found in 31 Countries.

Internationally Lokomat (Robotic Gait Assisted Walking) and Body Weight Support Treadmill Training programs are payable under Third Party Insurance for spinal cord injury and a range of neurodegenerative and neurodevelopment gait disorders including Multiple Sclerosis.

Lokomat (Robotic Gait Assisted Walking) Gait Training

Patients receiving Lokomat (Robotic Gait Assisted Walking) are scheduled daily; initially 1-hour session and then as the patient builds we recommend up to 2-hours each day attending.

Lokomat is NOT passive involvement. The Lokomat is constantly adjusted to best assist the functional responses of the patient. Patients commence with passive assistance however as the patient compliancy builds the Lokomat settings and various programs are tailored to the patient performance and capabilities. Some patients have high level spasticity and others a complete loss of tone. Each patient's presentation is different - Lokomat provides excellent opportunity to 'best-fit' the patients specific capabilities and capacity to re-train function. And this is replicable on every separate training session!

In addition the support harness treadmill system are utilized independent of the Lokomat to promote functional changes. Functional changes being driven by 'man and machine' are then put to the test with the patient then able to implement strategies being focused on during each Lokomat session.

This combination effect is both unique and significant towards each neurologic patient developing a sense of supportive assistance whilst focusing on improving functional independence.

Walking requires a 'fluid like connection between spinal reflex generators and higher brain centers'. The combined approach is invaluable to promote functional changes - neuroplasticity (the ability to salvage back what has been damaged).

 

Gait impairment is a major cause of ongoing disability in patients with multiple sclerosis (MS). New treadmills that provide body weight support and even robotic assistance to the lower limbs have recently been developed and are now commercially available. These treadmills allow the subject to execute the integrated process of walking in a task-specific manner that is repetitively reinforced in a normal pattern. Data from studies using these body-weight supported treadmills (BWSTT) in spinal cord injury and stroke patients suggest that intensive task-specific gait rehabilitative training may help to restore a normative gait pattern, improve overground walking and enhance quality of life in multiple sclerosis patients with neurological gait impairment.

In this study, we propose a series of prospective longitudinal clinical studies to collect pilot data on the use of task-specific BWSTT +/- Lokomat on improving ambulation, motor function and quality of life for MS patients with mild to moderate gait difficulty. Pilot data will also be collected for the effect conventional rehabilitation has on ambulation and motor outcomes as well as how these outcomes change during usual care. Our clinical research goals are to capture the initial pilot data (mean changes and variances in ambulation, motor, fatigue and quality of life outcomes) to facilitate the design of a larger clinical trial to test efficacy if these preliminary data are promising. The planned studies will study the effect of two forms of task specific training (BWSTT alone and BWSTT combined with Lokomat) compared to conventional gait rehabilitative methods and usual care

 

HyperMED MS protocols are intensive and integrated - Hyperbaric Oxygenation provides the available fuel and acts as a catalyst to the underlying central issue associated with demylination - hypoxia (inadequate oxygen) due to chronic swelling associated with demylination. Lokomat (Robotic Gait Assisted Walking) and other forms of intensive physical therapy are required to ‘drive’ neuroplasticity - the ability of the neurons in the nervous system to develop new connections and ‘learn’ new functions. The rate of neuroplasticity is directly impacted by the levels of continuing hypoxia which blocks recovery!  

This combined Hyperbaric Lokomat approach ‘awakens’ dormant neural pathways and provides accurate neurological repetition enhancing and re-training connections and pathways in the brain and spinal cord. Patients have the ability to ‘salvage back’ what has been damaged improving brain and spinal cord function - to regain walking ability or learn to walk!

Please also take the time to watch the following National Geographic Documentary on Professor Ed Cooper pioneering work on Median Nerve Stimulation.

The key message by Prof Cooper is the fact that  'awakening is the result of  accurate repetition many thousands of times that tells the brain and spinal cord  – wake-up, wake-up, wake- up, wake-up, wake-up ….’  

Median Nerve Stimulation (MNS) is an integral part of the HyperMED Protocol - application is recommend for all patients with neurologic disorders.

MNS provides a cost effective yet simple home application that enables parents to continue the benefits of HyperMED saturation and training. Equally Spinal Cord patients, victims of neurologic trauma and elderly patients suffering dementia related illness can also benefit from Median Nerve Stimulation. Science supports the fact that many disabled patients have intact but non-responding dormant neural pathways. These dormant pathways need to 'wake-up!'

 

Additional Review

 

HyperMED UPDATE Progressive MS

HyperMED UPDATE  Elaine Leggart - Progressive MS

 

 

NBC 30 Health - New Machine May Help MS Patients With Mobility - Mt Sinai Rehabilitation Hospital USA

HyperMED UPDATE  Progressive Multiple Sclerosis - Carey