Reflex Therapeutics Website

Clinical Information on IMF Therapy®

Moving success for palsy patients with the IMF concept

We would like to introduce the IMF concept
“movement through perception of movement“.

Palsy (after apoplexy, severe head injuries or MS) not only impairs motor nerves but also depth sensitivity. Research carried out by the internationally renowned scientist MERZENICH reveals that sensory stimuli alone do not result in neuro-plastic changes (M. exposed healthy mice to extreme noises). In further tests with mice he stimulated their limbic system with implanted electrodes, whilst exposing them to sounds. Within a short period of time he detected neuro-plastic changes to the synaptic connections and the auditory cortex.

When a patient suffers from impaired proprioception the peripheral facilitation only produces basic signals. It becomes necessary to improve information processing and to sensitise the somatic-sensory cortex, which we stimulate by asking the patient to imagine a movement.

In contrast to the cybernetic paradigm of the classic approach of information processing our IMF-concept is based on the belief that anticipative processes are a basic and vital mechanism of the perception of movement and of intentional, purposeful actions, which are organised by anticipative schemata. (NEISSER, U.) Just think of the angle of limb joints when anticipating or planning a movement (GEORGOPOULOS). Impaired movement as a result of palsy usually lead to neglecting the movement, thus pushing the movement schemata towards “non-use”. We consider imagining movement a therapeutic approach, which aims to activate anticipative schemata according to their task and to influence neuro-plasticity towards intentional motor-activity.

Current therapeutic methods for the rehabilitation of palsy:

Extract: Struppler et al: Rehabilitation of palsy using peripheral magnetic stimulation …
In: Neurology & Rehabilitation 3 (1997) 145-158

“These are currently the established therapeutic methods for the rehabilitation of palsy affecting the central motor nerves:

  • Conventional physiotherapy, following different schools, such as Bobath, Brunnstrom, PNF-technique etc.
  • Repetitive training of isolated movements: creating and channelling muscle activity through direct intentional activating a particular muscle.
  • Classic electro-stimulation: Inducting skin stimuli and muscle contraction with transcutaneously applied electric stimuli of varying frequencies.
  • EMG-triggered electro stimulation

All therapeutic methods listed here aim on the one hand at channelling deliberate motor activities and on the other hand at stopping spastic tonus increase.
These methods are indeed only applied when the patient has reached the stadium of spastic paresis, and not already during the phase of complete paralysis.

Within the channelling methods specific therapeutic techniques have been developed, like for example stroking and tapping on the muscle about to be channelled (PNF-technique). Recent studies based on neuro-physiologic methods have shown that this repetitive element is most effective for channelling tendencies. EMG-triggered electro stimulation also draws on this concept in its repetitive movement training. Physiotherapy aims to minimise the spasticity component in distal muscle groups such as lower arm and hand, for example through passive stretching of the muscle structure of the proximal extremities (Bobath concept). Inhibitive effects of classic electro stimulation still lack sufficient statistic evaluation. However, the positive effects of repetitive movement exercise and EMG-triggered electro stimulation, of channelling and limiting nature, have been proven.

Of all statistically evaluated methods these two are the most promising for the rehabilitation of hand movement.”

Off print from:
Mokrusch et al: EMG-controlled electro stimulation. Statement from the GESET.

T. Morkusch  ………….VPT München

The significance of EMG–controlled electro stimulation for the therapeutic treatment and rehabilitation of impairments of the central nervous system - Statement from the GESET

Abstract:

EMG-controlled electro stimulation (EMG-ES) is a method of treatment that is part of a younger group of therapeutic methods and is becoming increasingly popular. It combines low frequency myo-stimulation, (bio-) feedback methods and movement therapy. It is aimed at spastic and paretic patients, and its successes have been efficiently proven. Its effectiveness is mainly based on the plasticity of central nervous structures after a lesion. Indications are mainly apoplectic stroke with cerebral infarction and brain haemorrhage, but also other lesions of the central nervous system, such as surgery, trauma, inflammation, Multiple Sclerosis etc. The stimulation can be carried out as initiated, triggered or being dependent on EMG, the generic term is “EMG-controlled” electro stimulation.

After consultation of the available literature GESET would like to make the following statement:

Therapeutic successes of EMG-ES are limitation of spasticity as well as an increase in deliberate motor activity, resulting in a general improvement in carrying out everyday activities (ADL). EMG-ES is more effective than a mono-therapeutic approach with physiotherapy, and than a mono-therapeutic approach with electro stimulation.

EMG-ES can be used for central lesions, whatever the aetiology (the most comprehensive experiences have been made in the area of cerebral infarction), its use for peripheral lesions is not considered in this statement. The best results are achieved if therapy begins as soon as possible after the lesion (ideally within the first year), but in limited and slower form it can easily be applied for up to 10 years after the lesion.

Similar requirements apply to the patient’s age. Motivation and an understanding of the therapeutic method are vital requirements for a successful treatment. The question of the significance of the hemispheres (aphasia, neuropsychological disorder) has not been sufficiently clarified yet.

Ideally the treatment should comprise professional therapeutic assistance on 5-7 days per week, 1-2 sessions lasting 30-60 minutes per day. Therapy should begin immediately after acute treatment, ideally as part of the in-patient early rehabilitation process, followed by a series of part in-patient and/or outpatient treatments comprising 3-5 therapy sessions per week. After sufficient training and inducting sessions for the patient and/or a member of the family or another third person the therapy may be continued alternatively at home, as long as it is being sufficiently monitored by a professional.

The therapy should be continued between at least three months and 24 months at the most. In the first year of the therapy a control check should be carried out every three months, in order to establish its success and to decide on indications for further treatments.

After the first year checks will be necessary in six-months intervals. It should be possible to check the professionalism of the therapists. The machine should be able to provide reports on the number and duration of the sessions it has been used for.

Conclusion:
  • The most important knowledge (for example concerning the general effectiveness) has been statistically verified.
  • Some secondary results are currently only apparent as tendencies.
  • Taking both results into account it is strongly suggested to carry out further comprehensive studies and research.