Reflex Therapeutics Website

IMF Therapy® - A Way Forward?

by Jackie Coates BA Hons, DipCOT
Senior Occupational Therapist, O.T. Dept, Hill House Hospital,
Cockett, Swansea, SA2 OFB

Introduction

As an O.T. working in a rehabilitation/stroke unit, I learned of this promising therapy while setting up the Swansea Different Strokes exercise group. Since reading about it on the Different Strokes website, I set up a demonstration for rehabilitation staff in our Trust and for the exercise group and immediately felt that Intention Myofeedback (IMF) had huge potential. I was lucky enough to borrow the machine for 3 months to trial with my stroke patients.

What is IMF?

IMF is a new and proven non- invasive method of recovering lost movement following stroke, head injury, MS and spinal cord damage. The device has been developed by Ulrich Schmidt in Germany and is currently used in clinics in Germany, Czech Republic and Spain. There are a number of recent studies proving the efficacy of this treatment technique.

IMF uses visualisation to re-educate movement. The device comprises a separate surface EMG, an EMG amplifier and 2 stimulation generators that operate separately and independently. The surface EMG provides information about the level of electrical impulses produced by the patient while the 2 stimulation channels deliver micro voltages which produce the actual movement (similar to Functional Electrical Stimulation).

How is it used?

The surface electrodes are placed on the skin over muscles you want to re-educate - these may be in the trunk, arm, leg or face. The patient visualises a movement which uses the chosen muscle groups e.g. reaching into a cupboard. The sensitive sensors pick up minimal nerve impulses triggered by the imagined movement, amplify them and send them back to the muscle tissue as movement stimulation. The patient therefore imagines, moves and feels - the process of cortical reorganisation is underway. Ideally the patient needs to practice at home with 4 sessions of 30 minutes daily. It can take up to 2 years to treat all the affected muscle groups so the machine can be purchased or rented. It is recommended that each muscle group should be stimulated for approximately 6 weeks until the benefits are permanent.

In my experience there is a place for IMF in the hospital setting as once the patient is familiar with its use, it can be set up for them (if they cannot learn to do this themselves) and they can be left to conduct their own treatment leaving the therapist free to treat someone else.

Who can it work for?

This treatment will only work with patients who are motivated and cognitively intact enough to understand the principles of the treatment. It requires the ability to visualise and the ability to concentrate on this for up to 30 minutes, a skill which can be gradually built up over time.

Who markets this product?

In Britain a company called Reflex Therapeutics run by Keith Hall supplies these units. They come in a briefcase and are highly portable. Keith can send you an information pack, which contains reference to the research and will come and give a demonstration. I would advise that each person tries the therapy, as the demonstration cannot be fully understood by observing.

My Experience

I have used this machine by no means enough to really see its true potential but enough to make me sure it has a real role in rehabilitation. The evidence is that FES is effective so adding a visualisation component putting the patient in control of the movement can surely only be better.

IMF can be used by occupational therapists and physiotherapists but the patient needs to be chosen carefully as it cannot be used with a pacemaker or near any metal in the body. The patient also needs to be alert, orientated and motivated. I have used IMF once or twice only with 5 patients and instantly seen an increase in voluntary movement in 4 of these. The same has occurred with some of the clients in the Different Strokes exercise group including one lady who had a stroke 27 years ago. She was astonished to find that IMF was effective for her and that the neural pathways are still open and plastic all these years later!

Our department is not in a position to purchase this therapy and neither am I in a position to try and get hold of one through a research grant. However I am aware that in NANOT’s Research and Development action plan, there are centres of excellence in research who may be able to provide the evidence base from a British standpoint which may put this therapy on the map. Who knows, if our evidence supports it, maybe it will be recognised by NICE as a way ahead!