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Thread: PARASTEP

  1. #1

    PARASTEP

    IS ANYONE USING THE PARASTEP SYSTEM? IF SO, CAN YOU SHARE YOUR THOUGHTS ABOUT IT??

  2. #2
    I believe it was recently approved for coverage through Medicare, I think Medicare would be better off covering the FES bike instead. Beyond that, really dont know anyone who has ever tried it. Sorry I cant be of more help.

    "Life is about how you
    respond to not only the
    challenges you're dealt but
    the challenges you seek...If
    you have no goals, no
    mountains to climb, your
    soul dies".~Liz Fordred

  3. #3
    Here are some abstracts of studies of the Parastep system.

    • Brissot R, Gallien P, Le Bot MP, Beaubras A, Laisne D, Beillot J and Dassonville J (2000). Clinical experience with functional electrical stimulation-assisted gait with Parastep in spinal cord-injured patients. Spine 25:501-8. Summary: STUDY DESIGN: Clinical evaluation of the Parastep method, a six-channel transcutaneous functional electrical stimulation device, in spinal cord-injured patients. OBJECTIVES: To investigate the motor performances of this new technique regarding energy expenditure and to evaluate its advantages and limitations, especially in social activities involving ambulation. METHODS: This study was conducted in 15 thoracic spine-injured patients. The lesion was complete except in two patients. The gait ability and the functional use were judged clinically. Energy cost was evaluated from heart rate, peak oxygen uptake, and lactatemia. RESULTS: Thirteen patients completed the training (mean: 20 sessions) and achieved independent ambulation with a walker. The mean walking distance, without rest, was 52.8 +/- 69 m, and the mean speed was 0.15 +/- 0.14 m/sec. One patient with incomplete lesion, who had been nonambulatory for 8 months after the injury, became able to walk without functional electrical stimulation after five sessions. The follow-up was 40 +/- 11 months. Five patients pursued using functional electrical stimulation-assisted gait as a means of physical exercise but not for ambulation in social activities. The patients experienced marked psychological benefits, with positive changes in their way of life. In three subjects, a comparison of physiologic responses to exercise between a progressive arm ergometer test and a walking test with the Parastep (Sigmedics, Inc., Northfield, IL) at a speed of 0.1 m/sec was performed, showing that the heart rate, the peak oxygen uptake, and lactatemia during gait were close to those obtained at the end of the maximal test on the ergometer. CONCLUSIONS: In spite of its ease of operation and good cosmetic acceptance, the Parastep approach has very limited applications for mobility in daily life, because of its modest performance associated with high metabolic cost and cardiovascular strain. However, it can be proposed as a resource to keep physical and psychological fitness in patients with spinal cord injury. Unite de Biologie et Medecine du Sport, Centre Hospitalier Universitaire, Rennes, France. prevbrisso@aol.com
    • Chaplin E (1996). Functional neuromuscular stimulation for mobility in people with spinal cord injuries. The Parastep I System. J Spinal Cord Med 19:99-105. Summary: Continental Rehabilitation Hospital of San Diego, CA 92103, USA.
    • Gallien P, Brissot R, Eyssette M, Tell L, Barat M, Wiart L and Petit H (1995). Restoration of gait by functional electrical stimulation for spinal cord injured patients. Paraplegia 33:660-4. Summary: In this clinical study, we report the results of functional electrical stimulation for the ambulation of paraplegic patients without long leg braces (LLB), according to the Parastep approach. Of 13 SCI patients with complete neurological lesions included in this trial, 12 progressed to independent ambulation with the aid of the Parastep. The average walking distance was 76 m, with a maximum of 350 m, and the mean speed 0.2 m s-1. Compared to the situation with long leg braces, which in fact are given up by most paraplegic patients, long term home use seems to be much more important. Tolerance of this method is satisfactory. The psychological benefits of the device are remarkable. From this experience, it is concluded that this method is valuable for the restoration of standing and walking in the long term management of spinal cord injury patients. Department of Rehabilitation, Hopital Pontchaillou, University of Rennes, France.
    • Graupe D and Kohn KH (1998). Functional neuromuscular stimulator for short-distance ambulation by certain thoracic-level spinal-cord-injured paraplegics. Surg Neurol 50:202-7. Summary: BACKGROUND: Functional Neuromuscular Stimulation (FNS) for unbraced short-distance ambulation by traumatic complete/near-complete T4 to T12 paraplegics is based on work by Graupe et al (1982), Kralj et al (1980), Liberson et al (1961), and others. This paper discusses methodology, performance, training, admissibility criteria, and medical observations for FNS-ambulation using the Parastep-I system, which is the first and only such system to have received FDA approval (1994) and which emanated from these previous works. METHOD: The Parastep system is a transcutaneous non-invasive and microcomputerized electrical stimulation system built into a Walkman-size unit powered by eight AA batteries that is controlled by finger-touch buttons located on a walker's handbars for manual selection of stimulation menus. The microcomputer shapes, controls, and distributes trains of stimulation signals that trigger action potentials in selected peripheral nerves. Walker support is used for balance. The patient can don the system in under 10 minutes. At least 32 training sessions are required. RESULTS: Approximately 400 patients have used the Parastep system, essentially all achieving standing and at least 30 feet of ambulation, with a few reaching as much as 1 mile at a time. Recent literature presents data on the medical benefits of using the Parastep system-beyond the exercise benefits of short distance ambulation at will-such as increased blood flow to the lower extremities, lower HR at subpeak work intensities, increased peak work capability, reduced spasticity, and psychological benefits. CONCLUSIONS: We believe that the Parastep FNS system, which is presently commercially available by prescription, is easily usable for independent short-distance ambulation. We believe that its exercise benefits and its other medical and psychological benefits, as discussed, make it an important option for thoracic-level traumatic paraplegics. Department of Electrical Engineering & Computer Science, University of Illinois at Chicago, 60607, USA.
    • Guest RS, Klose KJ, Needham-Shropshire BM and Jacobs PL (1997). Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: part 4. Effect on physical self-concept and depression. Arch Phys Med Rehabil 78:804-7. Summary: OBJECTIVE: To determine whether persons with spinal cord injury (SCI) paraplegia who participated in an electrical stimulation walking program experienced changes in measures of physical self-concept and depression. DESIGN: Before-after trial. SETTING: Human SCI applied research laboratory. PARTICIPANTS: Volunteer sample of 12 men and 3 women with SCI paraplegia, mean age 28.75 +/- 6.6yrs and mean duration of injury 3.8 +/- 3.2yrs. INTERVENTION: Thirty-two FNS ambulation training sessions using a commercially available system (Parastep 1). The hybrid system consists of a microprocessor-controlled stimulator and a modified walking frame with finger-operated switches that permit the user to control the stimulation parameters and activate the stepping. OUTCOME MEASURES: The Tennessee Self-Concept Scale (TSCS) and the Beck Depression Inventory (BDI) were administered before and after training. Only the Physical Self subscale of the TSCS was analyzed. After training, individual interviews were performed to assess participants' subjective reactions to the training program. RESULTS: A repeated measures analysis of variance indicated that desired directional and statistically significant changes occurred on the Physical Self subscale of the TSCS (F(1,14) = 8.54, p < .011) and on the BDI [F[1,14) = 5.42, p < .035). CONCLUSIONS: Subsequent to the ambulation training program there were statistically significant increases in physical self-concept scores and decreases in depression scores. The Miami Project to Cure Paralysis, University of Miami School of Medicine, FL 33136, USA.
    • Jacobs PL, Nash MS, Klose KJ, Guest RS, Needham-Shropshire BM and Green BA (1997). Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: part 2. Effects on physiological responses to peak arm ergometry. Arch Phys Med Rehabil 78:794-8. Summary: OBJECTIVE: To examine the task-nonspecific effects of functional neuromuscular stimulation (FNS)-assisted ambulation training on the physiological responses of persons with paraplegia to upper extremity exercise challenge. DESIGN: Before-after trial. SETTING: Human spinal cord injury (SCI) applied research laboratory. PARTICIPANTS: Twelve men and three women with motor- and sensory-complete thoracic-level SCI (T4-T11), mean age 28.2 +/- 6.8yrs (range, 21.1 to 45.2yrs), mean injury duration 3.7 +/- 3.0yrs (range, 7 to 8.8yrs). INTERVENTION: Thirty-two sessions of FNS ambulation training using a commercial six-channel system (Parastep 1). This system is composed of a microprocessor-controlled electrical stimulation unit and a walking frame outfitted with finger switches that allow the user to independently control the system and stimulation parameters. OUTCOME MEASURES: Peak and subpeak physiological responses to arm ergometry testing and upper extremity strength measures, obtained before and after the FNS ambulation training. RESULTS: Statistically significant increases in peak values for time to fatigue, peak power output, and peak VO2 (all p < .001). Heart rate was significantly lower throughout subpeak levels of arm ergometry after the ambulation training [p < .05). Values of upper extremity strength were not significantly altered after training. CONCLUSIONS: FNS ambulation by persons with SCI paraplegia results in task-nonspecific training adaptations. Central cardiovascular adaptations were indicated as the primary source of these beneficial alterations in exercise responses. The Miami Project to Cure Paralysis and the Department of Neurological Surgery, University of Miami School of Medicine, FL 33136, USA.
    • Klose KJ, Jacobs PL, Broton JG, Guest RS, Needham-Shropshire BM, Lebwohl N, Nash MS and Green BA (1997). Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: part 1. Ambulation performance and anthropometric measures. Arch Phys Med Rehabil 78:789-93. Summary: OBJECTIVE: To describe performance parameters and effects on anthropometric measures in spinal cord injured subjects training with the Parastep 1 system. DESIGN: Before-after trial. SETTING: Human spinal cord injury applied research laboratory. PARTICIPANTS: Thirteen men and 3 women with thoracic (T4-T11) motor-complete spinal cord injury: mean age, 28.8yrs; mean duration postinjury, 3.8yrs. INTERVENTION: Thirty-two functional neuromuscular stimulation ambulation training sessions using a commercially available system (Parastep-1). The hybrid system consists of a microprocessor-controlled stimulator and a modified walking frame with finger-operated switches that permit the user to control the stimulation parameters and activate the stepping. OUTCOME MEASURES: Distance walked, time spent standing and walking, pace, circumferential (shoulders, chest, abdomen, waist, hips, upper arm, thigh, and calf) and skinfold (chest, triceps, axilla, subscapular, supraillium, abdomen, and thigh) measurements, body weight, thigh cross-sectional area, and calculated lean tissue. RESULTS: Statistically significant changes in distance, time standing and walking, and pace were found. Increases in thigh and calf girth, thigh cross-sectional area, and calculated lean tissue, as well as a decrease in thigh skinfold measure, were all statistically significant. CONCLUSIONS: The Parastep 1 system enables persons with thoracic-level spinal cord injuries to stand and ambulate short distances but with a high degree of performance variability across individuals. The factors that influence this variability have not been completely identified. The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami School of Medicine, FL 33136, USA.
    • Kordylewski H and Graupe D (2001). Control of neuromuscular stimulation for ambulation by complete paraplegics via artificial neural networks. Neurol Res 23:472-81. Summary: The paper describes the application of a neural network (ANN) for controlling a functional neuromuscular stimulation (FNS) system to facilitate patient-responsive ambulation by paralyzed patients with traumatic, thoracic-level spinal cord injuries. The particular ANN that is employed is a modified Adaptive-Resonance-Theory (ART-1) network. It serves as a controller in an FNS system (the Parastep system) that is presently in use by approximately 500 patients worldwide (but still without ANN control) and which was the first and only FNS system approved by FDA. The proposed neural network discriminates above-lesion upper-trunk electromyographic (EMG) time series to activate standing and walking functions under FNS and controls FNS stimuli levels using response-EMG signals. For this particular application, several modifications are introduced into the standard ART-1 ANN. First, a modified on-line learning rule is proposed. The new rule assures bi-directional modification of the stored patterns and prevents noise interference. Second, a new reset rule is proposed, which prevents 'exact matching' when the input is a subset of the chosen pattern. A single ART-1-based structure is being applied to solving two problems, namely (1) signal pattern recognition and limb function determination, and (2) control of stimulation levels. This also facilitates ambulation of paraplegics under FNS, with adequate patient interaction in initial system training, retraining the network when needed, and in allowing patient's manual over-ride in the case of error, where any manual over-ride serves as a re-training input to the neural network. The ANN control facilitates continuous update of control settings during normal use, without formal retraining. Knowledge Systems Institute, 3420 Main Street, Skokie, IL 60076, USA.
    • Nash MS, Jacobs PL, Montalvo BM, Klose KJ, Guest RS and Needham-Shropshire BM (1997). Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: part 5. Lower extremity blood flow and hyperemic responses to occlusion are augmented by ambulation training. Arch Phys Med Rehabil 78:808-14. Summary: OBJECTIVE: To test whether 12 weeks of exercise conditioning using functional neuromuscular stimulation (FNS) ambulation alters the resting lower extremity blood flow and hyperemic responses to vascular occlusion in subjects with paraplegia, and to determine whether an association exists between limb flow and lower extremity fat-free mass. DESIGN: Pretest, posttest. SETTING: Academic medical center. PARTICIPANTS: Subjects with chronic neurologically complete paraplegia. INTERVENTION: Thirty-two sessions of microprocessor-controlled ambulation using electrically stimulated contractions of lower extremity muscles and a rolling walker. OUTCOME MEASURES: Subjects underwent quantitative Doppler ultrasound examination of the common femoral artery (CFA) before and after training. End-diastolic arterial images and arterial flow-velocity profiles obtained at rest and after 5 minutes of suprasystolic thigh occlusion were computer-digitized for analysis of heart rate (HR), CFA peak systolic velocity (PSV), CFA cross-sectional area (CSA), flow velocity integral (FVI), pulse volume (PV), and CFA (arterial) inflow volume (AIV). RESULTS: Significant effects of training on CSA (p < .0001), FVI [p < .05), computed PV [p < .001), and computed AIV [p < .01) were observed. Resting HR was lower following training [p < .05). The change for resting PSV approached but did not reach significance [p = .083). Analysis of postocclusion PV and AIV showed significant effects for conditioning status [p values < .01), postcompression time [p values < .0001), and their interaction [p values < .01). At 1 minute after occlusion, the posttraining AIV response was 78.2% greater in absolute magnitude and 17.4% more robust when expressed as a percentage change from its resting value than before training. Significant correlations were found between thigh fat free mass and both AIV and PV [p values < .05). CONCLUSION: Exercise training using FNS ambulation increases the resting lower extremity AIV in individuals with paraplegia and augments the hyperemic response to vascular occlusion. Improved posttraining blood flow is attributable both to vascular structural changes and upregulation of vascular flow control mechanisms. Limb mass is associated with the volume of arterial blood flow. Department of Orthopaedics & Rehabilitation, The Miami Project to Cure Paralysis, University of Miami School of Medicine, FL 33146, USA.
    • Needham-Shropshire BM, Broton JG, Klose KJ, Lebwohl N, Guest RS and Jacobs PL (1997). Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: part 3. Lack of effect on bone mineral density. Arch Phys Med Rehabil 78:799-803. Summary: OBJECTIVE: To determine if the bone mineral density loss seen after spinal cord injury (SCI) is reversed by a walking program using the Parastep 1 system. DESIGN: Before-after trial. SETTING: Human SCI applied research laboratory. PARTICIPANTS: Thirteen men and 3 women with thoracic motor- and sensory-complete SCI, mean age 28.8yrs, mean duration postinjury 3.8yrs. INTERVENTION: Thirty-two functional neuromuscular stimulation (FNS) ambulation training sessions using a commercially available system (Parastep 1). This system consists of a microprocessor-controlled stimulator and a modified walking frame with finger-operated switches that permit the user to control the stimulation parameters and activate the stepping. OUTCOME MEASURE: Bone mineral density at the femoral head, neck, and Ward's triangle measured using a Lunar DP3 dual-photon densitometer. RESULTS: No significant change in bone mineral density was found using repeated measures analyses of variance. CONCLUSIONS: Axial loading combined with muscle stimulation and resistive exercise does not result in significant changes in bone mineral density in persons with complete paraplegia. The Miami Project to Cure Paralysis, University of Miami School of Medicine, FL 33136, USA.
    • Spadone R, Merati G, Bertocchi E, Mevio E, Veicsteinas A, Pedotti A and Ferrarin M (2003). Energy consumption of locomotion with orthosis versus Parastep-assisted gait: a single case study. Spinal Cord 41:97-104. Summary: STUDY DESIGN: Single case study. OBJECTIVES: To evaluate the energy expenditure during ambulation with the Advanced Reciprocating Gait Orthosis (ARGO), with and without functional electrical stimulation (FES), and with the Parastep system in a single subject, in order to avoid the effect of inter-subject variability. SETTING: The Centre of Sport Medicine and Bioengineering Centre 'Don C Gnocchi' Foundation ONLUS IRCCS, Milano, Italy. METHODS: A single patient (lesion level T5-T6) was trained specifically for each walking system and was evaluated after each training period. The effects of FES on muscle conditioning, spasticity and bone density were also evaluated. The HR/VO2 relationship and the energy cost of locomotion were measured during wheelchair (WHCH) use, during locomotion with ARGO (with and without FES) and Parastep system at different speeds. RESULTS: The following was observed at the end of the whole training: (a) circumferences of both lower limbs and quadriceps forces were increased, whereas fatigue index was slightly decreased, spasticity and bone density were unchanged; (b) compared to WHCH locomotion, the slope of HR/VO2 curves with ARGO was higher (slope difference=51.1 b 1O2(-1)), with ARGO+FES was similar (slope difference=-5.3 b 1O2(-1)) and with Parastep was smaller (slope difference=-55.6 b 1O2(-1)); (c) HR increased linearly with all locomotion systems, but did not rise above 125 bpm with Parastep; (d) the cost of locomotion was higher with Parastep than with ARGO (with and without FES), tested at each velocity; (e) Parastep appears to be easier to use for the subject. CONCLUSIONS: (a) FES can improve ambulation with orthosis, but the cost of locomotion remains very high; (b) the Parastep assisted gait elicits a higher energy expenditure than other orthoses, probably due to the lower speed of locomotion and to the high isometric effort of the stimulated muscles. SPONSORSHIP: This work has been partially supported by the Italian Minister of Public Health (Ricerca Finalizzata IRCCS no ICS030.7/RF97.25). Centro di Bioingegneria, Fondazione Don C Gnocchi ONLUS IRCCS-Politecnico di Milano, Milano, Italy.

  4. #4
    If you had to make a choice between the Parastep and a FES bike, which would you choose and why?

  5. #5
    Has anyone out there used the parastep?

  6. #6
    Gosh,
    The parastep has been around for 20 years...out of all the people on this forum, evidently no one has ever tried it. That is quite a statement for the medical community in the United States.

  7. #7
    rednecK "out of all the people on this forum evidently noone has ever tried it".

    Wrong.

    I have tried it (and so have others), used it and discussed it probably 5-10 times here on CC in the past 2 1/2yrs.


    Frankly, I REALLY wish that members would try, just try and use the FIND function once in a while because most likely out of the 45,000 topics we've discussed its been asked, answered, and archived many times.

    My aplogies for the rant but hopefully you can understand the issue of duplicate topics/answers and the energy involved in repeating oneself.


    davidh, Please be more specific than just saying "share your thoughts". What information are you looking for?

  8. #8
    I am currently training at Sci-Step and they just purchased the Parastep. Two trainers will be attending training on it next week in Florida and then I will begin using it. I will keep you updated on my progress!!

  9. #9
    A recent study on Parastep:

    • Spadone R, Merati G, Bertocchi E, Mevio E, Veicsteinas A, Pedotti A and Ferrarin M (2003). Energy consumption of locomotion with orthosis versus Parastep-assisted gait: a single case study. Spinal Cord 41:97-104. Summary: STUDY DESIGN: Single case study. OBJECTIVES: To evaluate the energy expenditure during ambulation with the Advanced Reciprocating Gait Orthosis (ARGO), with and without functional electrical stimulation (FES), and with the Parastep system in a single subject, in order to avoid the effect of inter-subject variability. SETTING: The Centre of Sport Medicine and Bioengineering Centre 'Don C Gnocchi' Foundation ONLUS IRCCS, Milano, Italy. METHODS: A single patient (lesion level T5-T6) was trained specifically for each walking system and was evaluated after each training period. The effects of FES on muscle conditioning, spasticity and bone density were also evaluated. The HR/VO2 relationship and the energy cost of locomotion were measured during wheelchair (WHCH) use, during locomotion with ARGO (with and without FES) and Parastep system at different speeds. RESULTS: The following was observed at the end of the whole training: (a) circumferences of both lower limbs and quadriceps forces were increased, whereas fatigue index was slightly decreased, spasticity and bone density were unchanged; (b) compared to WHCH locomotion, the slope of HR/VO2 curves with ARGO was higher (slope difference=51.1 b 1O2(-1)), with ARGO+FES was similar (slope difference=-5.3 b 1O2(-1)) and with Parastep was smaller (slope difference=-55.6 b 1O2(-1)); (c) HR increased linearly with all locomotion systems, but did not rise above 125 bpm with Parastep; (d) the cost of locomotion was higher with Parastep than with ARGO (with and without FES), tested at each velocity; (e) Parastep appears to be easier to use for the subject. CONCLUSIONS: (a) FES can improve ambulation with orthosis, but the cost of locomotion remains very high; (b) the Parastep assisted gait elicits a higher energy expenditure than other orthoses, probably due to the lower speed of locomotion and to the high isometric effort of the stimulated muscles. SPONSORSHIP: This work has been partially supported by the Italian Minister of Public Health (Ricerca Finalizzata IRCCS no ICS030.7/RF97.25). Centro di Bioingegneria, Fondazione Don C Gnocchi ONLUS IRCCS-Politecnico di Milano, Milano, Italy.

  10. #10
    Phebus,
    I did use the FIND function, and this is what I found. You have used the Parastep...this is the third time you've said so. I can't find any report of your experiences and opinion of the functionality of it's use. There are many generalized statements about it...but I found only one person who commented on walking with the Parastep. The sum of that report was that they could walk 50 meters. I also saw where another member asked a very similar question to the one I and davidh asked, well over a year ago. It never was answered either. I'll ask again...is there anyone on this forum who has used the Parastep and is willing to share their experience? Please tell me is it functional for everyday life tasks, or is it just a therapy tool to be used once a day?
    And even if it is only feasible to use it for a therapy tool, is it easy to use? Just give me the details please.

    Princessanne,
    Thanks for your reply. I will look forward to hearing about your experience with the Parastep. Please be as specific as you can.

    Dr. Young,
    I appreciate your input.

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