FES bikes

[SCI-Nurse]

This discussion was getting buried in the discussion about top rehab centers. Let's continue it here:

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Carl R
Member posted October 23, 2001 02:40 PM
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I first had to find a bike and get evaluated to see if my muscles would respond. HealthSouth rehabilitation has a ERGY. I call them first and have them fax over a prescription to Dr. Donovan. He signed off on twice a week for eight weeks. After the evaluation, I had the physical therapist fax him a prescription for the bike. He signed off on it as well. The problem is, my insurance will not pay for it as it is " investigational ". I am going through the process now of trying to appeal the decision with my insurance. I talked to Dr. Donovan at my 6 month checkup first and had given him a a few trial that had been done at the Cleveland FES clinic. I told him that I felt the bike could help with cardiovascular and strengthened my lungs enough to get rid of my trach.
You might call HealthSouth and see if they can send over a prescription for evaluation. They are located on the north side of Houston on Red Oak Drive. It's the only bike I could find in Houston.

Posts: 110 | From: Houston, Tx. USA | Registered: July 24, 2001
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martha
Member posted October 22, 2001 08:15 PM
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Carl R,
How did you talk Donovan into the rx for the FES bike? He's the one that told me he didn't agree with it's benefits and thought it would give false hope to those seeing their muscles reacting. When I mentioned its possible cardiovascular benefits, his response was "you can get a precious good cardiovascular workout pushing a wheelchair"!!! Unfortunately my husband's shoulders are already "going" after only a few months of his type of workout. Any insight on how to get through to the 'good doctor' would be greatly appreciated!
martha

Posts: 65 | From: Galveston, TX | Registered: July 24, 2001
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Carl R
Member posted October 22, 2001 02:48 PM
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I agree with the others,TIRR leaves a lot to be desired. I have yet to talk to a patient who has been there and come away with a positive feeling. The nurses and aides are not trained very well and are usually over worked. Most of the help are underpaid as well, and have not been there very long. The good ones stay few months and then move on to better paying jobs. I believe TIRR is rated highly because of Dr. William Donovan and Dr. Parsons. They seem to be very well respected, although personally I feel they are way too conservative. I have to give credit that they have slowly change their attitudes somewhat over the last three years. Dr. Donovan has written me prescriptions for FES bike and neuromuscular improvement program at another hospital (HealthSouth rehabilitation), even after he has told me that there really has not been enough information to prove the results of either.
As my dad said " if TIRR is the best, he would hate to see the worst. "

Posts: 110 | From: Houston, Tx. USA | Registered: July 24, 2001
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[Curt Leatherbee]

That so many Doctors are so naive. The Body needs excercise, not just the upper body, but the whole body. In my opinion, to heck with the Doctors. Buy the unit, if you Can't afford it, have a fund raiser through a local organization, it is a good cause. It almost seems like this is one of those things where you have to take the bull by the horns and do it yourself, the medical community generally is of little use in this area. Either they have no idea what FES is all about or they figure since one is relegated to a wheelchair, they might as well remain there. Curtis

"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

[SCI-Nurse]

Martha and Carl - If someone tells you that the FES ergometer is 'investigational', they are totally incorrect! Computerized Functional Electrical Stimulation (CFES) using a stationary ergometer is both FDA (Food and Drug Administration) and HCFA (Health Care Financing Administration) approved as medically necessary devices. There are numerous published articles re: CFES research that attest to the benefits of this technology. Included in these is a year long study done with persons who were from 3 years to 20 years post-injury at the time of entering the study. This was done by Mohr el al in Copenhagen and published in Jan 1997. You can find this article at http://www.musclepower.com/Publish.htm

As the SCI population ages, i.e. living longer with SCI, there is great concern about the wear and tear on the shoulder and its supporting structures, from the effects of long term use, doing excessive and continuous work, that it was not designed to do. The muscle function of the arm muscles cannot compare with the outcomes and beneficial effects of active contraction (through CFES) of the large muscles of the legs. CFES is currently the only medical technology available that provides active muscle function below the level of the injury.

At numerous SCI conferences, I have heard Dr. Barth Green, of the Miami Project, talk about the importance of SCI persons participating in CFES.
If you have a doctor who is unwilling to support your request to participate in or at least be evaluated for this technology, I would urge you to seek a second opinion from someone who is supportive of this technology.

My ten year experience coordinating a community- based CFES program, repeatedly demonstrated the important benefits of this therapy. My patients were free of illness and pressure sores, had significant reduction in spasticity, URI's and UTI's; many were able to return to school and/or work, felt energized and able to better cope with the challenges of daily living. CRF

[SCI-Nurse]

Many insurance companies will reimburse for this device. If you are having problems with this issue, I would encourage you to contact the manufacturers of the ERGYS 2 (Therapeutic Alliances, Inc.) www.musclepower.com as they will assist with the appeal process. There are several important steps or elements to include when appealing a denial for reimbursement.

An appeal should include: 1)a Certificate of Medical Necessity, that attests to your permanent disability, life time need for an ergometer, medical necessity for use (you need to be very specific with this information) 2) Published research and other supporting documents 3) Insurance terminology - that is medical in nature, addresses the long term continuous rehabilitation needs and benefits; You must not use words that refer to a maintenance type of therapy or program. For an outline of the steps of an appeal go to www.patientadvocate.org but I would very strongly urge you to have some professional assistance in this process.

Curtis's suggestion for a fundraiser to acquire an ergometer is a great idea. Contact NSCIA at email: nscia2@aol.com or 1-800-962-9629 for guidance in this process. TAI at www.musclepower.com also maintains a list of used ERGYS that are for sale and will help you determine whether one is in good working condition, make recommendations about upgrading the software or necessary maintenance. They are a most consumer-oriented company and eager to assist you. CRF

[musik0102]

I began the process of getting a FES bike for my boyfriend 2 months ago. Insurance has not denied the claim as of yet but they are taking their time with the process. We are working with a company out of Beavercreek Oh (the name of the co escapes me at this moment) and they have been very helpful with getting the right paperwork to the right people ect. I will update you all as this progresses......