Myo Plus Occupational Therapy Training Please note….. The MyoPlus initial system set-up should be done in conjunction with the attending Certified Prosthetist. For further details on this process, please see our online training course @ https://shop.ottobock.us/Online-Training It is recommended that the evaluation video be viewed prior to taking this therapy course: https://www.youtube.com/watch?v=gwtLVLShOpU&list=PLpvGLdlXdCU0Es_No CFSlTxb6V2r8IvEq&index=2 There are also helpful documents found under the Resources tab in the upper right hand corner, including the MyoPlus Therapy Brochure and Quick Guide. | © Otto Bock HealthCare Myo Plus Fitting Process… • Introduction • Features & Benefits • Componentry • MyoPlus App • Fitting Process • Therapy Protocol 1. Controls Training 2. Repetitive Drills 3. ADLs • Outcome Measures 3 | © Otto Bock HealthCare OT Myoelectric Rehabilitation General Program 3 2 PROSTHETIC TRAINING 1 MUSCLE SITE 1. Controls CONTROL 2. Repetitive Drills PRE-PROSTHETIC 1. Standard 2-site 3. ADLs TRAINING 2. Pattern Recognition *Specific to TD & control method 1. Post-op 2. Pre-prosthetic Atkins, DJ. Functional Skills Training with Body-Powered and Externally Powered Prostheses. In: Atkins DJ, Meier RH (eds), Functional Restoration of Adults and Children with Upper Extremity Amputation. 2004 | © Otto Bock HealthCare Myoelectric Control Previous Limitations… SITE 1 SITE 2 Modal Control | © Otto Bock HealthCare 5 Myoelectric Control Why is advanced control necessary? • OPEN/CLOSE • OPEN/CLOSE • OPEN/CLOSE • PRONATE/SUPINATE • PRONATE/SUPINATE • PRONATE/SUPINATE • OPPOSITION/LATERAL • 8 PROGRAMMED GRIPS | © Otto Bock HealthCare 6 Myo Plus Introduction • To gain full potential of the multiarticulating bebionic hand • To operate a hand and wrist rotator more naturally | © Otto Bock HealthCare 7 Myo Plus 4 5 How it works 3 6 2 7 Myo Plus Control 1 8 | © Otto Bock HealthCare 8 https://www.youtube.com/watch?v=B8Z_2tMUeiw&list=PLpvGLdlXdCU0Es_NoCFSlTxb6V2r8IvEq&index=1 Myo Plus Fitting Process… • Introduction • Features & Benefits • Componentry • MyoPlus App • Fitting Process • Therapy Protocol 1. Controls Training 2. Repetitive Drills 3. ADLs • Outcome Measures 9 | © Otto Bock HealthCare Myo Plus Advantages • Recording of the movement patterns is done through a simple process via the Ottobock MyoPlus app • Each movement of the prosthesis is assigned a pattern established by a unique movement of the phantom hand and stored in the prosthesis • The user determines which thoughts will control the prosthesis Myo Plus – Introduction | Academy | 06.01.2020| © Otto Bock HealthCare 10 Myo Plus User Benefits • Customization of patterns by the user makes for intuitive control • Direct selection of movements; no switching between grips or wrist rotation • More precise proportional control of prosthetic functions • New prosthetic movements can bed added via the easy-to-follow app • Settings, feedback and training can also be accessed through the app • Prosthesis control adjusts accordingly to the connected terminal device | © Otto Bock HealthCare 11 Myo Plus Clinical Application Myo Plus is recommended for…. • New or existing prosthetic users who can produce EMG signals • Transradial & transcarpal amputation levels (minimum requirement = 4 cm) • Traumatic or congenital etiology • Unilateral or bilateral amputations • Difficulty with myo-signal separation • Weak or unbalanced signals • Standard 2-site control has failed • Mode switching challenges • Desired fast & intuitive control | © Otto Bock HealthCare 12 Myo Plus Contraindications Currently, Myo Plus is not available for users with these amputation levels… • Transhumeral • Partial hand • Shoulder disarticulation Patients who are not able to generate patterns that are unique enough to be separable from each other will not be successful with this system | © Otto Bock HealthCare 13 Myo Plus Handling & Risks User Information: • Must not be used for the operation of motor vehicles • Must not be used for the operation of heavy equipment • Do not handle firearms while using the product • Keep system free of solid particles or liquids • Switch off the prosthesis when changing the terminal device • This product was developed for everyday use and must not be used for unusual activities such as extreme sports (free climbing, paragliding, etc.) | © Otto Bock HealthCare 14 Myo Plus Fitting Process… • Introduction • Features & Benefits • Componentry • MyoPlus App • Fitting Process • Therapy Protocol 1. Controls Training 2. Repetitive Drills 3. ADLs • Outcome Measures 15 | © Otto Bock HealthCare Myo Plus Componentry Overview Myo Energy Integral 757B35=5 Myo Plus TR 13E520 Myo Plus App 560X18-* Dome covers 13Z166 Electrode dome Myo cuff 757M20=* 13Z161, 13Z162, 13Z163 Remote electrodes 13E401=* Electrode positioning gauge 623F50 13E400=*/ | © Otto Bock HealthCare 16 Myo Plus Components For testing and training, the following is required: • Healthy muscles in the residual limb • Cognitive understanding of the new control system • A Myo cuff or prosthetic socket with Myo Plus components • A smartphone or tablet with the associated Myo Plus App Myo Plus App 560X18-* Myo cuff 757M20=* | © Otto Bock HealthCare 17 Myo Plus Compatibility Myo Plus bebionic Hand MyoBock https://shop.ottobock.us/Online-Training | © Otto Bock HealthCare 18 Myo Plus Fitting Process… • Introduction • Features & Benefits • Componentry • MyoPlus App • Fitting Process • Therapy Protocol 1. Controls Training 2. Repetitive Drills 3. ADLs • Outcome Measures 19 | © Otto Bock HealthCare Myo Plus Myo Plus App The Myo Plus App is the central adjustment software to: check system functionality evaluate movement patterns record data for prosthetic control train and improve movement patterns adjust speed and advanced settings disable selective movements in specific situations available for download from the Google Play Store or the Apple App Store | © Otto Bock HealthCare 20 Myo Plus Myo Plus App My Myo Plus Spiderplot/training Add pattern Prosthesis movements Movement quality Manual Control Myo Cuff Basic Set Settings Bluetooth Connections Clinician Mode Login General Imprint/information | © Otto Bock HealthCare Myo Plus Myo Plus App User Access: Practitioner Access: • Spiderplot/training Everything patient can access, plus: • Adding patterns (calibration) • The ability to create a test set • Prosthesis movements • Ability to create basic set • Movement quality • Delete all patterns • Manual control of prosthesis • Reset to factory setting Settings: • Speed of open/close and rotation • Accuracy of pattern recognition • Interference suppression • Threshold value • Reset to basic set | © Otto Bock HealthCare 22 Myo Plus Myo Plus App Compatible operating systems and devices • Apple iPhone 5, iPhone 6 Plus, iPhone 6s, iPhone 7, iPhone 8 Plus, iPhone X, iPod • Touch Generation 5, iPod Touch Generation 6 • Samsung Galaxy S5, Galaxy S7 Edge, Galaxy S8, Galaxy Note 3, Galaxy A3 (2016), Galaxy A3 (2017), Galaxy Tab A, Galaxy Tab S • Sony Xperia Z, Xperia Z1 • Xiaomi Mi A1, Redmi Note 3 • Acer Iconia One • Amazon Fire 10 • Blackberry Keyone • Google Nexus 6, Pixel • Huawei P9 Lite, P10 • LG Optimus G4, Optimus V30 • Motorola Moto X, Moto G3, Moto G5 Plus • One Plus 5T | © Otto Bock HealthCare 23 Myo Plus Fitting Process… • Introduction • Features & Benefits • Componentry • MyoPlus App • Fitting Process • Therapy Protocol 1. Controls Training 2. Repetitive Drills 3. ADLs • Outcome Measures 24 | © Otto Bock HealthCare Myo Plus Fitting Process… | © Otto Bock HealthCare Myo Plus Fitting Process 1. Initial Session • Needs to be done in conjunction with the attending Certified Prosthetist who has taken the Myo Plus Qualification course • Residual limb assessment: - Length - Strength - ROM - Sensation/Nerve condition - Skin condition - Discover if phantom sensation is present * Other considerations: • Prosthetic history • Hand dominance • Environment • Goals & daily activities • Gadget tolerance | © Otto Bock HealthCare Myo Plus Fitting Process 2. Evaluating Phantom Sensation Differentiated movements of the phantom hand ... • facilitate training with Myo Plus • enable an intuitive prosthesis control • increases the range of possible movement patterns | © Otto Bock HealthCare 27 Myo Plus Fitting Process 2. Evaluating Phantom Sensation • Mirror therapy can assist in pattern development • Always focus vision on the mirror, not the sound side • Start with 4 basic motions: hand open/close and palm up/down • Look at each position for 10 seconds • Next introduce motions/patterns (see next 3 slides for details) Mirror Therapy • Most effective for 2 weeks, 8-10 sessions per day • Monitor for grimacing/nausea; may need to revert to visualization Stralka, Susan, PT, DPT, MS: Mirror Mirror on the Wall: Motor Imagery Program, 2015 [Online | © Otto Bock HealthCare Course] Retrieved from https://myaota.aota.org/shop_aota/product/OL4911 Myo Plus Movement Patterns | © Otto Bock HealthCare Myo Plus Movement Patterns | © Otto Bock HealthCare 30 Myo Plus Movement Patterns | © Otto Bock HealthCare 31 Myo Plus Fitting Process 2. Evaluating Phantom Sensation • For existing myo-users, it´s recommended to use the same phantom hand movement for hand open and hand close, which is already used in the current fitting • For new myo-users, it´s recommended to use the physiological movement for hand open and hand close • For existing and new myo-users it´s recommended to use the physiological movement for wrist rotation (pronate and supinate) • For new users, phantom