Guest guest Posted March 18, 2008 Report Share Posted March 18, 2008 It has been quite awhile since I have had a chance to write in...I would like to share some things Ihave been learning since I last wrote...Through our holistic approach we have discovered that our entire family, especially our daughter with the delays, have been " encoded " by all of the lights, electronic security systems, etc that is society today. All of our cells and organs have had little blockages put up in our system from these devices which have been contributing to a lot of the health issues going on. Since we have been unecoded, things are improving, our daughter has gotten stronger and is more active, her organs are functioning better and she is absorbing more nutrients and putting on weight...her calcium levels which had been way to high since birth are now back within the normal limits (just this last month), and she is even standing on her feet again and we are working with her to start moving her feet towards being able to walk (she is 25months old)She is even making more sounds than she has ever made and her apraxia speech therapist said it should only be a matter of time for her to start using words becuase she is mimicing mouth movements but now she has to put the sound and the movement together. Another thing I have found out is that there is a device for kids with hypotonia, delayed skills, speech included, called Suit therapy that can help the kids overcome the delays. It isn't guaranteed for everyone but it has shown great improvement for a lot of kids. If you do a search for suit therapy, there is a place in FL and MI that have centers that will train the parents so you can do home therapy or you can go to the centers for intense 3-5wks of therapy...we are having our daughter try the suit come May to see if it will take her to the next level, they feel she is a very good candidate. We originally called MI and spoke with the people there, filled out the paperwork and then they called us to let us know whether or not she would be considered a candidate...Our regular doctors knew nothing of this method but will be learning through our experience...Fair warning it is pricey but we are getting state monies to help supplement the payments...The last thing we have found out is that our entire family has had issues with parasites in our systems that have also been interferring with our abilities to get " better " , so much to the point that sleep patterns have been goofey, and we have been passing them back and forth from just drinking from each others glasses etc...Now that our systems are cleaned out, we are all doing better. My husband is actually having his diabetic medications reduced so that he doesn't have to take as many...Food for thought if you seem to be getting no where with the traditional medical professionals...try the holistic approach and find a good kinesthesilogist and check out Premier Labs...they have talk show educational times on the radio and staff on the phone that are great at answering questions...Hang in there everyone and fight for what your gut tells you too...you know your families the best! Debbie & Cadyn Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2008 Report Share Posted March 18, 2008 Hi Debbie! When you first joined 8 months ago you wrote about your 17 month old having trouble sitting up due to her hypotonia. Lightbulbs aside - how is she today in regards to her motor skills and speech? Most of us here do follow some type of holistic approach to health - but don't know if many go to the extremes you are exploring which is why most of the messages you have written get few if any responses here. Like when you posted about applied kinesiology -most here don't practice that either -and actually there are studies in the US and Germany that say that method is no better than guessing. I don't know much about encoding -but even if that was an issue -how do you keep your child and family " normal " if you leave your home? What type of parasites did your entire family have? (what type of doctor diagnosed this if it was a medical doctor?) (is it contagious?) And Suit therapy -here's Cigna Healthcare's report on why they won't cover it for any condition: Page 1 of 6 Coverage Position Number: 0353 CIGNA HEALTHCARE COVERAGE POSITION Subject Suit Therapy Revised Date ............................. 5/15/2007 Original Effective Date ............. 5/15/2005 Coverage Position Number ............. 0353 Table of Contents Coverage Position............................................... 1 General Background ........................................... 1 Coding/Billing Information ................................... 4 References.......................................................... 4 Hyperlink to Related Coverage Positions Botulinum Toxin Type A (Botox® A) Gait Analysis Neurosurgical Treatment of Spasticity Physical Therapy INSTRUCTIONS FOR USE Coverage Positions are intended to supplement certain standard CIGNA HealthCare benefit plans. Please note, the terms of a participant's particular benefit plan document [Group Service Agreement (GSA), Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these Coverage Positions are based. For example, a participant's benefit plan document may contain a specific exclusion related to a topic addressed in a Coverage Position. In the event of a conflict, a participant's benefit plan document always supercedes the information in the Coverage Positions. In the absence of a controlling federal or state coverage mandate, benefits are ultimately determined by the terms of the applicable benefit plan document. Coverage determinations in each specific instance require consideration of 1) the terms of the applicable group benefit plan document in effect on the date of service; 2) any applicable laws/regulations; 3) any relevant collateral source materials including Coverage Positions and; 4) the specific facts of the particular situation. Coverage Positions relate exclusively to the administration of health benefit plans. Coverage Positions are not recommendations for treatment and should never be used as treatment guidelines. ©2007 CIGNA Health Corporation Coverage Position CIGNA HealthCare does not cover suit therapy for the treatment of any condition including, but not limited to, cerebral palsy or other neuromuscular conditions, because it is considered experimental, investigational or unproven. General Background Cerebral palsy is a term used to describe a group of chronic disorders that impair the control of movement and that appear in the first few years of life. It is not progressive. Cerebral palsy is classified according to the type of movement disorder and which limb or limbs are affected. The four broad categories include (Rudolph, 2003; National Institute of Neurological Disorders and Stroke [NINDS], 2006): • Spastic: In this form, the patient exhibits upper motor neuron signs, such as weakness, hypertonicity, hyperreflexia, clonus, pathologic reflexes and a tendency to contractures. This type affects 70–80% of patients with cerebral palsy and is further classified as to the limb impairment and includes: & #56256; & #56510; quadriplegia, the symmetric impairment of all four extremities & #56256; & #56510; diplegia, in which the bilateral spasticity of the legs is greater than that of the arms & #56256; & #56510; monoplegia, a rare type in which only one limb is involved & #56256; & #56510; paraplegia, involving only the lower extremities & #56256; & #56510; triplegia, a rare type, with only one unaffected limb Page 2 of 6 Coverage Position Number: 0353 • Athetoid, or dyskinetic: This form includes uncontrolled, slow, writhing movements. These movements may affect the hands, feet, arms or legs and, in some cases, the face and tongue, which may also affect speech, causing dysarthria. • Ataxic: This is a rare form, affecting the sense of balance and depth perception. • Mixed forms: It is common for patients to have symptoms of more than one of the three previous forms. The most common mixed form includes spasticity and athetoid movements. Patients may also experience impairments beyond the neuromuscular involvement, such as mental impairment, seizures, visual and auditory dysfunction, growth problems, and abnormal sensation and perception. The orthopedic difficulties encountered in children with cerebral palsy are frequently a result of high muscle tone, spasticity, and rigidity that prevent normal growth of muscle and cause contractures. Treatment of functional deficits associated with cerebral palsy usually applies a multidisciplinary approach and may include physicians of various specialties, occupational therapists, physical therapists, speech pathologists, social workers, and developmental psychologists. The treatment plan may include physical therapy, surgery, drug therapy, and/or mechanical aids and is tailored to the unique needs and impairments of each patient. The therapy is focused on decreasing the degree of impairment (e.g., muscle spasticity) and increasing participation in activities of daily living. Therapists in the disciplines of physiotherapy, occupational therapy, and speech therapy utilize physical and behavioral approaches aimed at lengthening contracted muscles, improving the strength of weakened muscles, increasing the range of motion at restricted joints, improving movement coordination, and developing compensatory strategies to accomplish tasks (United Cerebral Palsy [uCP], 2003). Suit therapy has been proposed as an alternative to conventional physiotherapy to treat the impairments associated with cerebral palsy. This therapy is based on a suit originally designed by the Russians for use by cosmonauts in space to minimize the effects of weightlessness. The idea is to move body parts against a resistance, thus improving muscle strength. Through placement of the elastic cords, selected muscle groups can be exercised as the patient moves limbs; thus, suit therapy is a form of controlled exercise against a resistance. It is also claimed that the suit improves coordination. The suit consists of a cap, a vest, shorts, knee pads, and shoes. An attached series of elastic cords provides compression to the body's joints and resistance to muscles when movement occurs. Suit therapy is often used as part of a comprehensive program of intensive physiotherapy of 5–7 hours a day for four weeks (UCP, 1999). The therapy suit is also known as the Adeli® suit (Ayurveda JS Co., Moscow, Russia), the TheraSuit™ (Therasuit LLC, Keego Harbor, MI), the NeuroSuit (Neurosuit LLC, Hiram, GA) and the Penguin suit. Suit therapy first started in clinics in Europe in the early 1990s. Currently, suit therapy is rendered at many physical therapy centers in the United States. Suit therapy has been proposed primarily as a treatment for cerebral palsy, but the manufacturer of the TheraSuit also recommends the treatment for other neuromuscular disorders, including developmental delays, traumatic brain injury, post-stroke, ataxia, athetosis, spasticity, and hypotonia. The manufacturer of the TheraSuit proposes that suit therapy will provide the following benefits: • retrain central nervous system • restore ontogenic development • provide external stabilization • normalize muscle tone • align the body to as close to normal • provide dynamic correction • normalize gait pattern • provide tactile stimulation • influence the vestibular system • improve balance • improve coordination • decrease uncontrolled movements in ataxia and athetosis • improve body and spatial awareness • support weak muscles • provide resistance to strong muscles to further enhance strengthening Page 3 of 6 Coverage Position Number: 0353 • improve speech production and fluency through head control and trunk support • promote development of both fine and gross motor skills • improve bone density • help decrease contractures • help improve hip alignment through vertical loading over hip joint U.S. Food and Drug Administration (FDA) The U.S. Food and Drug Administration (FDA) classifies the Adeli therapy suit and similar devices (e.g., therapy suit, Penguin suit, TheraSuit, NeuroSuit) as Class I limb braces or orthosis. Literature Review There are no published studies indicating which subset of patients may benefit from these devices or how long the results might last. In addition, there are no studies that demonstrate the relative safety and effectiveness of suit therapy compared to conventional physiotherapy treatment for the treatment of cerebral palsy. Bar-Haim et al. (2006) conducted a study to compare the efficacy of Adeli suit treatment (AST) with neurodevelopmental treatment (NDT) in children with cerebral palsy. Twenty-four children with cerebral palsy were matched by age and functional status and randomly assigned to the AST or NDT treatment groups. In the AST group (n=12) six children had spastic/ataxic diplegia, one triplegia and five had spastic/mixed quadriplegia. In the NDT group (n=12) five children had spastic diplegia and seven had spastic/mixed quadriplegia. Treatment was for two hours daily, five days per week over four weeks for a total of 20 sessions. Outcome measurements included the Gross Motor Function Measure (GMFM-66) and the mechanical efficiency index (EIHB). These were measured during stair-climbing, at baseline, immediately after one month of treatment, and 10 months after baseline. There was an increase in both the GMFM-66 and EIHB noted at one month for both intensive physiotherapy courses. This increase appeared to be greater than expected from natural maturation of children with cerebral palsy at this age. It was noted that the improvements in motor skills and their retention nine months after treatment were not significantly different between the two treatment modes. A post hoc analysis indicated a greater increase in EIHB after one month and 10 months in the AST group than that in the NDT group. This was noted to be more predominant in the children with higher motor function. The authors conclude that " The results suggest that AST might improve mechanical efficiency without a corresponding gain in gross motor skills, especially in children with higher levels of motor function. " The authors note that, " Future studies on the efficacy of AST should measure changes in metabolic efficiency and fitness level, as well as motor skills. It is also important to determine changes induced by the suit itself, by having two groups perform the same physical training, with and without the suit. Future studies should increase the number of participants and homogenize the participants with CP [cerebral palsy] to reduce variability. " Liptak (2005) conducted a review of nine complementary and alternative therapies for cerebral palsy. Regarding the use of the Adeli suit, the review noted that " no published evidence from a controlled trial is available in English to support or reject the use of the suit. Thus, no conclusive evidence either in support of or against the use of the Adeli suit is available. " The United Cerebral Palsy (UCP) Research and Education Foundation has published two research fact sheets on the Adeli suit. The first was published in March 1999, at which time suit therapy was only provided at facilities in Poland. Due to interest in suit therapy, the November 2004 UCP fact sheet reported on two studies funded by the UCP Research and Educational Foundation. The first study noted in the UCP research fact sheet was conducted by Dr. in Israel. The study involved 24 children between ages six and 12 years with cerebral palsy. The patients were randomly assigned either to a standard physical therapy program or to the Adeli suit using the original Russian protocol. Both groups were treated with a two-hour session, five days a week. Evaluation of a number of parameters showed marginal improvement in both groups that persisted over the following year. There was no statistical difference between the children who used the Adeli suit and those who did not (UCP, 2004). Page 4 of 6 Coverage Position Number: 0353 The second study noted in the fact sheet was conducted by Dr. Dabrowski at the Children's Hospital of Michigan. This study involved 57 children who were randomized to control and treatment groups. All children received one hour each of physical, occupational and speech therapy three times a week for 8–10 weeks, followed by a four-week home program. The experimental group wore the Adeli suit for the last four weeks of their therapy program. It was noted that both groups improved and sustained the improvement but without any statistical difference between the two groups (UCP, 2004). The UCP research fact sheet concluded that these studies show that a period of intensive therapy in ambulatory children with cerebral palsy can lead to improvement in a number of disabilities. However, they did not demonstrate that the use of the Adeli suit was helpful, and they reported that any effect is likely to be minor. Summary There is insufficient evidence in the published, peer-reviewed scientific literature to establish the safety and effectiveness of suit therapy for the treatment of functional impairments associated with cerebral palsy or other neuromuscular disorders. Well-designed clinical trials are needed to demonstrate that this treatment is as effective as conventional physiotherapy in the treatment of cerebral palsy or other neuromuscular disorders, that it improves patients' functional abilities and activities of daily living, and that it decreases impairment. Coding/Billing Information Note: This list of codes may not be all-inclusive. Experimental/Investigational/Unproven/Not Covered: CPT* Codes Description 97139 Unlisted therapeutic procedure (specify)† HCPCS Codes Description No specific codes ICD-9-CM Diagnosis Codes Description 343.0-343.9 Infantile cerebral palsy Multiple/varied †Note: Experimental/investigational/unproven and not covered when used to report Suit Therapy for the treatment of any condition, including but not limited to cerebral palsy or other neuromuscular conditions *Current Procedural Terminology (CPT®) ©2006 American Medical Association: Chicago, IL. References 1. Adeli Project [information on the Adeli approach]. Ayurveda JS Co. Accessed March 26, 2007. Available at URL address: http://www.adeli-suit.com/English/index.htm 2. Adeli Suit [product information]. Euromed. Accessed March 26, 2007. Available at URL address: http://www.euromed.pl/en/index.php?ppg=adeli_suit:suit Page 5 of 6 Coverage Position Number: 0353 3. Ashwal S, Russman BS, Blasco PA, G, Sandler A, Shevell M, son R; Quality Standards Subcommittee of the American Academy of Neurology; Practice Committee of the Child Neurology Society. Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2004 Mar 23;62(6):851-63. 4. Bar-Haim S, Harries N, Belokopytov M, A, Copeliovitch L, Kaplanski J, Lahat E. Comparison of efficacy of Adeli suit and neurodevelopmental treatments in children with cerebral palsy. Dev Med Child Neurol. 2006 May;48(5):325-30. 5. Behrman RE, Kliegman RM, Jenson HB, editors. textbook of pediatrics. 17th ed. Philadelphia, PA: W.B. Saunders Company; 2004. p. 2024-5. 6. Canale T, editor. 's operative orthopaedics. 10th ed. St. Louis, MO: Mosby, Inc.; 2003. p. 1218-23. 7. DeLuca PA. The musculoskeletal management of children with cerebral palsy. Pediatr Clin North Am. 1996 Oct;43(5):1135-50. 8. U.S. Food and Drug Administration (FDA). Code of federal regulations; title 21, vol. 8; subchapter H (medical devices); part 890 (physical medicine devices); subpart D (physical medicine prosthetic devices); sec. 890.3475]. Limb orthosis. Revised 2004 Apr 1. Accessed March 26, 2007. Available at URL address: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/search/search.cfm? db=CFR & id=890.3475 9. Goldstein M. The treatment of cerebral palsy: what we know, what we don't know. J Pediatr. 2004 Aug;145(2 Suppl):S42-6. 10. Hurvitz EA, Leonard C, Ayyangar R, VS. Complementary and alternative medicine use in families of children with cerebral palsy. Dev Med Child Neurol. 2003 Jun;45(6):364-70. 11. Liptak GS. Complementary and alternative therapies for cerebral palsy. Ment Retard Dev Disabil Res Rev. 2005;11(2):156-63. 12. Michaud LJ; American Academy of Pediatrics Committee on Children With Disabilities. Prescribing therapy services for children with motor disabilities. Pediatrics. 2004 Jun;113(6):1836- 8. 13. NINDS cerebral palsy information page. National Institute of Neurological Disorders and Stroke (NINDS). Bethesda, MD: NINDS, National Institutes of Health (NIH). Last update: January 25, 2006. Accessed March 26, 2007. Available at URL address: http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_pals y.htm 14. NOMC [North Oakland Medical Centers] Euro-Pçds program: SUIT therapy. 2004. Accessed March 26, 2007. Available at URL address: http://www.europeds.org/epp_st.htm 15. Rosenbaum P. Cerebral palsy: what parents and doctors want to know. BMJ. 2003 May 3;326(7396):970-4. 16. Rudolph CD, Rudolph AM, Hostetter MK, Lister GE, Siegel NJ, editors. Rudolph's pediatrics. 21st ed. New York, NY: McGraw-Hill; 2003. Ch. 25. 17. Suit therapy for cerebral palsy [information about the TheraSuit Method™ and the TheraSuit™]. Therasuit LLC. Accessed March 26, 2007. Available at URL address: http://www.suittherapy.com/ 18. United Cerebral Palsy (UCP). The Adeli Suit [research fact sheet: diagnosis/treatment]. Washington, DC: United Cerebral Palsy (UCP) Research & Educational Foundation; 1999 Mar. Page 6 of 6 Coverage Position Number: 0353 Accessed March 26, 2007. Available at URL address: http://www.ucp.org/ucp_generaldoc.cfm/1/4/24/24-6608/82 19. United Cerebral Palsy (UCP). The Adeli Suit Update [research fact sheet]. Washington, DC: United Cerebral Palsy (UCP) Research & Educational Foundation; 2004 Nov. Accessed March 26, 2007. Available at URL address: http://www.ucp.org/ucp_generaldoc.cfm/1/4/24/24-24/5896 20. United Cerebral Palsy (UCP). The Treatment of Cerebral Palsy [research status report]. Washington, DC: United Cerebral Palsy (UCP) Research & Educational Foundation; 2003 Jun. http://www.cigna.com/.../coverage_positions/medical/mm_0353_coveragepo sitioncriteria_suit_therapy.pdf ===== Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 19, 2008 Report Share Posted March 19, 2008 Thank you for the information on the insurance...we are just getting into that end of things now and will see where we end up, although from what I have been told, her state medical card should pick up a chunk of the expenses. The suit will be used in conjunction with all of her regular therapies, it will be used to enhance what they are already doing...The suit method isn't for everyone, the kids do have to " pass " certain medical criteria before it will even be tried as an option... As for Cadyn's sitting, she is doing great and her motor skills are showing greater signs of improvement over the last month or so, but we have been tackling her issues consistantly. I understand that the kinesthesiology approach is controversial, but then again in this country everything that is not considered traditional medicine is questioned...look at the mercury issues for teeth and vaccines...We are not the typical american in that we practice both easterna nd Western medicine to get to the results we are looking for, and with my science background I research everything before we move ahead so that we have a certain level of confidence, if that makes any sense, as I am sure it does based on the discussions i have read here in this group...I believe everyone is doing the same. As for the encoding, we learned about it from Premier Research Labs out of TX and once we were unencoded (they use a special laser light, non invasive) and then we carry a small techtite (spelling?) in our pockets that helps to create a barrier around us that works off the electromagnetic fields within our bodies..it sounds sci fi but it really isn't... As for the types of parasites we have I do not have the names off hand, they are in our files at home, but they found them through testing of the intestinal track and stool and the kids have them because I had them when they were born and of course the eggs continue to go through the life cycles until you get them back under control..Everyone has them, that much I do remember, but in our case they have gotten out of control because of diet etc. One sign my boys showed was a strong craving for sugars....now that theirs are under control the sugar cravings have subsided and they are also sleeping through the night, where as before they were up 2-3 times each night and no one got any sleep. For Cadyn, the parasites were eating the nutrients from her food before she had a chance to fully utilize them herself and now that too has changed and she is gaining weight and her doctors are happy... I realize not many people respond to my posts, which is fine, because I post so that if anything we have experienced can help someone else then that is a great thing...it is just posted as possible options because I know when we joined we were at a standstill and didn't know where else to turn, and after reading posts we started trying things and saw steps moving forward which we can never say thank you enough for.... Debbie & Cadyn > > Hi Debbie! > > When you first joined 8 months ago you wrote about your 17 month old > having trouble sitting up due to her hypotonia. Lightbulbs aside - > how is she today in regards to her motor skills and speech? > > Most of us here do follow some type of holistic approach to health - > but don't know if many go to the extremes you are exploring which is > why most of the messages you have written get few if any responses > here. Like when you posted about applied kinesiology -most here > don't practice that either -and actually there are studies in the US > and Germany that say that method is no better than guessing. > > I don't know much about encoding -but even if that was an issue - how > do you keep your child and family " normal " if you leave your home? > What type of parasites did your entire family have? > (what type of doctor diagnosed this if it was a medical doctor?) > (is it contagious?) > > And Suit therapy -here's Cigna Healthcare's report on why they won't > cover it for any condition: > > Page 1 of 6 > Coverage Position Number: 0353 > CIGNA HEALTHCARE COVERAGE POSITION > Subject Suit Therapy > Revised Date ............................. 5/15/2007 > Original Effective Date ............. 5/15/2005 > Coverage Position Number ............. 0353 > Table of Contents > Coverage Position............................................... 1 > General Background ........................................... 1 > Coding/Billing Information ................................... 4 > References.......................................................... 4 > Hyperlink to Related Coverage Positions > Botulinum Toxin Type A (Botox® A) > Gait Analysis > Neurosurgical Treatment of Spasticity > Physical Therapy > INSTRUCTIONS FOR USE > Coverage Positions are intended to supplement certain standard CIGNA > HealthCare benefit plans. Please note, the terms of a > participant's particular benefit plan document [Group Service > Agreement (GSA), Evidence of Coverage, Certificate of Coverage, > Summary Plan Description (SPD) or similar plan document] may differ > significantly from the standard benefit plans upon which > these Coverage Positions are based. For example, a participant's > benefit plan document may contain a specific exclusion related to > a topic addressed in a Coverage Position. In the event of a conflict, > a participant's benefit plan document always supercedes the > information in the Coverage Positions. In the absence of a > controlling federal or state coverage mandate, benefits are ultimately > determined by the terms of the applicable benefit plan document. > Coverage determinations in each specific instance require > consideration of 1) the terms of the applicable group benefit plan > document in effect on the date of service; 2) any applicable > laws/regulations; 3) any relevant collateral source materials > including Coverage Positions and; 4) the specific facts of the > particular > situation. Coverage Positions relate exclusively to the > administration of health benefit plans. Coverage Positions are not > recommendations for treatment and should never be used as treatment > guidelines. ©2007 CIGNA Health Corporation > Coverage Position > CIGNA HealthCare does not cover suit therapy for the treatment of any > condition including, but > not limited to, cerebral palsy or other neuromuscular conditions, > because it is considered > experimental, investigational or unproven. > General Background > Cerebral palsy is a term used to describe a group of chronic > disorders that impair the control of movement > and that appear in the first few years of life. It is not > progressive. Cerebral palsy is classified according to > the type of movement disorder and which limb or limbs are affected. > The four broad categories include > (Rudolph, 2003; National Institute of Neurological Disorders and > Stroke [NINDS], 2006): > • Spastic: In this form, the patient exhibits upper motor neuron > signs, such as weakness, > hypertonicity, hyperreflexia, clonus, pathologic reflexes and a > tendency to contractures. This type > affects 70–80% of patients with cerebral palsy and is further > classified as to the limb impairment > and includes: > & #56256; & #56510; quadriplegia, the symmetric impairment of all four extremities > & #56256; & #56510; diplegia, in which the bilateral spasticity of the legs is greater > than that of the arms > & #56256; & #56510; monoplegia, a rare type in which only one limb is involved > & #56256; & #56510; paraplegia, involving only the lower extremities > & #56256; & #56510; triplegia, a rare type, with only one unaffected limb > Page 2 of 6 > Coverage Position Number: 0353 > • Athetoid, or dyskinetic: This form includes uncontrolled, slow, > writhing movements. These > movements may affect the hands, feet, arms or legs and, in some > cases, the face and tongue, > which may also affect speech, causing dysarthria. > • Ataxic: This is a rare form, affecting the sense of balance and > depth perception. > • Mixed forms: It is common for patients to have symptoms of more > than one of the three previous > forms. The most common mixed form includes spasticity and athetoid > movements. > Patients may also experience impairments beyond the neuromuscular > involvement, such as mental > impairment, seizures, visual and auditory dysfunction, growth > problems, and abnormal sensation and > perception. The orthopedic difficulties encountered in children with > cerebral palsy are frequently a result > of high muscle tone, spasticity, and rigidity that prevent normal > growth of muscle and cause contractures. > Treatment of functional deficits associated with cerebral palsy > usually applies a multidisciplinary approach > and may include physicians of various specialties, occupational > therapists, physical therapists, speech > pathologists, social workers, and developmental psychologists. The > treatment plan may include physical > therapy, surgery, drug therapy, and/or mechanical aids and is > tailored to the unique needs and > impairments of each patient. The therapy is focused on decreasing the > degree of impairment (e.g., > muscle spasticity) and increasing participation in activities of > daily living. Therapists in the disciplines of > physiotherapy, occupational therapy, and speech therapy utilize > physical and behavioral approaches > aimed at lengthening contracted muscles, improving the strength of > weakened muscles, increasing the > range of motion at restricted joints, improving movement > coordination, and developing compensatory > strategies to accomplish tasks (United Cerebral Palsy [uCP], 2003). > Suit therapy has been proposed as an alternative to conventional > physiotherapy to treat the impairments > associated with cerebral palsy. This therapy is based on a suit > originally designed by the Russians for use > by cosmonauts in space to minimize the effects of weightlessness. The > idea is to move body parts > against a resistance, thus improving muscle strength. Through > placement of the elastic cords, selected > muscle groups can be exercised as the patient moves limbs; thus, suit > therapy is a form of controlled > exercise against a resistance. It is also claimed that the suit > improves coordination. The suit consists of a > cap, a vest, shorts, knee pads, and shoes. An attached series of > elastic cords provides compression to > the body's joints and resistance to muscles when movement occurs. > Suit therapy is often used as part of > a comprehensive program of intensive physiotherapy of 5–7 hours a day > for four weeks (UCP, 1999). > The therapy suit is also known as the Adeli® suit (Ayurveda JS Co., > Moscow, Russia), the TheraSuit™ > (Therasuit LLC, Keego Harbor, MI), the NeuroSuit (Neurosuit LLC, > Hiram, GA) and the Penguin suit. Suit > therapy first started in clinics in Europe in the early 1990s. > Currently, suit therapy is rendered at many > physical therapy centers in the United States. Suit therapy has been > proposed primarily as a treatment for > cerebral palsy, but the manufacturer of the TheraSuit also recommends > the treatment for other > neuromuscular disorders, including developmental delays, traumatic > brain injury, post-stroke, ataxia, > athetosis, spasticity, and hypotonia. > The manufacturer of the TheraSuit proposes that suit therapy will > provide the following benefits: > • retrain central nervous system > • restore ontogenic development > • provide external stabilization > • normalize muscle tone > • align the body to as close to normal > • provide dynamic correction > • normalize gait pattern > • provide tactile stimulation > • influence the vestibular system > • improve balance > • improve coordination > • decrease uncontrolled movements in ataxia and athetosis > • improve body and spatial awareness > • support weak muscles > • provide resistance to strong muscles to further enhance > strengthening > Page 3 of 6 > Coverage Position Number: 0353 > • improve speech production and fluency through head control and > trunk support > • promote development of both fine and gross motor skills > • improve bone density > • help decrease contractures > • help improve hip alignment through vertical loading over hip joint > U.S. Food and Drug Administration (FDA) > The U.S. Food and Drug Administration (FDA) classifies the Adeli > therapy suit and similar devices (e.g., > therapy suit, Penguin suit, TheraSuit, NeuroSuit) as Class I limb > braces or orthosis. > Literature Review > There are no published studies indicating which subset of patients > may benefit from these devices or how > long the results might last. In addition, there are no studies that > demonstrate the relative safety and > effectiveness of suit therapy compared to conventional physiotherapy > treatment for the treatment of > cerebral palsy. > Bar-Haim et al. (2006) conducted a study to compare the efficacy of > Adeli suit treatment (AST) with > neurodevelopmental treatment (NDT) in children with cerebral palsy. > Twenty-four children with cerebral > palsy were matched by age and functional status and randomly assigned > to the AST or NDT treatment > groups. In the AST group (n=12) six children had spastic/ataxic > diplegia, one triplegia and five had > spastic/mixed quadriplegia. In the NDT group (n=12) five children had > spastic diplegia and seven had > spastic/mixed quadriplegia. Treatment was for two hours daily, five > days per week over four weeks for a > total of 20 sessions. Outcome measurements included the Gross Motor > Function Measure (GMFM-66) > and the mechanical efficiency index (EIHB). These were measured > during stair-climbing, at baseline, > immediately after one month of treatment, and 10 months after > baseline. There was an increase in both > the GMFM-66 and EIHB noted at one month for both intensive > physiotherapy courses. This increase > appeared to be greater than expected from natural maturation of > children with cerebral palsy at this age. > It was noted that the improvements in motor skills and their > retention nine months after treatment were > not significantly different between the two treatment modes. A post > hoc analysis indicated a greater > increase in EIHB after one month and 10 months in the AST group than > that in the NDT group. This was > noted to be more predominant in the children with higher motor > function. The authors conclude that " The > results suggest that AST might improve mechanical efficiency without > a corresponding gain in gross > motor skills, especially in children with higher levels of motor > function. " The authors note that, " Future > studies on the efficacy of AST should measure changes in metabolic > efficiency and fitness level, as well > as motor skills. It is also important to determine changes induced by > the suit itself, by having two groups > perform the same physical training, with and without the suit. Future > studies should increase the number > of participants and homogenize the participants with CP [cerebral > palsy] to reduce variability. " > Liptak (2005) conducted a review of nine complementary and > alternative therapies for cerebral palsy. > Regarding the use of the Adeli suit, the review noted that " no > published evidence from a controlled trial is > available in English to support or reject the use of the suit. Thus, > no conclusive evidence either in support > of or against the use of the Adeli suit is available. " > The United Cerebral Palsy (UCP) Research and Education Foundation has > published two research fact > sheets on the Adeli suit. The first was published in March 1999, at > which time suit therapy was only > provided at facilities in Poland. Due to interest in suit therapy, > the November 2004 UCP fact sheet > reported on two studies funded by the UCP Research and Educational > Foundation. > The first study noted in the UCP research fact sheet was conducted by > Dr. in Israel. The > study involved 24 children between ages six and 12 years with > cerebral palsy. The patients were > randomly assigned either to a standard physical therapy program or to > the Adeli suit using the original > Russian protocol. Both groups were treated with a two-hour session, > five days a week. Evaluation of a > number of parameters showed marginal improvement in both groups that > persisted over the following > year. There was no statistical difference between the children who > used the Adeli suit and those who did > not (UCP, 2004). > Page 4 of 6 > Coverage Position Number: 0353 > The second study noted in the fact sheet was conducted by Dr. > Dabrowski at the Children's > Hospital of Michigan. This study involved 57 children who were > randomized to control and treatment > groups. All children received one hour each of physical, occupational > and speech therapy three times a > week for 8–10 weeks, followed by a four-week home program. The > experimental group wore the Adeli > suit for the last four weeks of their therapy program. It was noted > that both groups improved and > sustained the improvement but without any statistical difference > between the two groups (UCP, 2004). > The UCP research fact sheet concluded that these studies show that a > period of intensive therapy in > ambulatory children with cerebral palsy can lead to improvement in a > number of disabilities. However, > they did not demonstrate that the use of the Adeli suit was helpful, > and they reported that any effect is > likely to be minor. > Summary > There is insufficient evidence in the published, peer-reviewed > scientific literature to establish the safety > and effectiveness of suit therapy for the treatment of functional > impairments associated with cerebral > palsy or other neuromuscular disorders. Well-designed clinical trials > are needed to demonstrate that this > treatment is as effective as conventional physiotherapy in the > treatment of cerebral palsy or other > neuromuscular disorders, that it improves patients' functional > abilities and activities of daily living, and that > it decreases impairment. > Coding/Billing Information > Note: This list of codes may not be all-inclusive. > Experimental/Investigational/Unproven/Not Covered: > CPT* Codes Description > 97139 Unlisted therapeutic procedure (specify)† > HCPCS > Codes > Description > No specific codes > ICD-9-CM > Diagnosis > Codes > Description > 343.0-343.9 Infantile cerebral palsy > Multiple/varied > †Note: Experimental/investigational/unproven and not covered when > used to report Suit Therapy > for the treatment of any condition, including but not limited to > cerebral palsy or other > neuromuscular conditions > *Current Procedural Terminology (CPT®) ©2006 American Medical > Association: Chicago, IL. > References > 1. Adeli Project [information on the Adeli approach]. Ayurveda JS Co. > Accessed March 26, 2007. > Available at URL address: http://www.adeli- suit.com/English/index.htm > 2. Adeli Suit [product information]. Euromed. Accessed March 26, > 2007. Available at URL address: > http://www.euromed.pl/en/index.php?ppg=adeli_suit:suit > Page 5 of 6 > Coverage Position Number: 0353 > 3. Ashwal S, Russman BS, Blasco PA, G, Sandler A, Shevell M, > son R; Quality > Standards Subcommittee of the American Academy of Neurology; Practice > Committee of the > Child Neurology Society. Practice parameter: diagnostic assessment of > the child with cerebral > palsy: report of the Quality Standards Subcommittee of the American > Academy of Neurology and > the Practice Committee of the Child Neurology Society. Neurology. > 2004 Mar 23;62(6):851-63. > 4. Bar-Haim S, Harries N, Belokopytov M, A, Copeliovitch L, > Kaplanski J, Lahat E. > Comparison of efficacy of Adeli suit and neurodevelopmental > treatments in children with cerebral > palsy. Dev Med Child Neurol. 2006 May;48(5):325-30. > 5. Behrman RE, Kliegman RM, Jenson HB, editors. textbook of > pediatrics. 17th ed. > Philadelphia, PA: W.B. Saunders Company; 2004. p. 2024-5. > 6. Canale T, editor. 's operative orthopaedics. 10th ed. St. > Louis, MO: Mosby, Inc.; 2003. p. > 1218-23. > 7. DeLuca PA. The musculoskeletal management of children with > cerebral palsy. Pediatr Clin North > Am. 1996 Oct;43(5):1135-50. > 8. U.S. Food and Drug Administration (FDA). Code of federal > regulations; title 21, vol. 8; subchapter > H (medical devices); part 890 (physical medicine devices); subpart D > (physical medicine > prosthetic devices); sec. 890.3475]. Limb orthosis. Revised 2004 Apr > 1. Accessed March 26, > 2007. Available at URL address: > http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/search/search.cfm? > db=CFR & id=890.3475 > 9. Goldstein M. The treatment of cerebral palsy: what we know, what > we don't know. J Pediatr. 2004 > Aug;145(2 Suppl):S42-6. > 10. Hurvitz EA, Leonard C, Ayyangar R, VS. Complementary and > alternative medicine use in > families of children with cerebral palsy. Dev Med Child Neurol. 2003 > Jun;45(6):364-70. > 11. Liptak GS. Complementary and alternative therapies for cerebral > palsy. Ment Retard Dev Disabil > Res Rev. 2005;11(2):156-63. > 12. Michaud LJ; American Academy of Pediatrics Committee on Children > With Disabilities. > Prescribing therapy services for children with motor disabilities. > Pediatrics. 2004 Jun;113(6):1836- > 8. > 13. NINDS cerebral palsy information page. National Institute of > Neurological Disorders and Stroke > (NINDS). Bethesda, MD: NINDS, National Institutes of Health (NIH). > Last update: January 25, > 2006. Accessed March 26, 2007. Available at URL address: > http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_pals > y.htm > 14. NOMC [North Oakland Medical Centers] Euro-Pçds program: SUIT > therapy. 2004. Accessed > March 26, 2007. Available at URL address: > http://www.europeds.org/epp_st.htm > 15. Rosenbaum P. Cerebral palsy: what parents and doctors want to > know. BMJ. 2003 > May 3;326(7396):970-4. > 16. Rudolph CD, Rudolph AM, Hostetter MK, Lister GE, Siegel NJ, > editors. Rudolph's pediatrics. 21st > ed. New York, NY: McGraw-Hill; 2003. Ch. 25. > 17. Suit therapy for cerebral palsy [information about the TheraSuit > Method™ and the TheraSuit™]. > Therasuit LLC. Accessed March 26, 2007. Available at URL address: > http://www.suittherapy.com/ > 18. United Cerebral Palsy (UCP). The Adeli Suit [research fact sheet: > diagnosis/treatment]. > Washington, DC: United Cerebral Palsy (UCP) Research & Educational > Foundation; 1999 Mar. > Page 6 of 6 > Coverage Position Number: 0353 > Accessed March 26, 2007. Available at URL address: > http://www.ucp.org/ucp_generaldoc.cfm/1/4/24/24-6608/82 > 19. United Cerebral Palsy (UCP). The Adeli Suit Update [research fact > sheet]. Washington, DC: > United Cerebral Palsy (UCP) Research & Educational Foundation; 2004 > Nov. Accessed March > 26, 2007. Available at URL address: > http://www.ucp.org/ucp_generaldoc.cfm/1/4/24/24-24/5896 > 20. United Cerebral Palsy (UCP). The Treatment of Cerebral Palsy > [research status report]. > Washington, DC: United Cerebral Palsy (UCP) Research & Educational > Foundation; 2003 Jun. > http://www.cigna.com/.../coverage_positions/medical/mm_0353_coveragepo > sitioncriteria_suit_therapy.pdf > > ===== > Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.