Spinal cord injury dating
Exclusion Criteria: Functional electrical stimulation for walking (Parastep I System) is spectifically contraindicated and has no proven value for members with SCI with any of the following: Note: Aetna considers the FES exercise devices such as the FES Power Trainer, ERGYS, REGYS, Neuro EDUCATOR, STim Master Galaxy, RT200 Elliptical, RT300 FES Cycle Ergometer (also referred to as a FES bicycle), RT600 Step and Stand Rehabilitation Therapy System, and Spectra STIM to be exercise equipment.Most Aetna plans exclude coverage of exercise equipment; please check benefit plan descriptions for details.
Similarly, a complete lesion in the thoracic or lumbar spine will produce paraplegia, whereas an incomplete lesion at these levels will produce paraparesis.The American Spinal Injury Association (ASIA) Impairment Scale is a classification system used to describe the extent of SCI.The ASIA Impairment Scale: Another factor that influences the severity of impairment is the neurological extent of injury, namely the degree of tissue trauma to the spinal cord at the level of injury.The brain, through the UMN, exerts an inhibitory influence on the LMN so that they do not become hyperactive to local stimuli.The cell bodies of LMN are located in the central gray matter throughout the entire length of the spinal column, and their axons extend out via the spinal nerve roots and peripheral nerve branches to innervate skeletal muscles throughout the body.The authors concluded that the Parastep I System enabled persons with thoracic-level SCI to stand and ambulate short distances but with a high-degree of performance variability across individuals.
Furthermore, Graupe and Kohn (1998) reported that about 400 patients have used the Parastep I System and essentially all achieved standing and at least 30 feet of ambulation, with a few reaching as much as 1 mile at a time.
One method of categorizing the degree of injury is by a neurological examination that explores the segments of the cord which are still functional.
The most caudal segment of the cord with normal sensory and motor functions is denoted as the neurological level of injury.
Aetna considers replacement of a diaphragmatic/phrenic stimulation system medically necessary if the original diaphragmatic/phrenic stimulation system met criteria as medically necessary and is no longer under warranty and cannot be repaired.
Aetna considers diaphragmatic/phrenic pacing experimental and investigational for all other indications, including for use in individuals whose phrenic nerve, lung or diaphragm function are not sufficient to achieve adequate diaphragm movement from the electrical stimulation, because its effectiveness for indications other than the ones listed above has not been established.
Note: These criteria are adapted from the Food and Drug Administration (FDA) labeling for Parastep I System as well as information provided in published studies.