The Inerventions method


The Inerventions method is based on stimulating the antagonist to the spastic muscle with a low level electric current. The aim is to trigger reciprocal inhibition, the body’s own reflex, to reduce the tension in the spastic muscle.

Reciprocal inhibition means that the body reacts automatically through inhibiting the antagonist to a muscle that is activated. Muscles are normally activated by nerve signals with the origin in the central nervous system, however, Mollii replaces these nerve signals with electrical stimulation from the electrodes.

Antagonist stimulation of individual muscles in patients with spasticity has been shown to lead to increased reciprocal inhibition, and different studies of antagonist stimulation measure improvements on the Zancolli Scale, grip strength, fine motor ability, range of motion, gait and posture etc. (Perez 2003, Wright et al. 2013, Chung et al. 2010, Scheker 2009, Ozer et al. 2006, Al-Abdulwahab 2009).

Antagonist inhibition can be used in combination with other types of treatments and assistive devices. One study shows that a treatment combining antagonist stimulation and orthotics in children with cerebral palsy reduced spasticity by more than the individual treatments did in the same group of patients. (Scheker 2009).

One obstacle to earlier research into the effects of antagonist stimulation has been the difficulties involved in stimulating multiple muscles in a way that is repeatable on multiple occasions. Connecting and disconnecting cables, electrodes and control units for such studies would be time consuming and laborious for researchers. Moreover, a larger study would require a number of patients to be treated on repeated occasions. The introduction of Mollii will now make it possible to conduct research into repeated antagonist stimulation in relation to spasticity in a way that is feasible.

During spring/summer 2012 Inerventions conducted two parallel projects together with researchers at the Karolinska Institute, partly to evaluate the clinical benefit of electrical muscle stimulation in connection with spasticity, and partly to assess the cost benefit of using treatment with the Inerventions method in the home environment instead of traditional treatments. The results of these pilot projects display excellent patient results in combination with opportunities for healthcare providers to make savings compared with the cost of today’s care. Reports from these studies are available on the right of this page.

Despite the projects mentioned above and the improvements we have observed in our users, we are nevertheless acutely aware of the need for more research to measure and evaluate the effect of repeated antagonist stimulation of several muscles. Among other things, independent RCLs (randomized clinical trial) are needed. Inerventions is therefore currently funding an independent clinical research study in the form of an RCL of the effects of Mollii, which is being conducted on a large number of patients who are being followed over a period of several months. This study, which encompasses both the effect on patients and the economic aspects of the method, is also receiving state funding.

References
Perez, M. A., Field-Fote, E. C., Floeter, M. K. (2003). Patterned Sensory Stimulation Induces Plasticity in Reciprocal Ia Inhibition in Humans. The Journal of Neuroscience, 23(6):2014–2018.

Wright, P. A., Durham, S., Ewins, D, J et al. (2013). Neuromuscular electrical stimulation for children with cerebral palsy: a review. Arch Dis Child 97:364–371.

Chung, B. P. H., Cheng, B. K. K. (2010). Immediate effect of transcutaneous electrical nerve stimulation on spasticity in patients with spinal cord injury. Clin Rehabil 24: 202–210.

Scheker, L. R., Chesher, S. P., Ramirez, S. (1999). Neuromuscular Electrical Stimulation and Dynamic Bracing as a Treatment for Upper-Extremity Spastcity in Children with Cerebral Palsy. Journal of Hand Surgery 24B: 2: 226–232.

Ozer, K., Chesher, S. P., Sheker, L., R. (2006). Neuromuscular electrical stimulation and dynamic bracing for the management of upper-extremity spasticity in children with cerebral palsy. Developmental Medicine & Child Neurology 48:559–563.

Al-Abdulwahab, S. S., Al-Khatrawi, W. M. (2009). Neuromuscular electrical stimulation of the gluteus medius improves the gait of children with cerebral palsy. NeuroRehabilitation 24:209–217.

Spasticity
Cost-effectiveness analysis
FAQ

Systematic review

This recently published systematic review of 14 RCT-studies with 550 participants is evaluating TENS as a treatment against spasticity. The study shows significant evidence for TENS as a management for treating limb spasticity. Read abstract and conclusion below and find the complete study as a PDF below or at PubMed here.

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Study with conductive education

At the 9th World Congress of Conductive Education in Budapest, Mollii expert and Conductor Mira Auer presented her study from Pouilly-sur-Loire, France in 24 children. Mira has evaluated the combination of Conductive Education while using the Mollii suit in the Conductive education setting. We highly recommend you to read the report, especially if you are using Conductive Education yourself or in your child. Of course the report is extra interesting for Conductors, Mollii users and “Combiners”. Read the study here.

Multi-center study

Inerventions has been awarded an EU grant within the framework of Horizon 2020 to conduct a multi-center study in close collaboration with the Karolinska Institute, Hvidovre Hospitale in Copenhagen and the Medical University of Vienna. The aim is to study Molliis effect in the areas of stroke, cerebral palsy and spinal cord injury. The project will start in October 2016 and is expected to last to the end of 2018.


It is extremely gratifying that we are now entering into a close cooperation with three of Europe’s premier teaching hospitals, all of which have shown great interest Mollii and our approach to treat people with different types of brain and spinal cord injury. Thanks to this project, the evidence for Mollii be strengthened in our main user groups, stroke, cerebral palsy and spinal cord injury. In addition, we get incredibly valuable skills that will eventually help us to develop a better and more effective product.
The project will be implemented together with, among others, Prof. Jörgen Borg at the Karolinska Institute, Prof. Christian Wong at Hvidovre Hospitale, Dr. Winfried Mayr at the Medical University of Vienna and København Bandagist Jan Nielsen A/S.

”I believe that the research project will be extremely interesting to examine the clinical effects of Mollii on children with cerebral palsy. We will examine the effects in regards to pain, ability for mobility and general quality of life.” Christian Wong, Hvodovre Hospitale

For more information, please contact CEO Johan Seltborg, johan.seltborg@inerventions.se

Trial in Falun

On behalf of the County Hospital in Falun, Sweden, a clinical trial on children with cerebral palsy is currently taking place. The purpose is to compare the effect of usage of the electro dress Mollii with the effect that the children has prevously got by treatment with botulinum toxin. The clinical trial will go on for 6 months and the results will be published during 2017. Responsible for the trial are Orthopaedic Dr Hanne Hedin and Fysiotherapist Ann Sjödén. The target is to add other habilitation hospitals in the trial.

For questions or further information, please contact Hanne Hedin, hanne.hedin@telia.com.

Article in Orthopaedic Magazine

Electrical stimulation is a well established medical techniques that can be used to reduce spasticity and improve mobility in people with unbalanced muscle tension, but treatment with the individual electrodes are time-consuming for the patient. Read the full article in the PDF below.

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Case Study MS

The objective of this study was to explore the potential effects of 1 hour Mollii treatments on mobility, upper limb function and effort and to identify if any benefits that occur may be cumulative following alternate day intervention over a week. The study was performed by Joe Green, Specialist Physiotherapist at Hobbs Rehabilitation in the UK, sept 2016.

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NeuroFlexor

Inerventions has been looking for new measuring methods and protocols to evaluate Mollii’s effect on spasticity to complement the assesment of a physiotherapist.  Spasticity is very difficult to evaluate with the measuring protocols available, bias is very difficult to avoid or to eliminate. For the first time, during the month of June, we have evaluated Mollii’s effect on hand spasticity with a new, innovative measuring tool, NeuroFlexor(www.aggeromedtech.com). NeuroFlexor has been developed and validated by scientists at the Karolinska Institute in Stockholm. 

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Report Västernorrland

Six adults with cerebral palsy has been evaluated during a 6 months long evaluating period at the county of Västernorrland in Sweden. The report on four of them is attached as a PDF on this page.

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Study in Region Skåne

The purpose of this study was to examine the effects of treatment with electromagnetic link can provide. The study measured effects on participants’ gross motor skills, joint mobility, muscle tone and ability to cope with everyday activities based on their own goals. Other factors examined was expectations of the treatment and the experience of the ability to cope with everyday activities and the effect of treatment on pain and wellbeing. The study covers eight participants aged 7-31 years, of which seven have completed twelve weeks of treatment, all measurements and interviews.

The study was conducted in 2014 on pediatric rehabilitation and adult rehabilitation services in Region Skåne. Find the whole study and the additional comments from Inerventions at the link below (in Swedish).

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New syndrome

After performing several successful tests in collaboration with occupational and physical therapists, we are very happy to announce a new syndrome where Mollii seems to have good effect.

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Spasticity

Spasticity is a condition characterised by increased muscular tension and amplified or pathogenic reflexes.

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Abstract for masterstudy

A study of 6 Children with cerebral palsy was performed in Luleå during 2015. The whole study is not yet published but the abstract is available at LTU:s website here.