CleveMed Blogs

CleveMed will be attending and exhibiting at the Gait and Clinical Movement Analysis Society’s (GCMAS) 14th Annual Meeting in Denver, Colorado. The meeting will be taking place March 9-14.

GCMAS is a society that is made up of orthopedic surgeons, neurologists, developmental pediatricians, physiatrists, physical and occupational therapists, kinesiologists, engineers and many others who are interested in human movement. The professional members of GCMAS are all interested in the advancement of scientific knowledge of gait and human movement analysis in both research and clinical settings.

CleveMed will be showcasing KinetiSense, a compact, lightweight, wireless system for measuring motion and electrical muscle activity (EMG). KinetiSense utilizes a small subject worn device that measures three degrees of linear acceleration and three degrees of angular velocity with accelerometers and gyroscopes. The device also has the option of two channels of EMG for a total of eight channels of data. KinetiSense can communicate in real time with a PC via a Bluetooth^™ radio link or data can be stored in memory. The small size and wireless aspect of the device make the system suitable for a number of research applications, including gait measurement, biomechanics, rehabilitation and any other situation in which movement monitoring and analysis is desired.

A second product on display will be BioCapture, a wireless data acquisition and research system. BioCapture uses the BioRadio 150, a wireless 12 channel programmable physiological monitor. The user can measure up to 8 channels of electrical muscle activity (EMG) on the available programmable inputs. Data is then sent in real time to a PC and displayed and stored using the BioCapture software interface. LabVIEW^™ and MATLAB^® drivers allow the user to write customized interfaces around the BioRadio 150 hardware for real-time acquisition or post processing. Data is also saved in standard ASCII file format for easy import into third party packages, making the system appropriate for a number of custom research applications.

New, innovative, affordable teaching tools are required to train a new generation of researchers for high-tech 21st Century jobs; creating new drugs and technologies to cope with an aging population and understand neurological diseases and processes. CleveLabs^™, an innovative Neuroscience laboratory course with over 30 individual labs was developed to integrate wireless electrophysiology systems with a hands-on learning approach where the students can evaluate their own neurological signals.

Why you should consider CleveLabs:

• CleveLabs Laboratory Course System integrates innovative bioinstrumentation hardware and transducers with hands-on learning through interactive software that educates students on instrumentation, electrophysiology and clinical applications.
• Over 30 lab sessions are laid out in a concise, easy-to-follow format. Each lab includes background information, setup movies, data acquisition and real-time data analysis sections.
• CleveLabs allows Neuroscience programs to rapidly expand laboratories to accommodate larger incoming class sizes, with minimal staff training and without new facilities.
• A personal computer and the lab course kit are the only needed equipment, minimizing the requirements on the department. The compact, wireless system can turn any setting into a laboratory.

This post draws on the experience of several experts at CleveMed and is an adaptation from "A Laboratory Course for Teaching the Peripheral Nervous System using the Students own EMG/Physiological Signals" as presented at The Society for Neuroscience 2008

If you don’t want to miss a minute of life to groggy-tiredness, you need a full night’s sleep. Moreover, there are personal habits you can cultivate to help you sleep more effectively. I hope that these tips help you get some much needed, quality rest!

Sleeping Environment

• Use comfortable bedding.
• Keep a livable and constant temperature (75°F to 54°F) while you sleep.
• Keep pets outside the bedroom.
• Keep the bedroom quiet and block out noise.
• Reserve your bed for sleeping. Avoid staying in bed if you’re not sleeping within 15-20 minutes.
• If you can’t fall asleep get up and go to another room and do something relaxing such as reading.

Before Bed Time

• Take only a light snack such as warm milk. Heavy meals can cause your body to work to digest food and interrupt your sleep.
• Practice relaxation techniques before bedtime so you don’t take your worries to bed.
• Develop a pre-sleep ritual.
• Set a consistent time everyday to go to bed and to wake up. It takes your body time to adjust to changes in your sleep pattern; a good example of this is jet lag.

Personal Habits

• Avoid eating 2 hours before bedtime.
• Exercise during the day up to 2 hours before bed.
• Avoid naps during the day.
• Avoid caffeine 6 hours before bed.
• Alcohol is a depressant and may help you fall asleep but keeps your body awake processing it. Avoid alcohol 6 hours before bed.
• Nicotine is a stimulant and should be avoided particularly near bedtime and upon waking up at night.
• Bright lights and TV keep you awake and have a negative affect on sleep.
• Clear you mind before bed time, stop working on tasks 2 hours before bed.
• If you can’t seem to get quality sleep despite efforts and suspect that you might suffer from a sleep disorder, it’s a great idea to create a sleep journal. Try and keep track of your time in bed, time asleep, time awake, time out of bed and personal habits for each day. This is a great source of information for you and for any medical professional you talk to about you sleeping problems (I will work on posting an example of this in the future).

There are dozens of other tips to a good night’s sleep and some of these are not the same for everyone. If you have more advice to add to this list, feel free to comment on this post and we’ll continue the discussion!

In this week’s post we decided to write about one of the more popular topics suggested by our readers: definitions of types of sleep studies devices according to CMS (the Center for Medicare & Medicaid Services) and AASM (the American Academy of Sleep Medicine). Hope these quick summaries help in understanding these terms better. CleveMed currently has three devices that fall within these defined categories for the purposes of sleep (Type I - Sapphire PSG, Type II - Crystal Monitor PSG, and Type III - SleepScout).

Definitions according to Center for Medicare & Medicaid Services (CMS) Guidelines

Type I – Attended studies (Sleep studies that are preformed with the oversight of a sleep technologist.) with full sleep staging (Sleep staging monitors the transition through the sleep stages. Traditionally with the use of EEG electrodes that monitor the brain). Type I devices must includes the following channels:

• EEG
• EOG
• ECG/Heart rate
• Chin EMG
• Limb EMG
• Respiratory effort at thorax and abdomen
• Air Flow from nasal canula thermistor and/or X-Flow (AASM re- commends RIP technology
• Pulse Oximetry
• Additional channels for CPAP/BiPap levels, CO2, pH, pressure, etc.

(CPT #95810 Baseline PSG, 95805 MSLT, 95811 Titration)

Type II – Home sleep study test (HST) with type II portable monitor, unattended(Sleep studies that are preformed without the oversight of a Sleep Technologist.); minimum of 7 channels. Type II devices must includes the following channels:

• EEG
• EOG
• ECG/heart rate
• EMG
• Airflow
• Respiratory effort
• Oxygen saturation

(HCPCS #G0398)

Type III – Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels. Type III devices must includes the following channels:

• 2 respiratory movement/airflow
• 1 ECG/heart rate
• 1 oxygen saturation

(HCPCS #G0399, CPT 95806)

Type IV – Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels. Type IV devices must allow channels that allow direct calculation of an AHI or RDI as the result of measuring airflow or thoracoabdominal movement. Alternatively devices that record other information to derive AHI or RDI must be approved by CMS through the review of published peer-reviewed medical literature.
(HCPCS #G0400)

Definitions according to American Academy of Sleep Medicine (AASM) Guidelines

Type I - Monitoring devices perform in-laboratory, technician-attended, overnight polysomnography (PSG) and are discussed separately. (CPT #95810 Baseline PSG Study, CPT #95805 MSLT Study and CPT #95811 Titration Study (CPAP))

Type II – Monitoring devices can perform full PSG outside of the laboratory. The major difference from type 1 devices is that a technologist is not present. These devices are called comprehensive portable devices. (CPT #95807)

Type III – Monitoring devices do not record the signals needed to determine sleep stages or sleep disruption. Typically channels include:

• Four physiologic variables are measured including:
• Two respiratory variables (eg, respiratory movement and airflow)
• Cardiac variable (eg, heart rate or an electrocardiogram)
• Arterial oxygen saturation
• Some devices may have other signals including a monitor to record snoring, detect light, or a means to determine the body position.

(CPT #95806)

Type IV – These devices are called continuous single or dual bioparameter devices. Monitoring devices record one or two variables and can be used without a technician. Typically channels include:

• Arterial oxygen saturation
• Airflow