Carrick Institute

CITV Technology Review: The NSI Unit

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– Hello and welcome to CI TV. I’m your host Dr. Freddy Garcia joined by Dr. Brittany Forrester and today we’re doing a product review on the neurosensory integrator up next.

-So what is a neurosensory integrator? In this particular model that we have we have the 50 inch smart panel, it’s touch sensitive and it comes with specific and special software. This software’s comprised of modules and each module give the patient a different type of stimulation with the goal of biasing a specific type of activation or pathways or different parts of the brain that you want to stimulate. Your goal as a clinician is to be able to do a good and thorough physical and neurological examination so you know exactly which pathways and parts of the brain you wanna either excite or inhibit. In the next section we’ll dive deeper into what those modules are. So what are the different types of modules that we have available to us in this particular NSI unit? Well in this one we have an eye-hand module, a tracking module, saccades module, a T scope, we have audio-visual timing module, opti-kinetics, a visual motor module, a vestibular module which is great, a rotator module, memory saccades and even a go no go. Now what I love about the NSI is that it’s always upgradeable by software. In fact this unit is in need of a software update which is gonna give us even more modules. Maybe we’ll review them at a later time. So theoretically the longer you have your NSI unit, the better it should be improving and hopefully helping your patients even more. Next we’ll go on and demo some of the modules along with Dr. Forrester. So let’s dive deeper into one of the modules.

-One of the first modules is the eye-hand module. Now this module also has three subsections under it, it has proactive, reactive, and enhanced speed subsection. We’re gonna keep it simple and go proactive. Now there’s a lot of choices and options but in those options for each module there’s a lot of power. One of the first options is how much stimuli you wanna give. Now the more stimuli, the greater potential for fatigue of your patients so you do have to watch your patient to make sure they’re doing thing within their metabolic capacity. Anybody who understands a functional neurology model knows how to assess and keep that in mind. You also can now put on a grid, you could have a central fixation or a central flash, basically if you want them to be looking at a central target and keep that in focus or if you wanna give ’em a grid and make things a little bit easier. You could also pick a background color and a stimuli color depending if you wanna use the color as a particular form of stimulus. You also have the stimulus size which can be very important depending on the age and the visual acuity of your patient. Now for the actual stimulus you have a couple options. You could have just normal circles, you could have letters, you could have numbers. Now if you have letters you could give it an extra cognitive load, for example you could say when a letter pops ups there give me a word that begins with that letter. So that extra cognitive load could be exactly what your patient needs depending on what you saw on your neurological and physical exam. You could have numbers. You could have them do like a dual task, add the previous number and the current number that you see. You could mix some up with both. Additionally you could have the stimuli pop up more centrally on the screen or more peripherally or both. So we’ll do a both, keep it simple. Also you could mess around with the contrast sensitivity. We’ll keep that simple as well. Now one of my favorite options is the quadrant loading that you see here. Now quadrant loading is hey, out of the stimuli, let’s say of 100, maybe I wanna bias the upper right quadrant more than the other ones. So to do that I would kinda hit up a little bit here and towards the right and you start biasing that particular quadrant. Now those that understand neurology are already getting ideas and saying wow! I’m able to bias the upper quadrants versus the lower quadrants and then the left versus the right and then you start thinking hey, maybe I should start having the patient do the therapy with their left hand versus their right hand. So you get very specific in regards to how you’re biasing activation in your patient’s brain, which should be very exciting to you. So let’s do one of these. We’ll keep it simple. We’ll make this a little more centered. And just have her do 10. We’ll watch. She touches the first letter to get it going and then whenever the central one flashes she has to touch it so she cannot lose sight of that. And as you could imagine, amazing. But now on the back end of it you also get all of your results and it does save it. Now we’re just working with the demo patient but you can see how the central fixation was on, the amount of stimuli that she had, the quadrant horizontal, basically the loading, that we were doing letters, the central flash was on. Here’s your results, it took her 11 seconds total overall and it even tells you based off the quadrant which one she did better or worse on. Again that tells you more information about your patient’s condition which hopefully matches up with her neurological and physical exam and again it gives you the results as well. So one of my favorite modules. There’s other modules to go through, so let’s demo some of those next.

-The next module we wanna demonstrate is called the T scope. Now I’m gonna call it T scope because I can’t say really well tachistoscope. For some reason I can’t get that all repeatedly very well so T scope is what we’re gonna stick with. So for the T scope it’s a really neat module. So this one’s a time based module. We’re gonna just demo a minute of it. You could have the grid to give you a little bit of a visual help and you could also have stimuli persistence which means whatever stimulus pops up there, normally when you click it would go away which kinda reduces the amount of stimulus on the screen, you keep it up there it makes it a little more challenging for the patient. We’ll talk about what happens as well. You have a verbal, you could have a verbal stimulus, you could have a tracer or you could also go in reverse order. Now what’s gonna happen is the computer is gonna tell you some words or numbers and you have to touch ’em back in the order or reverse order that you heard them in. Now something that you could do is we could say that manually and say alright give us five in that order every single time or we could do auto-sequential which means let’s say you got two stimulus and you got those right, the next time it would give you three and the next time it would give you four and the next time it would give you five. So the more correct, the more it would challenge you and it kinda makes it into a little bit of a game for the patient. Now some patients you may wanna use this for are patients who are looking for frontal lobe stimulations. We’ve also had great success in patients, stroke patients who had some language issues. So this is a very novel and neat module and let’s do a quick demonstration of it. So for this one let’s see, we’ll do one minute of stimulus, we may stop sooner. We’ll set it to manual and we’ll give her, well let’s try six, I’m gonna give her a little bit of a challenge and let’s do, yeah we’ll do both words and numbers. Let’s do words level two. We’ll see how she does. We also have the quadrant loading here, we’ll just leave that centered. Again if you know your neurology you can know how you’re gonna bias different quadrants. Alright and here we go.

– [TV] Find the following words in sequence, all, now, light, white, went, what. Find the following words in sequence, came, do, well, out, black, be. Find the following words in sequence, soon, sang, get, who, at, good.

[Dr. Garcia] Now I gotta tell you, I was watching it, I had 100% accuracy but on her result screen we can see something a little bit different. She had total of three trials. She missed three. We can see how the quadrants are loaded, so it kinda tells all your settings and your overall results and so again I think a very novel and powerful module that you can use with a specific type of patient once you understand what type of stimulus they need. So this is one of the things that I think makes the NSI kind of interesting and powerful, it’s novelty in some of the stimulation that you provide.

-So let’s take a look at another module next. So the next module we’re gonna demonstrate is the go no go module. Now this module has two different options, you can do a visual go no go or a auditory go no go. We’ll do ’em both ’cause I think they’re both very cool. First we’ll do visual. Now first let’s talk about what types of patients this may be good for. We find this very useful for patients with impulsivity issues, also ADD ADHD patient population can find this very beneficial. You have the number of stimuli you can do, the stimuli size, you can do the quadrant loading so if I hit that it won’t go into that quadrant. We’re gonna just do them all for the sake of demonstration. We have proactive, reactive timing meaning it’ll either wait for her to hit the button or it’ll kinda have a timer and if she’s not fast enough it’ll disappear. You could do it matched or unmatched. In this scenario we’re gonna keep it matched. Now she’s gonna get two visual stimulus and they’re gonna be colors. If they match she’s gonna touch the center stimulus, if they don’t match, she’s gonna touch the peripheral stimulus. So let’s just see how she does. And last thing is she can do colors, letters, numbers, animals, and objects. So again you’re looking for that matching and depending on whether they match or un-match she’s gonna have her reaction to it. So she has to have that moment of processing and then react. So let’s see how she does. Perfect, okay again it gives you your results, tells you where the percentages of those stimuli was so you could see if there were better or worse in a specific quadrant. Let’s take a look at what an auditory go no go would look like. Let’s go here. Okay so on this one she’s either gonna hear a letter or number and depending on the settings that you choose, the numbers are gonna be on the right side and that’s where she’ll have to touch. So if she hears a number she’s gonna touch the right side of the screen. If she hears a letter she has to touch the left side of the screen. We’ll drop this down to make it a little quicker. So again she’s presented with the stimulus, she has to process what she understands it to be and then have an appropriate reaction to it. So it requires an element of impulse control before you react ’cause obviously you wanna react quickly but then still have accuracy. So let’s give this a go.

– Okay, awesome. Once again it gives you all the results that you’d want and a very novel way to present the go no go stimulus which is a very powerful stimulation for a particular patient population. Gotta love this. So the next module I wanna jump into is called the rotator. Now I find the rotator to be very interesting because it’s a very novel stimulus. Again you have four different subsections, we’ll just do an easy one. Alright so what’s gonna happen is she’s gonna see a rotating disc on the screen. You know, a rotating disc, who would I use this with? Some of your patients have movement perception issues, a patient who has an inappropriate OTR, otolithic tilt response, this is a way to get this very novel stimulus in addition to the fact that you can load them by giving them different stimuli, loading it by different hands that they’re gonna use. So let’s kinda take a look at what this looks like. This is pretty neat. So in this one we could choose how many stimuli, we’ll just do a simple 20. The speed, the stimulus size, contrast sensitivity, you could pick the direction that the disc is going to be moving into, whether it’s clockwise, counterclockwise, or both and the rotator size and that gives you kind of a little preview. So I’ll let Dr. Forrester step on up and let’s give this a go. Hit launch for me. And she hits the first button and then her job is to catch the moving targets. Changes direction on her and she’s done. Okay now for you guys at home you’re thinking wow that looks pretty simple but if somebody has an inappropriate OTR or visual motion perception issues this can be challenging for them and it may be exactly the type of stimulus they need. This should be very difficult to produce in a real world without such technology and I love the fact that we have technology that can provide these types of stimulations. Another very powerful use for the NSI.

– Alright so in closing, we’ve taken a look at the neurosensory integrator, it is one of my favorite tools to have in a clinic. I did a lot of research before we bought one for the Carrick Institute Learning Center because we wanna have the most effective devices that our doctors should be using with their patients. Now what types of patients will you wanna use an NSI for? You could help patients with Parkinson’s Disease, ADHD, children that are on the spectrum, vestibular disorders, frontal lobe disorders, basal ganglionic lesions, we work with a lot of concussions and use the NSI as well. We could use it in language rehabilitation, in cerebellar rehabilitation, and really that’s a long list but that’s where a lot of the power lies for a device like this. Because it’s software with a touch panel, you basically have this continuous upgrade capability and as long as the developers are communicating with the care faculty and their teams in regards to the developing newer modules, you have kind of an endless amount of capability in a single unit. I know lots of doctors actually have multiple of them because they used it that much. Now in regards to the fact that maybe potential cons, I asked around and I was was worried about the electronic components, specifically the touch panel in regards to that being durable and the company reassured me that they have had no durability issues and if there ever was the replacement parts are very moderately priced. I thought that was very good ’cause I imagine if you’re doing, if you have you know a six to 10 hour patient day and you have somebody smacking this all day long, how durable would these pieces be? Apparently they’re very durable and they reassured me of that so I wanted to ask for you guys. Another section that I was kinda worried about is having a panel for patients that are particularly light sensitive. And come to find out they do have on every single one of the modules a contrast and sensitivity portion to accommodate those patients. So again the power for the NSI unit lies in its software and its customizability for your specific patient. Now remember this isn’t one of those things that you’re gonna throw in front of a patient and go hey magically make you better, it is up to you to know how to do an appropriate physical and neurological examination and know exactly what type of stimulation you wanna present that patient. But if you have that skill, then I have to say, this is a highly recommended device that you should probably already have in your practice. My name’s Dr. Garcia, I hope you liked this product review of the neurosensory integrator.

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