0696 suit therapy - aetna better health...number: 0696 *please see amendment for pennsylvania...
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Suit Therapy - Medical Clinical Policy Bulletins | Aetna Page 1 of 20
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Suit Therapy
Policy His tory
Last Review
02/08/2018
Effective: 01/07/2005
Next
Review: 07/26/2018
Review History
Definitions
A dditiona l In form at ion
Clinical Policy
Bulletin Notes
Number: 0696 *Please see amendment for Pennsylvania Medicaid at the end of this CPB.
Policy
Aetna considers suit therapy or home use of a suit therapy
device (also known as the Adeli Suit, Penguin Suit, Polish Suit,
Stabilizing Pressure Input Orthoses, Therapy Suit, Therasuit,
and TheraTogs) experimental and investigational for the
treatment of members with cerebral palsy (CP) or other
conditions (e.g., gait rehabilitation following stroke) because
there is inadequate evidence of the effectiveness of this
therapy in the management of these conditions.
Aetna considers dynamic movement TLSO "brace" (Dynamic
Lycra Suit) experimental and investigational for the treatment
of members with CP or scoliosis because there is inadequate
evidence of the effectiveness of this therapy in the
management of these conditions.
Aetna considers Dynamic Movement Orthoses experimental
and investigational for the treatment of members with CP,
hemiparesis/hemiplegia, scoliosis, and all other indications
because there is inadequate evidence of the effectiveness of
this therapy in the management of these conditions.
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Also see
CPB 0405 - Mechanical Stretching Devices for
Contracture and Joint Stiffness (../400_499/0405.html)
.
Background
The Adeli Suit (also known as the Polish Suit, Therapy Suit,
and Therasuit) is a modification of a space suit, called the
“Penguin” suit used by Russian cosmonauts to counter the
effects of long-term weightlessness on the body while in
space. The inner workings of the suit have elastic bands and
pulleys that created artificial force against which the body
could work to help prevent muscle atrophy and osteoporosis.
Although the cause of motor dysfunction between cerebral
palsy (CP) patients and astronauts are different, results of a
treatment trial with the Penguin suit to rehabilitate patients with
CP appeared promising. The Penguin suit was then modified
resulting in an elasticized suit for use in positioning and
stretching muscles during physical therapy. Suit therapy for
CP is currently available at the Euromed Clinic in Poland and
at several other centers in Europe and the United States. The
Adeli Suit is used in the Polish facility as part of a
comprehensive program of intensive physiotherapy
administered 5 to 7 hours per day for 5 to 6 days a week for 4
weeks.
According to the Euromed Rehabilitation Center website: "The
Adeli Suit consists of a vest, shorts, knee pads and specially
adapted shoes with hooks and elastic cords that help tell the
body how it is supposed to move in space. Therapists use the
Adeli Suit to hold the body in proper physical alignment.
During specialized exercises, the therapists adjust the elastic
connectors that topographically mirror flexor and extensor
muscles, trunk rotators and the lower limbs. Additional
attachments correcting the position of the feet, head and other
areas of the body have also been designed. A patient, while
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wearing the Adeli Suit, goes through various exercises
including "how to walk". The Suit works as an elastic frame
surrounding the body and does not limit the amplitude of
movement but adds an additional weight load on it within
designed limits."
There are published anecdotal reports (the majority of which
are published in the Russian language) of children gaining in
speech, fine motor control, as well as movement with suit
therapy, but no randomized controlled clinical trials of suit
therapy have been published. The U.S. Food and Drug
Administration (FDA) has classified the Adeli Suit and other
similar devices as a class 1 limb orthosis (brace). Thus, the
Adeli Suit is exempt from the premarket notification procedures
of the FDA and the manufacturer is not required to provide
evidence of efficacy prior to marketing.
Enough interest has been generated by anecdotal and verbal
reports that the United Cerebral Palsy (UCP) Research and
Educational Foundation (2004) funded 2 studies on suit
therapy. While the results of these studies are not yet
available in the peer-reviewed published medical literature, the
UCP Research and Educational Foundation website is making
the information available due to the current interest in suit
therapy.
The first study by Dr. Alexander Frank and associates at the
Motion Analysis Laboratory, Assaf Harofeh Medical Center,
Zerifin, Israel, reported the results of 24 children who had CP
and a functional level of II, III or IV according to the Gross
Motor Function Classification System. Patients were randomly
assigned to either a standard physical therapy program or to
the Adeli Suit. Both groups were treated 5 days per week for 2
hours. Marginal improvement was noted in both groups
without any statistical difference in results between the 2
groups.
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A second study by Dr. Edward Dabrowski at the Children's
Hospital of Michigan reported the results of 57 children, all of
whom received 1 hour of physical, occupational, and speech
therapy 3 times a week for 8 to 10 weeks followed by a 4-week
home program. The experimental group wore the Adeli Suit
for the last 4 weeks of their therapy program. Both groups
improved and sustained their improvement without any
statistical difference in results between the 2 groups. The
UCP Foundation concluded that "[t]hese 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 use of the Adeli Suit
was helpful. Any effect is likely to be minor."
Controlled clinical studies are necessary to determine the
beneficial effects of suit therapy, if any, for the treatment of
CP, especially which patients would benefit the most and how
long any beneficial results would last.
Liptak (2005) reviewed 9 treatment modalities used for
children who have CP including the Adeli Suit. The author
noted that no conclusive evidence either in support of or
against the use of the Adeli suit is available.
Bar-Haim and colleagues (2006) compared the effectiveness
of Adeli suit treatment (AST) with neurodevelopmental
treatment (NDT) in children with CP. A total of 24 children with
CP, levels II to IV according to the Gross Motor Function
Classification System (GMFCS), were matched by age and
functional status and randomly assigned to the AST or NDT
treatment groups. In the AST group (n = 12; 8 males, 4
females; mean age of 8.3 years [SD 2.0]), 6 children had
spastic/ataxic diplegia, 1 triplegia and 5 spastic/mixed
quadriplegia. In the NDT group (n = 12; 9 males, 3 females;
mean age of 8.1 years [SD 2.2]), 5 children had spastic
diplegia and 7 had spastic/mixed quadriplegia. Both groups
were treated for 4 weeks (2 hours daily, 5 days per week, 20
sessions). To compare treatments, the Gross Motor Function
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Measure (GMFM-66) and the mechanical efficiency index
(EIHB) during stair-climbing were measured at baseline,
immediately after 1 month of treatment, and 10 months after
baseline. The small but significant time effects for GMFM-66
and EIHB that were noted after 1 month of both intensive
physiotherapy courses were greater than expected from
natural maturation of children with CP at this age.
Improvements in motor skills and their retention 9 months after
treatment were not significantly different between the 2
treatment modes. Post-hoc analysis indicated a greater
increase in EIHB after 1 month (p = 0.16) and 10 months (p =
0.004) in AST than that in NDT, predominantly in the children
with higher motor function (GMFCS Levels II and III). The
results suggested that AST might improve mechanical
efficiency without a corresponding gain in gross motor skills,
especially in children with higher levels of motor function.
These investigators also stated that "[f]uture studies on the
effectiveness 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 to reduce variability …. ".
TheraTogs (TheraTogs, Inc., Telluride, CO) are an orthotic
undergarment that consist of a 2-piece body suit and a
strapping system that is customized for the child. TheraTogs
are worn every day and, according to the manufacturer's
website, are indicated for children with a variety of disorders,
including ataxia, athetosis, low muscle tone, poor postural
alignment and joint deviations. There is a lack of evidence of
the effectiveness of TheraTogs in the peer-reviewed,
published medical literature.
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Stabilizing Pressure Input Orthoses (SPIO) are made from a
Lycra-like blend material that are intended to provide deep
pressure through compression to improve positional limb and
body awareness, core muscle and joint stabilization, and
increase precision of muscle activation and movement.
Hylton and Allen (1997) stated that the use of flexible
compression bracing in persons with neuromotor deficits offers
improved possibilities for stability and movement control
without severely limiting joint movement options. This
treatment modality has been explored with increasing
application in children with moderate to severe CP and other
neuromotor deficits with good success. Significant functional
improvements using Neoprene shoulder/trunk/hip bracing led
these researchers to experiment with much lighter
compression materials. The stabilizing pressure input orthosis
(SPIO) bracing system is custom-fitted to the stability,
movement control and sensory deficit needs of a specific
individual. The SPIO bracing system supposedly can provide
an improved base of support for functional gains in balance,
dynamic stability, general and specific movement control with
improved postural and muscle readiness. However, there is
currently insufficient evidence to support the effectiveness of
SPIO.
Autti-Ramo and colleagues (2006) reviewed the evidence on
the effectiveness of using upper and lower limb casting or
orthoses in children with CP. These researchers used
computerized bibliographic databases to search for systematic
reviews without any language restrictions. Identification,
selection, quality assessment, and data extraction were
performed independently by 2 investigators. Of the 40
identified reviews, 23 were selected for closer consideration,
and 5 reviews met the inclusion criteria. The quality of existing
systematic reviews and original studies included in the review
varied widely. The following evidence was found: (i) casting of
lower limbs has a short-term effect on passive range of
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movement; (ii) orthoses that restrict ankle plantar flexion
have a favorable effect on an equinus walk, but the long-
term clinical significance is unclear; and (iii) evidence on
managing upper limb problems with casting or splinting in
children with CP is inconclusive. The author concluded that
there is a paucity of evidence from primary studies on the use
of orthoses in children with CP. They stated that more original,
well-designed research is needed.
Available evidence does not demonstrate durable benefits
from the use of suit therapy for CP (NHSC, 2002; NHS QIS,
2005).
In a case report, Bailes et al (2010) investigated the effects of
intensive suit therapy on gait, functional skills, care-giver
assistance, and gross motor ability in children with CP. Two
children with spastic diplegia classified at level III on the
GMFCS participated. Outcomes were assessed using
dimensions D and E of the GMFCS, the Pediatric Evaluation of
Disability Inventory (PEDI), and instrumented gait analysis.
Each child participated in the Therasuit Method, 4 hours a day,
5 days a week for 3 weeks. Very small improvements in
function were noted in dimension D of the GMFCS and PEDI
Self-care Domain with decreased function in other areas.
Improved walking speed, cadence, symmetry, joint motion,
and posture were found with gait analysis. The authors
concluded that further investigation is needed of the suit itself,
and intensive therapy programs in children with CP.
Bailes et al (2011) examined the effects of suit wear during an
intensive therapy program on motor function among children
with CP. A total of 20 children were randomized to an
experimental (TheraSuit) or a control (control suit) group and
participated in an intensive therapy program. The PEDI and
GMFM-66 were administered before and after (4 and 9
weeks). Parent satisfaction was also assessed. No significant
differences were found between groups. Significant within-
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group differences were found for the control group on the
GMFM-66 and for the experimental group on the GMFM-66,
PEDI Functional Skills Self-care, PEDI Caregiver Assistance
Self-care, and PEDI Functional Skills Mobility. No adverse
events were reported. The authors concluded that children
wearing the TheraSuit during an intensive therapy program did
not demonstrate improved motor function compared with those
wearing a control suit during the same program.
Maguire et al (2012) presented the protocol of
a study designed to investigate the long-term effects on the
recovery of gait, balance and social participation of gait
rehabilitation with TheraTogs compared to gait rehabilitation
with a cane following first time acute stroke. This study will be
a multi-center, single-blind, randomized trial with 120 patients
after first stroke. When subjects have reached Functional
Ambulation Category 3 they will be randomly allocated into
TheraTogs or cane group. TheraTogs will be applied to
support hip extensor and abductor musculature according to a
standardized procedure. Cane-walking held at the level of the
radial styloid of the sound wrist. Subjects will walk throughout
the day with only the assigned walking aid. Standard therapy
treatments and usual care will remain unchanged and
documented. The intervention will continue for 5 weeks or
until patients have reached Functional Ambulation category 5.
Outcome measures will be assessed the day before begin of
intervention, the day after completion, 3 months, 6 months and
2 years. Primary outcome is Timed "up and go" test;
secondary outcomes are peak surface electromyography of
gluteus maximus and gluteus medius, activation patterns of
hemiplegic leg musculature, temporo-spatial gait parameters,
hemiplegic hip kinematics in the frontal and sagittal planes,
dynamic balance, daily activity measured by accelerometry,
Stroke Impact Scale. Significance levels will be 5 % with 95 %
confidence intervals. Intentio-t-treat analyses will be
performed. Descriptive statistics will be presented. The
authors concluded that this study could have significant
implications for the clinical practice of gait rehabilitation after
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stroke, particularly the effect and appropriate use of walking
aids. The results could be important for the development of
clinical guidelines and for the socio-economic costs of post-
stroke care.
In a case-study, Matthews and Crawford (2006) noted that
treatment of scoliosis has been under discussion in relation to
surgical intervention since the Boston brace was presented by
Hall in 1976. The effects of rigid bracing on thoracic skeletal
integrity and the possible deformation of ribs due to the high
localized pressure due to prolonged wear have been high-
lighted. The lack of compliance has encouraged clinicians to
examine other options for non-surgical treatment. The
Spinecor and Triac bracing systems have been developed as
a result of this research; however, both of these orthoses had
been designed with idiopathic scoliosis in mind. Little research
has been done into the effects of bracing on the neuropathic
curve. The use of dynamic Lycra garments in the treatment of
neurological scoliosis offers the advantage of deformity
correction without the bulk and discomfort of rigid braces.
Recent clinical experience has shown that the Lycra suits have
a positive effect in the treatment of scoliosis. The
authors discussed the treatment of a child presenting with a
spinal tumor and although not truly of neurological
presentation indicates that the garment can be used for the
different scoliotic presentations.
In a phase 1 exploratory study, Matthews et al (2009) aimed to
establish proof of concept of the effects of dynamic
elastomeric fabric orthoses (DEFOs) on the gait of children
with spastic diplegic CP. Replicated single case experiments
employing an ABA methodology were carried out on 8
subjects (median age of 5.5 years, range of 3 to 13 years; 4
girls and 4 boys) utilizing quantitative/qualitative data
collection. Outcome measures were: 10-meter walking test
(10MWT); physiological cost index (PCI); visual analog scale
(VAS) scoring of perceived gait changes; functional mobility
changes using Patient Specific Functional Scale (PSFS);
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subject/carer perceptions recorded in daily diaries. Results
identified following analysis of quantitative data indicated a
treatment effect from the orthoses, which could be
corroborated by participant's subjective impressions and
comments. Statistically significant (p < 0.05) intervention-
related improvements in gait velocity and gait consistency
were identified in 5/8 and 4/8 subjects, respectively. Power
calculations support the feasibility of a larger controlled study
to further investigate this orthotic intervention. This study
indicated that DEFO leggings can confer beneficial effects on
the gait of some children with spastic diplegia resulting from
CP. They noted that these findings have implications for
orthotic intervention with this subject group.
In a pilot study, Jeon et al (2012) evaluated the feasibility of
intensive training using a spring-assisted hand orthosis on
upper extremity in individuals with chronic hemiparetic stroke.
A total of 5 participants for the experimental group and 5 for
the control group were recruited from a local rehabilitation
hospital. Subjects in the experimental group participated in 4
weeks of training using a SaeboFlex orthosis for 1 hour per
day, 5 times per week. Each subject in the control group wore
the same orthosis for 1 hour per day without participating in
upper extremity training. Outcome measures included the Fugl-
Meyer Assessment, Box and Block Test, and Action Research
Arm Test; kinematic parameters were collected using a 3-D
motion analysis system. The Fugl-Meyer assessment and the
Box and Block Test score were increased significantly in the
experimental group after the intervention.
The resultant velocity of the wrist joint for the reach-to-grasp
task decreased significantly, and the resultant velocity of the
shoulder joint while performing a reach-to-grasp task at
acromion height decreased significantly in the experimental
group. The authors concluded that spring-assisted dynamic
hand orthosis training is feasible in recovering the movement
of the hemiparetic upper extremity.
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In a pilot study, Barry et al (2012) compared the effect of
therapy using a wrist-hand orthosis (WHO) versus manual-
assisted therapy (MAT) for individuals with chronic, moderate-
to-severe hemiparesis. The relationship between the
repetitions during therapy and functional change was also
examined. A total of 19 participants were randomly assigned
to either the WHO group (n = 10) or the MAT group (n = 9).
The WHO group performed therapy while wearing a dynamic
WHO (SaeboFlex), the MAT group performed therapy with
manual assistance of a therapist. Both groups participated in
1 hour of therapy per week for 6 weeks and were prescribed
exercises to perform at home 4 days per week. Pre- and post-
training assessments included grip strength, the Action
Research Arm Test (ARAT), Box and Blocks (B&B) test, and
Stroke Impact Scale (SIS). There were no significant
between-group differences for any of the measures. Within-
group differences showed that the WHO group had a
significant improvement in the ARAT score (mean = 2.2; p =
0.04). The MAT group had a significant improvement on the
percent recovery on the SIS (mean = 9.3 %; p = 0.03) and
approached a significant improvement on the ARAT (mean =
1.4; p = 0.08). When analyzing all participants together, the
relationship between the number of exercise repetitions and
functional improvement was moderate for the ARAT and the
B&B test (r = 0.55, p = 0.02, and r = 0.30, p = 0.10,
respectively). The authors concluded that small improvements
in function and perception of recovery were observed in both
groups, with no definite advantage of the WHO.
van der Heide and colleagues (2015) stated that numerous
dynamic arm supports have been developed in recent
decades to increase independence in the performance of
activities of daily living. Much effort and money have been
spent on their development and prescription, yet insight into
their effects and effectiveness is lacking. These investigators
performed a systematic review of evaluations of dynamic arm
supports. The 8 technical evaluations, 12 usability
evaluations, and 27 outcome studies together make 47
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evaluations. Technical evaluations were often used as input
for new developments and directed at balancing quality, forces
and torques, and range of motion of prototypes. Usability
studies were mostly single-measure designs that had varying
results as to whether devices were usable for potential users.
An increased ability to perform activities of daily living and
user satisfaction were reported in outcome studies. However,
the use of dynamic arm supports in the home situation was
reported to be low. Gaining insight into why devices are not
used when their developers believe them to be effective
seems crucial for every new dynamic arm support developed.
The authors noted that the methodological quality of the
outcome studies was often low, so it is important that this is
improved in the future.
In a systematic review and meta-analysis, Martins and
colleagues (2016) evaluated the effectiveness of suit therapy
on functioning in children and adolescents with CP. These
researchers performed a comprehensive search of peer-
reviewed articles on electronic databases, from their inception
to May 2014. Studies included were rated for methodological
quality using the Physiotherapy Evidence Database scale.
Effects of suit therapy on functioning were assessed using
meta-analytic techniques. From the 46 identified studies, 4
met the inclusion criteria and were included in the meta-
analysis. Small, pooled effect sizes were found for gross
motor function at post-treatment (g = 0.46, 95 % confidence
interval [CI]: 0.10 to 0.82) and follow-up (g = 0.47, 95 % CI:
0.3 to 0.90). The authors concluded that the small number of
studies, the variability between them, and the low sample sizes
were limitations of this review. Findings suggested that to
weigh and balance benefits against harms, clinicians, patients,
and families need better evidence to examine and prove the
effects of short intensive treatment such as suit therapy on
gross motor function in children and adolescents with CP.
Therefore, the authors stated that more research based on high-
quality studies focusing on functioning in all dimensions
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of the International Classification of Functioning, Disability and
Health perspective is needed to clarify the impact of suit
therapy.
Dynamic Movement Orthoses:
Serrao and colleagues (2017) noted that patients with
cerebellar ataxia show increased upper body movements,
which have an impact on balance and walking. In a
longitudinal, uncontrolled study, these researchers examined
the effect of using dynamic movement orthoses (DMO),
designed as elastic suits, on trunk motion and gait
parameters. A total of 11 patients (7 men, 4 women; mean
age of 49.9 ± 9.5 years) with degenerative cerebellar ataxia
were enrolled in this study. Linear over-ground gait of patients
was recorded using an opto-electronic gait analysis system
before DMO use (DMO-) and during DMO use (DMO+). Time-
distance parameters, lower limb joint kinematics, body sway,
trunk oscillations, and gait variability (coefficient of variation,
CV) were recorded. Patient satisfaction with DMO device was
measured using Quebec user evaluation of satisfaction with
assistive technology. When using the DMO, patients showed
a significant decrease in stance phase duration, double
support phase duration, swing phase CV, pelvic range of
movements (ROMs), body sway, and trunk ROMs. A
significant increase was observed in the swing phase duration
and knee joint ROMs. Of the 11 subjects, 10 were either quite
satisfied (8 points) or very satisfied (2 points) with the assistive
device. The authors concluded that the DMO reduced the
upper body motion and improved balance-related gait
parameters. These researchers proposed that DMO be used
as an assistive/rehabilitative device in the neuro-rehabilitation
of cerebellar ataxia to improve the trunk control and gait
stability. They stated that DMO may be considered a
prototype that can be modified in terms of material
characteristics, textile layers, elastic components, and
diagonal and lateral seams. These preliminary findings need
to be validated by well-designed studies.
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CPT Codes / HCPCS Codes / ICD-10 Codes
Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":
Code Code Description
ICD-10 codes will become effective as of October 1, 2015:
CPT codes not covered for indications listed in the CPB:
There is no specific CPT code for suit therapy or Dynamic Movement Orthoses:
There is no specific HCPCS code for suit therapy device:
ICD-10 codes not covered for indications listed in the CPB (not all-inclusive):
G80.0 -
G80.9
Cerebral palsy
G81.00 -
G81.94
Hemiplegia and hemiparesis
I69.00 -
I69.998
Sequelae of cerebrovascular disease
M40.00 -
M41.9
Kyphosis and scolliosis
The above policy is based on the following references:
1. Rosenbaum P. Controversial treatment of spasticity:
Exploring alternative therapies for motor function in
children with cerebral palsy. J Child Neurol. 2003;18
Suppl 1:S89-94.
2. Shvarkov SB, Davydov OS, Kuuz RA, et al. New
approaches to the rehabilitation of patients with
neurological movement defects. Neurosci Behav Physiol.
1997;27(6):644-647.
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3. Semenova KA. Basis for a method of dynamic
proprioceptive correction in the restorative treatment of
patients with residual-stage infantile cerebral palsy.
Neurosci Behav Physiol.1997;27(6):639-643.
4. Sologubov EG, Iavorskii AB, Kobrin VI, et al. Role of
vestibular and visual analyzers in changes of postural
activity of patients with childhood cerebral palsy in the
process of treatment with space technology. Aviakosm
Ekolog Med. 1995;29(5):30-34.
5. Semenova KA, Antonova LV. The influence of the LK-92
'Adeli' treatment loading suit on electro-neuro-myographic
characteristics in patients with infantile cerebral paralysis.
Zh Nevrol Psikhiatr Im S S Korsakova. 1998;98(9):22-25.
6. Iavorskii AB, Kobrin VI, Sologubov EG, et al. Changes in
individual profiles of cerebral hemispheric asymmetry
during somatosensory stimulation due to wearing of
G-suits by healthy adults and children. Aviakosm Ekolog
Med. 1997;31(6):18-23.
7. Shvarkov SB, Davydov OS, Kuuz RA, et al. New
approaches to the rehabilitation of patients with
neurological motor defects. Zh Nevropatol Psikhiatr Im S
S Korsakova. 1996;96(3):51-54.
8. Semenova KA. The validation of a method of dynamic
proprioceptive correction for the rehabilitative treatment
of patients with the residual stage of infantile cerebral
palsy. Zh Nevropatol Psikhiatr Im S S Korsakova.
1996;96(3):47-50.
9. Iavorskii AB, Sologubov EG, Kobrin VI, et al. The
influence of space loading suits on interhemispheric
asymmetry of the brain in infantile spastic cerebral palsy.
Zh Nevrol Psikhiatr Im S S Korsakova. 1998;98(9):26-29.
10. Sologubov EG, Iavorskii AB, Kobrin VI. The significance
of visual analyzer in controlling the standing posture in
individuals with the spastic form of child cerebral
paralysis while wearing 'Adeli' suit. Aviakosm Ekolog
Med. 1996;30(6):8-13.
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11. Nemkova SA, Sologubov EG, Iavorskii AB. New
possibilities of the use of space technologies in the
treatment of children with injuries of the central nervous
system. Aviakosm Ekolog Med. 2002;36(3):55-58.
12. United Cerebral Palsy (UCP) Research & Education
Foundation. The Adeli Suit, 3/99. Research Fact Sheets:
Diagnosis/Treatment. Washington, DC: UCP; March
1999. Available at:
http://www.ucp.org/ucp_generaldoc.cfm/1/4/24/24-
6608/82. Accessed November 17, 2004.
13. United Cerebral Palsy (UCP) Research & Education
Foundation. New: The Adeli Suit Update, 11/2004.
Research Fact Sheets. Washington, DC: UCP;
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19. Rennie DJ, Attfield SF, Morton RE, et al. An evaluation of
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verzekeren prestatie. Diemen, The Netherlands; CVZ;
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39. Martins E, Cordovil R, Oliveira R, et al. Efficacy of suit
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Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan
benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial,
general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care
services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors
in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely
responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is
subject to change.
Copyright © 2001-2018 Aetna Inc.
http://aetnet.aetna.com/mpa/cpb/600_699/0696.html 10/29/2018
AETNA BETTER HEALTH® OF PENNSYLVANIA
Amendment to Aetna Clinical Policy Bulletin Number:
0696 Suit Therapy
There are no amendments for Medicaid.
www.aetnabetterhealth.com/pennsylvania Updated 02/08/2018