Transcription:
Advanced Technologies to Treat Spinal Cord Injury

Melanie Cole (Host): Robotics and advanced technology are transforming rehabilitation for people with spinal cord injury, stroke and other neurological conditions. Today, there’s hope for a much fuller recovery and a much brighter future. My guests today are two physical therapists from the Courage County Rehabilitation Institute in Minneapolis to tell us more. Brian LeLoup, he's the director of subacute services, and Jeanne Olsen, she’s a rehabilitation services manager for activity-based locomotor exercise aquatics and fitness. Welcome to the show. So, Brian, I'm going to start with you. How are robotics and advanced technology being used in rehab for people with spinal cord injury and using, applying this technology to rehab. Is it helping to restore things we weren't seeing before?

Brian LeLoup (Guest): A great question, Melanie, and I think the answer is…the short answer is yes, and really what it comes down to is, regardless of who we're talking about spinal cord injury if we're talking about just life, it is good for people to get up and move, when you have kind of suffered from a spinal cord injury, you enter a period of rehabilitation, where you're really looking to maximize your recovery from that injury. And a huge component of that really becomes, how can you get up and get moving?

Research has been progressing in this field, and really been speeding up around the concept of neuroplasticity. So, it's not just, how do I move kind of given the parts of my body that were un-involved in the injury, but really, how can I help my spinal cord actually change function better and improve below the level where I was injured? And really that's where these advanced technologies, and these rehabilitation robotics are coming in. They're allowing people that have had a spinal cord injury to really maximize and improve their function kind of both right after injury and long-term.

Melanie: So, Brian, I'm sticking with you for a second. How soon after injury are we talking about because we know now that people that have had heart surgery or a new hip, they get up the same day in some circumstances. So, what about somebody with spinal cord injury?

Brian: And that's really it. The sooner the better is the answer. Now, obviously after that type of an injury there is normally a period where you're looking at stabilization of the spine, medical stability those sorts of things, but really as soon as it is safe and reasonable for an individual to get up and get moving in these devices, we're really initiating it. And what the research is showing is kind of the sooner you can get it initiated, the long-term benefit of that continue to compound on each other.

Melanie: So, Jeanne, why is it so important to get moving so quickly, and as Brian said, as long as we're talking about spinal stability and that they can try and move around, what is happening in the body that makes it so important to keep moving as quickly as possible?

Jeanne Olson (Guest): Yeah, so even the general population, it's well proven that 150 minutes of aerobic exercise each week is important for somebody with a spinal cord injury that can be challenging to be able to achieve that level of exercise. So, it's important to get moving quickly, and to have the proper sensory cues, for a person with a spinal cord injury, you can activate below the level of injury and give feedback to the spinal cord. The spinal cord is smart, and so, it will re-learn the stepping and standing components, The Able Program with Courage County is part of the customer and Dana Reeve Foundation, and they have been doing basic science research that has demonstrated a lot of functional quality life and health improvements as a result of this intensive exercise and locomotor training.

Melanie: So, Jeanne, tell us about some of those functional benefits.

Jeanne: We see people that have been able to reduce the amount of pain medication that they take, the amount of medication that they take for their specificity. Being able to hold their grandson on their lap for the first time, basic quality of life things that people are able to achieve, when you're able to use a treadmill system or robotic system to be able to stand, that upright position gives you improvement in your cardiovascular system, and also, your bone and bladder function. And, as we know, anybody that exercises, they can sleep better, their fatigue is improved and their pain can be reduced.

Melanie: So, Brian, if somebody has a spinal cord injury, but they still want to get that type of exercise that, Jeanne, was discussing. How can they use a treadmill or a robotic walking device because some of these are so cool. So, explain some of them for us.

Brian: Yeah, you're exactly right. They're very cool, and I think, frankly, the future of them are really fun to kind of pay attention to, but right now, there's basically two types. There's the type that kind of attached to a treadmill. So, if you can imagine an individual has kind of a glorified climbing harness, they are attached to some sort of an overhead lift system that allows them to take as much of their body weight as they can, but also supports them if they can't support their body weight against gravity. Just like being kind of in a pool where you're much lighter in a pool, it's the same thing, and then a robotic exoskeleton is basically attached to their trunk and or lower legs, so some kind of a cuff attachment on your thigh and lower leg, and basically what happens is, as the treadmill moves, the robotic exoskeleton moves, and an individual begins the practice of walking. And these devices all have different levels of adjustments, but the intent of all of these devices is to get individuals up and moving in an appropriate gait pattern. And then frankly as able, turn the devices down to allow the individual to do as much of the work, as much of the walking as possible, and that's really where the training occurs.  

So, that's kind of one major type of robotic exoskeleton, the other major type that's out there is kind of a freestanding one, and this is the type of device where, again, they attached to an individual's lower legs and trunk, but then they are kind of walking out in the environment. Normally they're using some kind of upper extremity device, like a walker or forearm crutches, to aid with balance, but it's the same the same idea where this exoskeleton assists the individual in actually taking the step and allows them to get up, get mobile, get the practice. And then depending upon the device, the idea is to continue to turn that device down to allow the individual to do as much as possible.

Melanie: And, Jeanne, do you have something to add about this with some of the treadmills, and how robotic that they are, and the early recovery process?

Jeanne: Yes. So, the robotic, like to loco-mat, for example, can be used even while somebody is still hospitalized, and then progress to other form. So, the treadmill that we use in The Able Program, it has a harness, like Brian just described, but then we have staff that do specific cues to the leg that give feedback up the spinal cord, and then somebody is supporting their trunk, and somebody else is controlling the body weight support system. All of this is intended to excite the nervous system, and to get it charged up to participate in other exercises

Melanie: Wow, that's amazing, really amazing bit of technology. And, Brian, what other technology and robotics are now being used in rehabilitation?

Brian: Well I think probably one of the other most exciting kind of technologies that’s being used is really the broad range of electrical stimulation that's being used in rehabilitation, which is really kind of allowing individuals to allow an electrical stimulation to kind of help turn on the muscles that individuals have trouble recruiting and that can be their leg muscles, that can be their trunk muscles, that can be…a lot of places are doing direct implantable devices, but really adjuncting our volitional control of muscles with an outside electrical source, and kind of helping…

Melanie: Who's running the outside electrical source? Would that be patient themselves or is that you physical therapists?

Brian: That's a great question. Most of these are clinical paradigms to start with, so the physical therapist is doing, or we have, as Jeannie mentioned, our Able Programming where our able staff are kind of putting them through a protocol, and using these devices. We also are seeing a huge kind of change in what we call our functional electrical stimulation cycling programs or bikes, where again whether it's in a clinic model where a therapist is doing it or an individual is coming to independently ride, they can come and independently set themselves up, say with electrodes on their legs, and ride a recumbent bicycle. Now, it's a stationary bike so they're supported, but it still allows them to get all the benefits of you and I going to the gym and riding a recumbent bicycle. So, the cardiovascular, the bone density, the bowel, the bladder, the goodness, if you will of exercise, but it also has that added benefit of happening below the level of the lesion, and really affecting that sensory input as part of the recovery.

I think the other the other big changes, really are this vast array of kind of overhead or overhead or ceiling mounted bodyweight support systems. So, I encourage Kenya, we have the vector system, which is the ceiling mounted system, which, again, allows an individual who can't support all of their body weight right away to kind of get up and get moving. And they do as much as they have the ability to do, and the device takes the rest of their body weight, but this is a device that can say, allow someone to only manage 50 percent of their body weight, and it's not just about walking, but they can work on their balance, they can work on going from sitting to standing, they can work on going up downstairs, they can work on getting from the floor up to the ground, or excuse me from the floor up to standing.

So, this concept though, this underlying concept that movement is key to recovery, early initiation of appropriate movement is key to long term recovery, and the intensity of the amount of practice that individuals do in these activities is important to recovery. And so, these technologies whether it's through robotic technology, the unweighting technology, the electrical stimulation technology really allow for that practice to occur, and it is important to call out that and it's applied in a manner that not only allows for practice, but actually allows for stimulation and changes to occur at the nervous system level. So, there's one thing to be up and moving, but it's another thing to really change the nervous system and improve the function long-term

Melanie: Yeah, the vector gait and safety systems are so absolutely amazing for people with spinal cord injury, and so, Jeannie last word to you. What would you like people to know about recovery from spinal cord injury or stroke and the Courage Kenny Rehab Institute, and how exciting the technologies are nowadays for people that are looking for these new advancements that can help them progress to recovery?

Jeanne: Yes, thanks. It's really exciting all the different advancements that have made, both in research and technology, and the access to it, that we have at Courage County to these devices. It's really hopeful for people with spinal cord injury or other neurological conditions, the progress that they can make and the improvements in their quality of life.

Brian: And, Melanie, I think I think Jean is exactly correct, what we try to do at Courage County is really match the individual, and kind of where they are in their recovery and what they need with the technology that can maximize their benefit, and with the skilled professional that can kind of help direct that care. And I think that's one of the exciting components is really being able to meet individuals where they are, and help them take the next steps in their recovery.

Melanie: Great. Thank you both so much for being with us today and for giving such great information to our listeners. You're listening to the Well Cast with Allina Health, and for more information, you can go to, AllinaHealth.org, that’s, AllinaHealth.org. This is Melanie Cole, thanks so much for listening.