Transcription:
Rehabilitation Enhanced by Advanced Technology

Melanie:  Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole, and I invite you to listen as we examine rehabilitation enhanced by advanced technology. Joining me in this panel today is Stephanie Salentine, she's the manager of rehabilitation services at Northwestern Medicine's Marianjoy Rehabilitation Hospital, and Dr. Anita Kou, she's a physical medicine and rehabilitation physician with subspecialty in spinal cord injury medicine. She's also the Medical Director of the Spinal Cord Injury Rehabilitation Program at Northwestern Medicine's Marianjoy Rehabilitation Hospital. Thank you so much, both of you, for joining us today,

Dr. Kou, I'd like to start with you. Tell us a little bit about Marianjoy's comprehensive portfolio of advanced technology. What's going on that's exciting there?

Dr. Anita Kou: Well, Melanie, Marianjoy has the Tellabs Center for Neurorehabilitation and Neuroplasticity, also short for TCNN, and that is a dedicated center to treating our patients with a nervous system injury, such as a stroke brain injury, spinal cord injury, neuromuscular, and vestibular disorders.

At Marianjoy, we can treat both adults and children who have impairment in their movement. And here, we're proud to have therapists who hold specialty certifications in different advanced technology, robotics, and 3D interventions that will work with individuals to retrain their brain through neuroplasticity and repetition to improve one's recovery outcome.

So some notable technology that we have at Marianjoy includes an Ekso, which is a bionic exoskeleton. It's a robotic device with an outer framework where an individual will wear it with a lower extremity weakness or paralysis. And when they wear it, they can stand and walk with it. And Marianjoy is fortunate to be designated as the only center of excellence by Ekso Bionics in Illinois, and one to five such designated centers in the US. And I feel really grateful that we can offer this treatment to our patients during their acute rehabilitation, but also chronically for our patients as an outpatient intervention.

And just like we have lower extremity robotic exoskeleton, we also have upper extremity robotic exoskeleton devices like the Armeo, Armeo Spring, Armeo Power, for example. And these machines allow patients to practice movements in their arm and hand to recover after new weakness. And we won't also forget that we have surface functional electrical stimulation interventions with our Bioness L300, Bioness H200 or RT300, where non-invasive surface electrodes can be place on muscles and technology then delivers electrical stimulation to activate the peripheral nerves that control the muscle movement in specific extremities.

We even have application of virtual reality here at Marianjoy to improve one's balance and vertigo through the Bertec Balance Advantage System and RealEyes xDVR Binocular Video Goggles. So we have a lot of advanced technology at Marianjoy and not only is it for adult patients, but when appropriate, we even use this advanced technology to be fitted for our pediatric patients.

Melanie: That is amazing. Dr. Kou. So Stephanie, Dr. Kou just mentioned all of this really cool equipment that is great for other providers to know that you have at Marianjoy. Tell us how you're using that advanced technology. What are you doing with patients? What are you seeing as far as outcomes and results from this advanced technology?

Stephanie Salentine: I think what is special about the way that we use our advanced technology is that we use it within a clinical setting and a research setting. Our patients don't have to qualify for a research study that may include strict inclusion and exclusion criteria. Our patients are assessed for appropriateness, all of our patients. The technology serves as another tool in a therapist toolkit for all appropriate patients.

That being said, we are also creating and participating in research to ensure that we're contributing to the body of knowledge that exists about advanced technology and robotics, as well as obviously consistently striving to provide optimal care within our inpatient and our outpatient settings. I think the benefit of this is that we're able to utilize technology for patients who do not qualify for research, but also for those who do. And by that, we're able to offer advanced technology and robotics to a larger group. Using this kind of technology allows for our therapists to be able to practice within the evidence in a really safe environment.

Dr. Anita Kou: I really agree with Stephanie on that. Whether it's in a patient who's just getting introduced to Marianjoy through an acute inpatient rehabilitation stay or they were referred to our outpatient services, it's very natural for our patients here to get introduced to advanced technology at the TCNN, because our teams just see the positive outcome, encouraging results that the technology brings.

And the timing of it is very important too. I mean, on the acute rehab side, early on patients will get sessions of the advanced technology intervention in addition to their hands-on care from our inpatient therapists interventions. So that makes the rehab journey off to a great start. And then continuing that journey when they go home and they come back as an outpatient and looking for further recovery, we can tailor it with these dedicated sessions.

Melanie: Well, then Dr. Kou, why is this so unique, what you're doing? Not only how does it benefit patients, but as far as the patients go, what are you seeing? How are they reacting to this?

Dr. Anita Kou: One unique thing is not every rehabilitation facility in the US has the advanced technology. And so accessibility and availability is what makes it unique at Marianjoy. And so being able to offer it for patients early on, but then also making it easier for accessibility for them to come back and continue it, makes it stand out.

Stephanie Salentine: I think you're right, Dr. Kou. Using the advanced technology allows for our therapists, as I was saying before, to practice within the evidence in a safe environment. So it allows us to use the principles of neuroplasticity such as repetition, specificity, intensity to ensure that we partner with the patients to achieve the best outcome and the best results.

You know, I think it's important to note that technology is a part of the treatment plan, though, right? It's vital that it's incorporated within the plan of care and coupled with traditional and functional intervention to be able to provide the most optimal outcome. It's this coupling that we see that enables us to partner with the patient to get the best outcome. We are able to combine traditional therapy and functional intervention with the use of our advanced technology to ensure an optimal and desired outcome.

Melanie: Dr. Kou, give us a complex case where advanced technology was used. Tell us about a case that you find interesting and that you think other providers want to hear about.

Dr. Anita Kou: I remember having one patient in particular who came into Marianjoy with a new traumatic spinal cord injury, kind of an unfortunate case, had a fall at home and he came in with no strength in his bilateral upper extremities and only trace movement in his lower extremities. Based on that kind of initial exam, our prognosis for him to be able to ambulate was very guarded.

So we wanted to get him into the TCNN with the advanced technology right away. And he was introduced first to kind of functional surface electrical stimulation with the RT300 and eventually did well enough to progress with the Armeo Power to kind of help with his upper extremity emerging strength and with active range of motion in those extremities. And with his lower extremities, with our SCI therapy, he did get some emerging strengths and we utilized the ZeroG gait and balancing training system where he was put in a harness system to help protect him from falls, kind of retrain him while he's learning to walk again.

And so an incredible story at the end of his inpatient stay with us, he was walking 400 feet at least at a supervision level with a rolling Walker. So that's just an amazing kind of testament to how early intervention with advanced technology coupling with SCI therapy really made a big difference for this individual.

Stephanie Salentine: I agree, Dr. Kou. We also had another patient that presented after experiencing a stroke. He presented with very little movement of his left upper extremity. Our occupational therapist started him on the Armeo Power, which is our robotic upper extremity exoskeleton, and he began to demonstrate increased movement of his upper extremity.

He actually progressed through our upper extremity advanced service line requiring less and less support as the days went by and making great gains and movement and function. He was at discharge able to use his arm to complete ADL tasks and IDL tasks after he discharged from the inpatient setting.

Melanie: This is amazing. What a great conversation we're having. And Stephanie, expand a little bit and provide an overview for us of Marianjoy's research for other providers on the Armeo Power. What did it seek to uncover and the meaningful endpoints of the study?

Stephanie Salentine: Absolutely. So through our consistent literature review of interventions on upper extremity motor recovery, we identified a gap in the evidence as it relates to more moderately to severely impaired upper extremities. We developed a protocol based on current best practice guidelines and combined robotic therapy and task-specific training. For this study, we fully integrated this protocol into the patient's standard inpatient rehab stay to evaluate the efficacy and effectiveness of the treatment interventions.

Now, while there's no definitive number, neuroplasticity research indicates that high repetition training is actually required to induce a cortical change. So we utilized graded robotic assistance training to support these patients with limited motor control and achieving higher repetition training. This can be very, very difficult in a traditional clinical setting. This is why the advanced technology is so important because, like I said many times, but we'll say just once more, that it really allows for our therapists to be able to achieve the repetitions and the specificity in a safe environment.

Frequently, with more limited motor control, increase in movement doesn't necessarily mean normal movement. It requires specific training to learn how to incorporate the more impaired upper extremity into function. So for our research, our theory was that we would be able to use robotic therapy to increase motor capacity and task-specific training to turn that increased capacity into increased motor function. So what we found was is that overall both groups in our study who participated in the protocols showed improvements in not only motor recovery, but self-reported functional use and also participation in the self-care tasks that they were completing.

Melanie: Stephanie, what's next when it comes to your research in this area? Tell us a little bit about 3D video goggles for rehabilitation of the upper extremities and kind of give us your summary of what you would like other providers to know about Marianjoy's Rehabilitation Hospital, and the exciting technology that you're using there.

Stephanie Salentine: Absolutely. So this is our new proposed research. The purpose of this project is to utilize a three-dimensional virtual reality technology to provide therapy services to our stroke population. So we'll be using a head-mounted 3D virtual reality system. We'll be providing therapeutic interventions to improve functional outcomes for patients that are admitted with a diagnosis of ischemic or hemorrhagic stroke.

The purpose of our study is to evaluate this technology's acceptability, tolerability and feasibility of use in an inpatient setting for therapists and patients. So it's an exciting new path that we're going down with our advanced technology research.

Melanie: Dr. Kou, last word to you. What else would you like providers to know about using this advanced technology, robotics, 3D, most effectively in their clinical rehabilitation practices, and when you feel it's important they refer to the specialists at Marianjoy Rehabilitation Hospital?

Dr. Anita Kou: I think it's, I guess, the word that comes to mind is hope, you know. We can still provide hope to these patients and not forget the amazing ability for the body to really want to heal, this neuroplasticity that Stephanie had referred to. And I would just challenge our providers out there to get to know the nearby rehabilitation facilities in the US, who their physical medicine and rehabilitation providers are in their local community that do offer similar advanced technology. And so when they see their patient the next time, who has a stroke or a brain injury or spinal cord injury, that even in the chronic stage or their injury or disease, there's hope with advanced technology intervention and research is really just helping changing that landscape for us.

I am proud that Marianjoy's doing research with advanced technology. There's talk of some studies out there about brain computer interface system for spinal cord injury recovery of movement and sensation. So, even though early intervention is key when addressing these acute neurological injuries, there's research going on using advanced technology and our traditional therapies in playing a role in these chronic conditions.

Melanie: Thank you, ladies, so much for joining us today and telling us about the exciting advanced technology available at Marianjoy Rehabilitation Hospital. To refer your patient to Marianjoy, please visit our website at Marianjoy.org to get connected with one of our providers.

That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. Please remember to subscribe, rate and review this podcast and all the other Northwestern Medicine podcasts.

I'm Melanie Cole.