High-Tech, Real-Life Rehab
When patients suffer a brain injury, fall, or have balance issues, rehabilitation can make all the difference in their recovery. Now that rehab is going high-tech.
It looks like a spacesuit, but Angelica is gearing up to use a new machine. The Vector helps patients like Angelica learn to walk again after an injury. She's recovering from a brain aneurysm.
Dr. Alan Novick of the Memorial Rehabilitation Institute in Hollywood, Florida is excited by the Vector's potential. "It keeps the patient from falling, so it builds a lot of confidence. This is one of the most exciting devices we've had in a very long time." He told Ivanhoe.
Patients are fully supported. They can walk long distances and practice a normal gait by swinging their arms, something they can't do with a walker.
Therapists don't have to physically hold the patient up, so they can assist in other ways. It also allows patients to walk sooner after their injury.
"If I give somebody a walker, I'm already changing their pattern. With the Vector, I don't need that walker." Said Anna Maria Castaneda, a therapist at the Memorial Rehabilitation Institute.
The Vector can help any patient who experiences weakness. 1.7 million Americans suffer a brain injury each year. One in three older adults falls and about 15 percent of Americans have problems with balance or dizziness.
The institute also uses models like an ATM and a car to help patients with everyday activities they're likely to face when they return home. Patients practice getting in and out of the car and using the ATM.
It's high-tech and real-life therapy helping patients get back to everyday life.
Dr. Novick says the Vector can help patients with any kind of neurological injury or other conditions like Parkinson's, MS, stroke or spinal cord injuries.
SPINAL CORD INJURY: The spinal cord acts as a hub for a group of nerves that run from the brain to other parts of the body. These nerves allow the brain to send messages to the arms, legs and other areas to command movement. There are other nerves that travel back from the arms and legs to the brain that bring information back about senses and the environment. Unlike many other parts of the body, the spinal cord is extremely sensitive and cannot repair itself once damaged. A complete spinal cord injury occurs when there is a complete loss of function in the body below the injured section. An incomplete spinal cord injury still has some function below the injured section. Each year, there are approximately 12,000 new cases of spinal cord injuries in the United States. (Source: http://www.medicinenet.com/spinal_cord_injury_treatments_and_rehabilitation/article.htm)
TREATMENT: Injuries to the spinal cord can be difficult for doctors to treat. In some cases, steroids are given to the patient in the very early stages of the injury in order to quickly reduce inflammation and swelling. When performing surgery on the spinal cord, doctors must first relieve any remaining pressure and reduce any amount of compression. If the vertebrae are severely damaged, it may not be able to support the patient and metal screws and plates must be inserted. (Source: http://www.medicinenet.com/spinal_cord_injury_treatments_and_rehabilitation/page4.htm#how_is_a_spinal_cord_injury_treated)
NEW TECHNOLOGY: A new high-tech device known as Vector is helping spinal cord injury patients walk again without the fear of falling. The Vector is a robotic support system that attaches a patient to a harness that's connected to a trolley system on the ceiling. This harness holds the patient upright as they practice walking and gives them added support. Vector is also well received because its harness keeps the patient from falling down while they rehab their walking. Eliminating this fear allows the patients more focus on the rehab and less worrying about not supporting themselves. (Source: http://www.bioness.com/Healthcare_Professionals/Vector_Gait_and_Safety_System.php)
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Alan Novick, M.D., Medical Director for the Memorial Rehabilitation Institute in Hollywood, Florida.
Tell me a little bit about the vector machine.
Dr. Novick: The vector is a fabulous new device we have to help our patients in the South Broward community. What it does is offload the body weight of patients. If somebody doesn't have enough strength to support themselves standing or walking, the machine can take up to 100% of their body weight off so that the patient can then use the strength they have to start practicing how to stand, walk and how to start moving again.
So before, they would just use the pole which is kind of its restricting their hands?
Dr. Novick: Well before, the vector patients would have to start in a parallel bar situation with a therapist holding them for support. Often patients would be very afraid. If they don't have enough strength to support themselves they would be very cautious to even attempt standing with a therapist out of fear. Having the vector which supports any particular amount of weight we set it up for, the patient is more secure and more willing to start standing and walking. We've actually had it about two to three weeks now, so we're just in the beginning stages.
The patient we just saw, was she the first one to use it?
Dr. Novick: She wasn't one of our first ones to use it. We've had several patients now over the past two weeks but she has had a very nice outcome with it.
Can you tell me how big of a difference you're seeing with her?
Dr. Novick: The injuries to her brain caused her to have a lot of weakness and a lot of balance issues and initially before we placed her in the vector she could not stand on her own. She would need a therapist helping support her and she was having difficulty taking steps. Once we put her in the vector she had a more natural gait pattern, started progressing the weak side much better and the changes we've seen during the treatment session. When we start working her with a walker, a lot of the improvement that we saw in the vector carried over.
She had a brain aneurysm that burst?
Dr. Novick: Yes.
Is it just for those kinds of patients or who else?
Dr. Novick: It's really for anyone who has significant weakness for whatever reason. Whether somebody has incomplete paraplegia from a spinal cord injury, had a stroke, or they've had other injuries to the brain, anyone who has neuromuscular weakness or balance problems could benefit from the vector.
How much longer do you think she's going to have to use it here?
Dr. Novick: Again, the nice thing with the vector is that we see carryover. The ultimate goal is to get patients where they can function in their own home environment using an assistive device, whether it's a walker or a cane. That will be the ultimate goal. We use the vector to start getting her up to start working on the quality of her gait pattern but then also working with a walker so we can ultimately get her home. At the pace she's going I don't think it's going to be too much longer.
If you were to guess, would it be weeks, months?
Dr. Novick: We're looking at about another week here.
And she's been in here for two weeks?
Dr. Novick: Approximately.
The physical therapist said it takes a lot more stress off of her. Do you want to talk about that?
Dr. Novick: Sure. Often depending on the level of weakness the patient is dealing with, sometimes we may need not only one therapist but two therapists to support a patient. You'll need one to help them with the balance and sometime the leg is so weak you'll need one therapist to help advance the leg. With the vector, it's supporting the patients so the therapist is then freed up to help guide the leg and help talk to them, but not physically assisting the patient. From the standpoint of our therapist's health, it's certainly wonderful for our staff as well but also is so beneficial to our patients.
So it helps them up and then it helps them have their natural ability to walk. Is there anything else that it helps too?
Dr. Novick: It does a lot of things. First of all, the way I like to look at it is almost like when you're in a pool. The buoyancy of the water supports you even if you're weak. The buoyancy keeps you up and you're not very worried about falling. We like the pool for a lot of our patients; it's a good environment. The vector gives us that on dry land. It supports the body weight and keeps the patient from falling so it builds a lot of confidence. If you're trying to fight through the weakness and the fear that you may fall, that's really very challenging for a patient.
You would have to think that this would help financially.
Dr. Novick: It really isn't about budget or time because ultimately the vector is just one tool in our tool chest of all the different things we can treat a patient with. It's not the only treatment that's going to make them get better quicker. It just is a way that we can treat these patients in a safer manner and get them mobilized earlier. We know that the earlier we get people up and moving the less complications they have.
Are you noticing any downsides at all to this?
Dr. Novick: Not yet.
How much would it cost a patient to use it?
Dr. Novick: Its part of the hospital fee. It's no different than using the parallel bars or walker from our standpoint, it's part of their rehabilitation program.
So nothing extra?
Dr. Novick: No and it really shows the commitment of the memorial healthcare system to our community. We could sit back with traditional therapies and be satisfied with that but this is a way to help our patients and our community in a way that's really very different and very exciting.
How many patients do you think are using it so far here?
Dr. Novick: At this point we probably have 12 to 15 I would say.
And you have high hopes for this?
Dr. Novick: This is one of the most exciting devices we've had in a very long time. Just on the preliminary, we're already seeing such good carryover of the skills they learn while on vector that it really looks like this is going to be a great benefit to our patients.
How far have the patients today come?
Dr. Novick: I think it's one of the disadvantages of only seeing the after shot. Four or five days ago she could not get up. She has come a very long way in a very short time. We used the vector last week on a young man who had an incomplete spinal injury and had partial paralysis of his legs. It was fascinating to see. He did not have sufficient strength to hold up his own body weight but one session on the vector; we initially took 90 percent of his weight off and he could advance the legs and walk. By the end of that session we had reduced it where he was having 60 percent of his body weight. We took off only 40 and he was able to walk in the vector. In the past, it may have been weeks of therapy before we could get him standing in parallel bars. It was very exciting to see him up and walking that quickly.
You can adjust the percentage of how much it's actually holding him up?
Dr. Novick: Correct. Anywhere from minimal amount of weight taken off all the way to taking all of their body weight off.
Do you know what it was when she was up there?
Dr. Novick: I don't know. I didn't see how they set it.
What kind of patients would this help?
Dr. Novick: Anyone who has a neurologic injury with weakness particularly to the legs or balance problems. A patient who had a stroke, a spinal cord injury, a traumatic brain injury, these would all be great candidates for this. We think there's other applications as well, patients with Parkinson's disease who may have some balance disorders, multiple sclerosis patients, anyone with neurologic deficits would greatly benefit.
So we're talking about millions of people that this could help.
Dr. Norvick: I think this is going to help a lot of people of our community.
We saw the patient upstairs on the balance ball. How much is taken off or is it just the same amount?
Dr. Novick: Well typically we adjust how much weight we take off their body depending on how their strength is. Often that may change even from one session to the next as they potentially get stronger. It may also change depending on the activity we're working on. For example, when she's standing and supporting all of her body weight we may have to take more weight off of her. Whereas when she's sitting on the balance ball she's working more on core strength and balance. She's not having to support all of her weight so we may take less off, enough where she is still able to stay upright and work on balance.
Are they doing this every day when they're here or is this like a once a week kind of thing?
Dr Novick: Every patient's rehabilitation program is geared toward their individual needs. There is no one set pattern. Depending on the patient needs, we will adjust the frequency up or down. Once we see a patient is able to walk a little bit more, then we may have fewer sessions on the vector and more sessions with a cane or walker towards getting them home. In the early part of the admission it would be pretty typical that they would get several sessions and frequently on the vector.
So you're certified as a stroke center as well as a brain injury center?
Dr. Novick: The Memorial Rehabilitation Institute is credited for traumatic brain injury and stroke. We're also a designated traumatic brain injury and spinal cord injury program from the Department of Health Division. We're a state brain and spinal cord injury certified program and we see a lot of the fairly devastating injuries, severe strokes, severe spinal cord injuries, traumatic brain injury patients and all of them would greatly benefit from this device.
We saw her downstairs doing the car and groceries and ATM machine, is that new?
Dr. Novick: We built this facility about six years ago and we've had the car since then. Interestingly it actually grew out of patient responses. We would often have patients who the day of discharge were fearful about getting into a car even though we had trained them in a little simulator. As we looked at building a state-of-the-art facility we felt from our own patient surveys that a real car was essential.
The patients go through about how many hours a day of therapy?
Dr. Novick: For our patients in a comprehensive rehabilitation center like we are, patients by federal regulation have to be able to participate in at least three hours of therapy per day, so all of our patients have a minimum of three hours and often more depending on their individual needs.
What's the most that they could do?
Dr. Novick: There isn't a most.
There is no over doing it right?
Dr. Novick: Yes there is. We try not to fatigue patients so sometimes you can actually overdo it particularly depending on the diagnosis. Usually we gear the program to the individual patient's needs and abilities. If somebody can tolerate more than three hours we try to gear it toward their needs.
Talk about the psychological advantage that the vector has because of the patient's fear of falling down?
Dr. Novick: Sure. Because of their particular illnesses or weakness, a lot of our patients are at risk of falling. Some of our patients even have already fallen when they first had their stroke. There is a strong psychological factor of fear. If you're weak and you're not able to move around the way you normally would it's a very scary thing to try to get up and be afraid of falling. The vector tends to take that fear totally away because they are supported. Sometimes we even let them try to fall a little bit to get that feel that it's supporting them and you just see as their working with the vector their confidence builds. They can now focus on working on the walking or working on the balance and not concentrating so much on trying not to fall.
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