Neurologists at Sunnyview Rehabilitation Hospital in Schenectady are using cutting edge robotic assistance devices to help individuals recover from brain injuries.
Thomas Turner says on July 1st, he suddenly felt a sharp pain and a pop in his forehead and then had a headache. The Schenectady resident laid down on his bed, nauseous and sick. Ultimately, doctors would tell him he had a stroke. The New York State Department of Health reports 6,000 people die from stroke each year. Those who survive often have a rough road ahead.
Turner has been at Sunnyview Rehabilitation Hospital since his stroke undergoing therapies.
“Oh, let’s see. I’ve been doing OT [occupational therapy], PT [physical therapy] and speech [therapy.] Speech is helping me accentuate and be louder when I talk,” Turner said. “PT has helped me with walking upstairs, long-distance walking, getting in a car. Let's see, mat work, strength work. Really going out of their way to help me get back to where it was. And OT’s helped me with everyday life, getting showered, cooking in the kitchen. I can’t complain. They’ve done an excellent job, so far.”
One of those treatments is using the EKSO Exoskeleton, which came to market in 2013. The patient puts a device that looks like a backpack over their shoulders and it straps around their chest and waist. It continues down with straps on their thighs and calves and the patient slides their feet into sandal-like bottoms. A solid pole goes from the bottom of their feet up to their hips on each side of their body.
Turner stands up from his wheelchair to grip a walker while one therapist steadies his waist from behind and another guides the walker moving backwards while watching Turner’s feet.
Melanie Melewski, a brain injury physical therapist, explains how it works.
“It's adaptive, it will do anything from zero percent of the work up to 100 percent of the work,” Melewski said. “So, it allows our patients to work where they're at. It'll put them on a trajectory that’ll allow them to take better steps, more normal steps and start to get back to where they were before. It also allows them to work on endurance, because if they're getting fatigued, the machine can keep taking more steps for them, as well. It also has different modes like squats, you can work on backwards walking, it doesn't have to be with a walker. We can work on different devices like a cane or crutches.”
Turner describes what it feels like to walk with it.
“It’s like the Robocop! I mean, you're locked in and somewhere in between that and the loader from the Aliens movie riding in it,” he explained. “It feels pretty comfortable and stable, you know, it takes a little getting used to, but once you're used to it, I think it's fine.”
The device is approved by the FDA for therapy treating acquired brain injury, stroke, traumatic brain injury, and spinal cord injury, and was recently approved for Multiple Sclerosis. It is not approved for home use.
Melewski says therapists used to have to help patients manually.
“There's been partial bodyweight support training, but in that case, therapists have to manually facilitate the steps which can be not only fatiguing on the therapist, but may not be the most consistent or just holding them up and trying to manually facilitate them,” Melewski said. “So it's safer for the therapist, safer for the patient and allows really, really quality steps as well.”
She adds it also expedites physical therapy improvements.
“The idea is that it allows us to get a higher intensity early,” she said. “And in the acute setting when people are just a few weeks out, a few days out from their initial injury that's a really crucial area for where their brain can learn the most. So, we're very lucky to have one of these on the inpatient side of things. Not a lot of places do.”
Another robotic assistance device helping patients is named Burt. It’s for upper-extremity rehabilitation training – and it has a fun side. The Brian Injury Association’s Diana Ernos agreed to be the “patient” for a demonstration.
Ernos sits in a chair facing a monitor, rests her forearm on a robotic arm before her and grasps a knob to move the device. Occupational therapist Rebecca Grondin straps Ernos’ arm into it and explains how it works.
“This combines a little bit of visual feedback, biofeedback, where your arm is doing something paired with the screen,” Grondin said. “Also it provides a little bit of gravity assistance so it takes the weight off of your arm to allow you to move a little bit more freely and then we can always kick in the robot to assist you to get to a full range of motion. So, it can do a combination of things that traditionally things like weight training and therapies can't do. It also incorporates cognitive functioning as well as decision making, things like that. So, we can kind of target multiple different areas of rehab.”
On the monitor, a patient can choose which simulation they would like, such as air hockey, catching a butterfly with a net or blackjack.
“Anytime you're working with somebody who's had a stroke, or brain injury, or any kind of neurological injury, high repetition is key, so this allows the opportunity for lots of repetitions in a fairly short amount of time, which has been shown to improve functional use of the upper extremity, which then translates over into being able to dress yourself, feed yourself, brush your hair, brush your teeth, all that stuff. This we can use as many times as you want. Typically, we'll do like a 30- to 60-minute session a couple of times a week and we'll alternate it with our other technologies that we have here too just to get a little bit more variety.”
According to the New York State Department of Health, nearly 400 incidents of traumatic brain injury occur daily in the state. Each year, TBIs result in more than 2,000 deaths and 19,000 hospitalizations. Additionally, about 1,000 New York residents suffer a traumatic spinal cord injury each year.
Paul Novak, director of the neuro-rehabilitation unit at Sunnyview, says they are fortunate to have the technology at the hospital, since the next closest location for a lot of the technology they use is either New York City or Boston.
“A lot of the research shows that if you get a lot of high dosing, a lot of repetition movements, you can facilitate recovery faster,” Novak said. “Melanie also mentioned the goal of getting people up and moving earlier in their recovery, too. I mean, there's a lot of research that supports mobilizing people or moving people early in their recovery, it's going to result in a better outcome. So, a shorter time in the hospital, a better outcome as relates to the ability to walk, to move an arm, to move a leg. There's also a lot of research that shows some of these exercise-type of technology also will support some of the cognitive recovery, as well.”
By way of disclosure, St. Peter’s Health Partners, which runs Sunnyview, is a WAMC underwriter.
