From advanced treadmills to videogames, new technologies are helping physical therapy patients restore or gain new motor skills.
Physical therapy is a broad profession, aimed at maintaining or restoring maximum movement and function in patients affected by a variety of injuries, diseases or even old age. Patients come from all walks of life, from professional athletes to high-school students to those with disabilities.
For four-year NBA player and former Dublin Coffman High School star Chris Quinn, physical therapy is a means to a higher level of athleticism. A history of ankle injuries led Quinn to OrthoNeuro, where therapists help him improve his career by avoiding future problems.
On the other hand is 4-year-old James Nelson, who has undergone therapy since he was 10 months old. James has a neurodegenerative genetic disorder called spinocerebellar ataxia. His mother, Denise Hoffman, is hopeful that a physical therapy program at Nationwide Children's Hospital could someday help her son walk unassisted for the first time.
For James, Quinn and all patients in between, advances in physical therapy technology and techniques can help them more easily meet their goals. Central Ohio health-care facilities are using-even developing-new methodology, from videogames to motion-sensing devices, to improve the outcomes of all patients, regardless of their diagnosis.
Nationwide Children's Hospital
In early September, James finished an eight-week program at Nationwide Children's using the LiteGait system, a treadmill that uses a harness and a series of straps to help support a patient's weight. Children with cerebral palsy or other motor disorders can move their legs more freely without fear of falling.
"Typically, we wouldn't be able to utilize the treadmill with children with more severe cerebral palsy, so this allows them to practice walking and develop strength," says Dr. Amy Newmeyer, director of Nationwide's comprehensive cerebral palsy program. "The benefit is primarily strengthening. Children with cerebral palsy have decreased strength because they can't move around the same as other kids."
Getting stronger helps patients walk longer distances, do more around the house and transfer from a wheelchair to bed or from sitting to standing. With LiteGait, patients have an intense regimen of three weekly sessions; traditional therapy occurs once a week. The system can be customized to provide more or less support, and users can even run or walk backward.
For James, the improvement has been dramatic. His first time on the treadmill, he could only drag his feet. Eight weeks later, he can sometimes manage large, even steps.
"One of the benefits of this is that I can actually step back and watch his gait pattern, because he's in a completely fall-free environment," says Michelle Sveda, a physical therapist who has worked with James. "So, if he needs help advancing his legs, I can come down and manually pick them up or just literally watch his gait pattern, motivate him, and be upright and more at his level socially versus down at his feet."
"We've seen improvement from day one," says Hoffman, as her boyfriend, Robert King, demonstrates how James can almost stand up on his own. "He's up on both toes, with one hand holding himself up. That is so close," King says.
"Even outside with full-size chairs, he'll come out and get his hands down and stick his butt up in the air and get right in it. That's something that he wasn't doing before," Hoffman says.
James doesn't seem to mind the hard work. When Sveda turns the treadmill off after a half-hour, he continues walking in place and then eagerly tackles walking backward.
"The children seem to really like it. For some kids, the motivation is just developing skills and getting stronger," Newmeyer says. "The families have really liked having this technology available here. They have reported that they definitely see improvements in those everyday skills at home."
Another program under study at Nationwide Children's is Reach, a type of constraint-induced movement therapy that strengthens a child's weaker arm by putting the stronger limb in a cast.
"We see anyone who has some type of paralysis or weakening on one side from traumatic brain injuries, stroke, basically any kind of neurological condition that would affect the particular part of the brain that would cause a motor deficit on one side of the body," says Marianne Mayhan, an occupational therapist in the division of clinical therapies.
"It's a bit different than traditional therapy in that it's very intense. We see the children every day for three hours for four weeks, which is a lot compared to what kids typically get. A lot of times traditional therapy is one visit a week for 30 to 45 minutes," Mayhan says.
"Essentially what we're doing is retraining the brain, in a way, and it's a nice way to do that in a shorter timeframe. We're helping these kids establish new habits that they're able to take and use and be more independent in their daily lives," says occupational therapist Teresa Orr.
The combination of the therapy's intensity and the cast can be a big initial adjustment. But at the end, feedback from patients and their families has been "nothing but positive," Mayhan says. "Some children now have awareness of that extremity, and to a parent that's a huge achievement. We also have patients who are now able to do things they weren't able to do from a function standpoint, like drinking, feeding themselves and dressing themselves."
Anyone who's ever played a videogame on the Nintendo Wii system knows the thrill of moving and watching an on-screen counterpart dive for tennis balls or hit grand slams. For patients at OhioHealth's Westerville Medical Campus, using the Traq 3D system is like Wii on steroids.
"It's an interactive gaming system that can go from as low level as just shifting weight back and forth to full-fledged running and jumping, and running and jumping with resistance bands attached to you," says athletic trainer Jeff Bright.
Patients wear a motion sensor around their waist and take cues from a large projection screen; markers let them know when they've hit the target. "It's based on the level of the patient," Bright says. "With a 1-inch movement, we're basically just getting them to shift their weight. So, they shift their weight 1 inch, that signals the game, hits the marker and then they just move back to center. Or they have to go 36 inches, which would be a very large lunge or a very large step from side-to-side or front-to-back."
The program has drills for shifting weight, shuffling side-to-side, running (forward or backward) and jumping. "It takes us through all the movements we use and it gives the patients targets, gives them something to look at," Bright says. Instead of focusing on their feet, patients focus on the screen and the task at hand.
After these basic drills, patients play games that combine movements. Goalie Wars, for example, is a soccer game where the patient alternately attempts to score and block against an on-screen goalie. Another game simulates jumping for rebounds in basketball or for blocks in volleyball.
Traq 3D adds an element of fun and motivation to workouts. "We tell patients we're going to do squats, and they have it in their head already that they can't do squats. But if I say we're going to go do a shift and bump and all you've got to do is bend down and clear the markers, now they're not squatting. They're bending down. So, mentally, it changes what they say," Bright says.
Traq 3D, which tracks patients' progress and measures their movements, is just one part of a collaborative system that helps determine whether an athlete is ready to return to sports, says Dr. Gregory Berlet, an orthopedic surgeon at the Westerville Medical Campus. "In the past, the doctor would ask, ‘Do you feel like you're ready to play?' and the patient would say ‘yes' and the doctor would say, ‘Well, go get 'em!' But that's not really good enough," Berlet says.
"The Traq 3D will get us to a point where I can work you out and I will measure how fast you're moving to your right, left, front and back. You may feel good, but I may pick up a deficiency when you're running to your right. If you're a running back in football, it's probably not safe to be putting you on the field if you're only cutting well to the left," Berlet says.
The campus's physical therapy space, which opened in 2008, includes not only Traq 3D, but also elements for post-surgery rehabilitation, protected equipment for muscle building, and treadmills and other typical gym equipment. "You've got to look at the program together-the collaboration with physicians on-site who are guiding what's going on and involved in the development of the space, so that we're doing it as a cooperative model," Berlet says. "This isn't a box that we decided to put therapy in, this space from the ground up was designed with the function in mind."
Active patients can get frustrated when they find that physical therapy gets them back to their normal daily activities, but not back on the playing field. Enter OrthoNeuro's On Track program.
"The rehabilitation phase can bring them back to some of their goals, but often patients have goals that exceed what the therapy does for them. They want to get back to a high level of participation in whatever their activity was, whether it's a 60-year-old tennis player or a 20-year-old triathlete," says Dr. Timothy Duffey, an orthopedic surgeon at OrthoNeuro. "On Track bridges that training between rehabilitation and the goal they want."
For some patients, returning to athletics or the health club can be intimidating because they are not sure what they're allowed or able to do after surgery. "They're afraid when going to the gym that personal trainers might not understand what it is they need," says advanced training coordinator Jay Holdgreve. On Track utilizes an array of testing to ensure patients are moving with no impediments.
"I do a lot of functional testing on them with the functional movement screen and the selective functional movement assessment to break down where they are right to left so we don't have any issues," Holdgreve says. "Usually I start with the basics to make sure they're able to fundamentally move in proper movement patterns, recruiting the proper muscles."
Hoops star Quinn's functional movement test revealed good muscle core strength and decent balance on single tasks, but his core broke down when performing multiple movements at one time, Holdgreve says. "We had to start with the basics that with a professional athlete you wouldn't think you would need to start at in order to get those muscles to fire properly. Now, we're up to restive jumping and single-legged squats. We're pretty advanced with him now."
"In my line of work, if you're not on the field or on the court, you're no good to your team. Having a history of ankle sprains, I just wanted to do anything I could in the off-season for the upcoming season to make sure that they're strong and ready. So far, it's been a great thing for me," says Quinn, a free agent who finished the 2009-10 season with the New Jersey Nets.
On Track, developed two years ago, "is unique in that it's not offered by a lot of physician groups. It is offered by independent businesses, but those businesses are not overseen by physicians a lot of the times. The physician oversight in this program, along with the certified trainers and the licensed therapists, provide the medical expertise that you might not see in the private sector," Duffey says.
Ohio State University
If you've ever walked by a videogame arcade or have a tween in your house, you probably know Dance Dance Revolution (DDR), where players stand on a lighted platform and follow on-screen cues to perform a "dance."
Simultaneously following the arrows and moving to the beat of the music is relatively easy for most, but much more difficult for someone with Huntington's disease, a progressive neurodegenerative genetic disorder that affects muscle coordination and can cause cognitive decline.
Deborah Kegelmeyer and Anne Kloos, associate professors of clinical allied medicine in Ohio State University's division of physical therapy, have found success using a modified version of DDR as therapy for Huntington's patients. Funding from the Huntington Society of Canada enabled them to start a six-week program.
"It's probably the second-ever study looking at an intervention in physical therapy for Huntington's disease," Kegelmeyer says. "Our graduate research assistant took a DDR game pad and a laptop computer to people's homes twice a week." The assistant, Nora Fritz, presented the study at the European Huntington's Disease Network Meeting in Prague in September.
"It cues them with visual cues and then with the beat of the music, as well as making them step rapidly in multiple directions, which is an exercise we do in physical therapy for balance," Kegelmeyer says. "This seemed like a much more fun way than me saying, ‘Step forward. Step back. Step sideways,' and that would last about five minutes, whereas with the game they did it for 45 minutes straight."
The program enrolled both early- and middle-stage patients. "It was very encouraging because we saw improvements, especially in the early-stage patients, in a relatively short amount of time. They only did the intervention twice a week for six weeks," Kloos says.
Poor balance can cause Huntington's patients to walk slower, with their feet wider apart, and to spend too much time with their feet on the ground. "After the study, people were walking with what we call a narrower base of support, with the feet closer together," Kegelmeyer says. "Across the board and with high significance, all of them were spending less time with their feet on the ground."
"That would be a very positive thing," Kloos says. "If they do improve their dynamic balance, it might lessen their risk for falls."
Traditional therapy for Huntington's patients includes daily aerobic exercise-walking or riding a stationary bike-as well as strengthening, stretching and balance moves. "We know from scientific evidence that for people to really, permanently improve their function, they need to practice lots and lots and lots of times. To get that amount of practice in, they've got to be motivated to do it. ... Using videogames might help people to be able to be more highly motivated and to practice much more than with the traditional [techniques]," Kloos says.
Kegelmeyer and Kloos plan to conduct more research, possibly evaluating DDR's effect on multiple sclerosis or launching a more extensive Huntington's study, to follow more people over a longer period of time. They also hope to work with OSU's Advanced Computing Center for the Arts and Design on a more customized game.
"The thing about videogames, especially DDR, is that there are a lot of components of it that are very good for improving a person's balance and physical abilities, but there's also that cognitive component because they have to pay attention and think about what they're doing in relation to these different cues," Kloos says. "We think that the combination of both a physical type of activity with a cognitive challenge might have a greater effect."
Michelle Davey is an editorial assistant for Columbus C.E.O.
Reprinted from the November 2010 issue of Columbus C.E.O. Copyright © Columbus C.E.O.