Neurologists at Sunnyview Rehabilitation Hospital in Schenectady use state-of-the-art robotic assistive devices to help people recover from brain injuries.
Thomas Turner says July 1stst, he suddenly felt a sharp pain and snap in his forehead, then had a headache. The Schenectady resident lay on his bed, nauseous and sick. In the end, the doctors would tell him he had had a stroke.. The New York State Department of Health reports that 6,000 people die each year from stroke. Those who survive often have a difficult road ahead.
Turner has been at Sunnyview Rehabilitation Hospital since his stroke and undergoing therapy.
“Ah, let’s see. I did OT [occupational therapy]PT [physical therapy] and speech [therapy.] Speech helps me emphasize and be louder when I speak,” Turner said. “PT helped me climb stairs, walk long distances, get in a car. Let’s see, mat work, strength work. They really went out of their way to help me get back to where I was. was. And the occupational therapists have helped me with everyday life, showering, cooking in the kitchen. I can’t complain. They’ve done a great job, so far.
One of these treatments uses the EKSO exoskeleton, which came to market in 2013. The patient puts a backpack-like device on their shoulders and it straps around their chest and waist. It continues with straps on the thighs and calves and the patient slips his feet into sandals-like stockings. A sturdy pole goes from the bottom of their feet to their hips on either side of their body.
Turner rises from his wheelchair to grab a walker as one therapist stabilizes his waist from behind and another guides the walker backwards while watching Turner’s feet.
Brain injury physiotherapist Melanie Melewski explains how it works.
“It’s adaptive, it’ll do anything from zero percent of the job to 100 percent of the job,” Melewski said. “So it allows our patients to work where they are. This will put them on a trajectory that will allow them to take better steps, more normal steps, and begin to return to where they were before. It also allows them to work on their endurance, because if they get tired, the machine can also continue to take more steps for them. It also has different modes like squats, you can work the reverse, it doesn’t need to be with a walker. We can work on different devices like a cane or crutches.
Turner describes what it’s like to walk with it.
“It’s like Robocop!” I mean, you’re locked in and somewhere between that and the Aliens movie charger rolling around in it,” he explained. “It’s quite comfortable and stable, you know, it takes a bit of getting used to, but once you get used to it, I think it’s fine.”
The device is FDA-cleared for the treatment of 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 had to help patients manually.
“There has been partial training in bodyweight support, but in this case therapists have to manually facilitate steps which may not only tire the therapist but may not be the most consistent or just hold them back and try to facilitate them manually.” says Melewski. “So it’s safer for the therapist, safer for the patient and also allows for really, really quality steps.”
She adds that it also speeds up improvements in physical therapy.
“The idea is that it allows us to get to a higher intensity early on,” she said. “And in the acute setting, when people are just weeks, days away from their initial injury, that’s a really crucial area where their brain can learn the most. So we’re very lucky to have that. one on the inpatient side. Not many places do that.
Another robotic assistive device helping patients is called Burt. It’s for upper limb rehabilitation training – and it has a fun side. Diana Ernos of the Brian Injury Association agreed to be the “patient” for a demonstration.
Ernos sits in a chair facing a monitor, rests her forearm on a robotic arm in front of her, and grabs a button to move the device. Occupational therapist Rebecca Grondin attaches Ernos’ arm to it and explains to him how it works.
“It combines a bit of visual feedback, biofeedback, where your arm does something associated with the screen,” Grondin said. “Also, it provides a bit of gravity assist, which takes the weight off your arm to allow you to move around a bit more freely, and then we can still activate the robot to help you achieve a full range of movements. So it can do a combination of things that traditionally things like strength training and therapies can’t. It also incorporates cognitive functioning as well as decision-making, things like that. So we can kind of so as to target several different areas of rehabilitation.
On the monitor, a patient can choose the simulation they want, such as air hockey, catching a butterfly with a net, or blackjack.
“Anytime you’re working with someone who’s had a stroke, brain injury, or any other type of neurological injury, high repetition is key, allowing for a lot of repetitions in a fairly short amount of time, which which has been shown to improve the functional use of the upper extremity, which then translates into being able to dress, eat, brush your hair, brush your teeth, all that stuff. “Use as many times as you want. Typically we’ll do a 30-60 minute session a few times a week and alternate it with our other technologies we have here too just to get a 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, head injuries lead to more than 2,000 deaths and 19,000 hospitalizations. Additionally, approximately 1,000 New York residents suffer a traumatic spinal cord injury each year.
Paul Novak, director of the neuro-rehab unit at Sunnyview, says they’re lucky to have the technology in the hospital, since the next closest location for much of the technology they use is New York or Boston.
“A lot of research shows that if you get a lot of high doses, a lot of repeated movements, you can facilitate faster recovery,” Novak said. “Melanie also mentioned the goal of getting people up and moving earlier in their recovery. I mean, there’s a lot of research that supports mobilizing people or moving people early in their recovery, that’s going to translate to better outcomes. So a shorter time in the hospital, a better outcome in terms of being able to walk, move an arm, move a leg. There’s also a lot of research that shows that some of these exercise-like technologies will also support some cognitive recovery.
As a disclosure, St. Peter’s Health Partners, which manages Sunnyview, is an underwriter of WAMC.