Neurorehabilitation Center: An Investment in Technology

As you may know, the field of rehabilitation medicine has historically been relatively low-tech.  Much of the specialized care provided by physical and occupational therapists in rehabilitation hospitals is “hands-on” and “high-touch.”  Unlike acute care community hospitals where state-of-the-art technology is employed at every level of patient care, in rehabilitative medicine the therapist’s hands and experience have been the primary tools for patient recovery.

Yet in recent years, technological advances have provided opportunities for innovation within rehab medicine.  Scientists apply the term neuro-plasticity to the action of brain growth and adaptation in response to challenge.  As it receives specific appropriate input through the senses, with appropriate frequency, intensity and duration the brain physically changes its structure. This structural change takes place through the growth of pathways between the brain neurons. In this way, brain function can be shifted from one area to another when a certain area of the brain cannot function correctly due to injury.

In addition to assessment, a key benefit to technologically advanced equipment is the opportunity for objective assessment of an individual’s impairments.  Being able to more specifically diagnose and quantify the level of functional deficits allows a very targeted and individualized treatment plan to be developed.

The Comprehensive Outpatient Neurorehabilitation Center will include three specific technologies to enhance the assessment and treatment of patients.

SMART Equitest

The SMART Equitest is designed to provide objective assessment of balance control and postural stability under test conditions that reflect the challenges that a patient would encounter in real life. The precise data helps to identify and differentiate underlying sensory and motor impairments and enhances the ability to diagnosis and treat problems of imbalance and posture instability. 

Balance and mobility disorders are often difficult to diagnose and treat using traditional models of care. The interactive technology and proven protocols of the SMART Equitest will enable our physical therapists to objectively and systematically manipulate sensory and motor impairments. This protocol measures the body’s ability to process sensory and visual cues and helps identify the “real world” environments where patients may be at risk.

The SMART Equitest resembles a voting booth in size and shape. Patients are secured in a safety harness and stand on a moveable platform which objectively measures balance control and stability under multiple conditions. The moveable enclosure simulates real life disturbances occurring in the visual environment.  Data is used to calculate and record the position of the patient’s center of gravity.

Once the assessment is complete and an individualized treatment plan developed, the SMART Equitest is also used as a treatment modality.  Impaired sensory systems can be stimulated or, when impairments are permanent, the compensatory use of intact systems can be promoted. These assessment and training conditions, which are not predictable enough to learn, provide consistent challenge to the patient. 

Bryn Mawr Rehab Hospital currently has a precursor to the SMART Equitest in use in our Main Therapy Gym, the Smart Balance Master. Currently, six trained physical therapists use this equipment which was purchased twelve years ago with very positive results.  Because of the growing need for assessment and treatment on this equipment for those with balance and dizziness disorders, the therapists find themselves negotiating for its use and not being able to schedule treatment sessions in as timely a manner as they and their patients would prefer. 

With the purchase of two new SMART Equitest systems, Bryn Mawr Rehab Hospital will be able to provide the most advanced assessment and treatment opportunities to our patients on both the inpatient and outpatient side, and for the number of sessions and in the desired timeframe that will maximally benefit patients.  We anticipate the two SMART Equitest systems will be in use for more than 4,000 assessment/treatment hours per year.

The Dynavision D2

The Dynavision helps Occupational Therapists to diagnose and treat patients experiencing: 

• Visual processing impairments

• Decreased reaction timing speed                               

• Impaired motor planning

• Reduced balance and control

• Central vs. peripheral processing problems 

The Dynavision D2 consists of a large, computerized light board containing 64 small red square target buttons that light up randomly one at a time, as well as a center area that can be programmed to display numbers. The therapist programs the board and challenges the patient’s ability to either hit lights or divide attention between reading numbers and locating the lighted buttons. Once located, they must touch the button to extinguish the light. The target button beeps when it is touched and another button is randomly illuminated in a new location on the board. The patient then attempts to extinguish as many targets as possible during a pre-set program on the board lasting from 30 seconds to 4 minutes. The board is mounted on a wall and can be adjusted up or down to accommodate individual differences in height and for patients in wheelchairs.

The computerized Dynavision D2 allows our therapists to obtain a client’s baseline performance and to measure the results of subsequent training sessions. Because of the numerous programming options, the therapist can program the board to provide the patient with the desired assessment and training challenge. A computerized analysis of performance shows progress and educates the patient on the need to learn strategies to compensate for their impairments.
 
Training sessions on the Dynavision address sustained attention, central and peripheral reaction timing, cognitive impairments, and physical endurance, compensatory strategies, peripheral awareness, and visual-motor skills. The Dynavision comes with a laptop computer offering measurable objective data to show progress and outcome that can be saved and viewed in graph format to display individual progress. The therapist can choose from printout options for information analysis, making it reader-friendly for educating patients, sharing results in team meetings with physicians, and incorporation into reports. The data is password protected to keep patient information confidential.

With the growth of our mild traumatic and post concussion program, the hospital’s current Dynavision is unable to accommodate outpatient need. The system is being used at full capacity, serving, on average 15 outpatients per day, with each patient receiving up to 30 minutes of actual therapy time during each therapy session.

Training programs are customized between each patient, putting the system in use by our occupational therapists for eight hours per day. On average, a patient will require up to 12 Dynavision therapy sessions. The addition of a new Dynavision D2 will allow us to offer this therapy to approximately 250 to 300 new patients and allow expanded therapy sessions for our current patients.  

Bryn Mawr Rehab Hospital is proud of one of our occupational therapists, Clint Beckley OTR/L, who worked with the Dynavision engineers in enhancing the new model to provide enhanced benefit to patients with neurological impairments.  He was one of a core team around the nation invited to participate in the re-engineering of the Dynavision the hospital seeks to purchase.

Neuro Vision Rehabilitator

The addition of Neuo Vision Rehabilitator (NVR) therapy at Bryn Mawr Rehab Hospital will offer a complementary treatment capability of addressing deficits in visual processing skills. NVR will provide a measurable way to demonstrate vision system improvements and skills, which directly translate into everyday functional capabilities such as driving, reading, balance, safety awareness and vocational skills.

The main visual skills usually affected in the neurologically injured population and especially the mild traumatic brain injury and post concussive patient include:

• Peripheral awareness.

• Ocular motor control and speed.

• Scanning accuracy and eye movement. 

• Visual spatial processing (where you are in relation to your environment).

• Saccadic movement skills (pattern movements such as left to right and top to bottom) most common of which is reading and visual pursuits.

Neuro vision processing deficits cannot be seen on an MRI. Patients with these deficits may feel like their world is moving or the floor may feel like it is tilted.  Patients can have a hard time focusing, and reading can be impossible in that words seem to double, split apart or run together.

The Neuro Vision Rehabilitator is an adaptation of video game technology using a Wii Fit balance board, a Wii remote and special head gear that tells the computer where a patient’s eyes are focused. A patient will aim the Wii remote at targets projected on a screen helping them to integrate balance, vision, hearing and eye-hand coordination in a way the brain functioned before sustaining an injury.

The Wii remote and special glasses, when used with the six NVR Therapy Modules, provide real space interactive feedback, integrating vision, auditory, proprioception, (awareness of movement derived from muscles, tendons, and joints) balance and visuomotor control. The patient is provided with motivating auditory and tactile feedback as they interact with the program.

Bryn Mawr Rehab Hospital occupational therapists will utilize NVR technology to provide a computer controlled interactive environment which measures and stores abilities, scores and changes in vision system skills for each patient. It is anticipated that the majority of our patients receiving outpatient neurorehabilitation services will benefit from the benefits this equipment can provide.

Join us in our life-enhancing work by investing in the state-of-the-art Comprehensive Outpatient Neurorehabilitation Center.