Space suits, video games may be in rehab’s future
Investigators develop new high-tech tools
Cerebral palsy, spinal cord injury, and other rehab patients may one day have new and innovative tools to help them improve function, thanks to research that’s now under way.
Among the new technology being studied is a device that works in a similar way to a Russian space suit that was used on the Mir space station. Another project involves a wheelchair that is interfaced with a computer racing game. A third area of new research involves assessing muscle activity in patients who have hip joint fractures, and a fourth study will evaluate a new rehab strategy, called intentional focus, to determine whether it improves outcomes for stroke patients.
While the research areas are diverse, the investigators share a common goal of improving rehabilitation for future patients. Here’s a look at several promising research projects and potential new rehab tools:
• Axial load suit project: No longer called the "space suit project," as the actual Mir space station suit was returned to the National Aeronautics and Space Administration (NASA), the suit project is under way at the Rehabilitation Institute of Michigan in Detroit.
"We’re still looking at reasons why a suit might be effective, although we’re not using the actual space suit," says Kim Dunleavy, PT, MS, OCS, a clinical associate at the Rehabilitation Institute of Michigan and an assistant professor at Wayne State University.
Suit combats effects of weightlessness
"The Russians developed the suit to minimize the effects of antigravity in space because a lot of cosmonauts were coming back with major muscle loss and osteoporosis," Dunleavy explains. "The body adapts to the effects of forces placed on it, so if you take gravity away, the body depletes itself."
The project began when NASA loaned the institute the Adeli space suit, which has a series of stretch cords in the exoskeleton that can be tightened to produce an axial load that mimics the effect of gravity, explains Nancy McNevin, PhD, a kinesiologist and director of the Brasza Motion Analysis Lab at the institute.
"The suit has been studied in Poland and Russia, and they’ve found some support for the theory that it improves functional ambulation in cerebral palsy children," McNevin says. "However, we wanted to look at it ourselves, because it hasn’t been clinically assessed and the evidence is more anecdotal."
So McNevin and colleagues studied the suit’s impact with stroke patients and found that it did result in changes in balance and muscle recruitment patterns, McNevin says.
"There was a change in the enhanced center integration, and these were all positive changes, significant changes," McNevin says.
Later this year, investigators hope to begin to study incomplete spinal cord injury patients to see whether the same benefits will occur with that population, McNevin says.
Since the original space suit no longer is available, the institute enlisted the help of a graduate student who is creating an exoskeleton that will allow therapists to fine-tune the forces on different body segments, McNevin says.
"If they need more upper-body support, we can adjust for that," she adds. "But if they’re wheelchair-bound, it won’t work, because they have to have some sensory motor control in their legs."
Investigators also will evaluate the principles behind the suit to determine which types of patients would benefit from this type of therapy, Dunleavy says.
"The suit itself is fairly unique, but the principles behind it are being used by lots of therapists around the country," Dunleavy explains. "It’s the principle of trunk stability enhanced by compression or loading and using tactile input, the sensory input to improve muscle contractions and stability."
The suit has the potential to be a useful tool in rehab therapy, especially with certain types of patients. Rehab providers already probably have had patients who have gone overseas to Poland to use the Adeli suit in hopes of improving their function beyond what traditional rehab has offered them, Dunleavy notes.
• GameWheels: A technology similar to GameWheels was tested at the veterans Wheelchair Games held in New York City last summer and was featured in published research in 2000 and 2001.
The high-tech device essentially has a platform with a slight wheelchair ramp and two rollers that restrain the back wheels of the wheelchair. A groove in the front of the ramp holds the front casters of the wheelchair and keeps it stable, explains Shirley Fitzgerald, PhD, associate director of research at the Department of Veterans Affaris R&D Center for Excellence for Wheelchairs and Related Technology in Pittsburgh.
"Think of a treadmill and how a person who is walking on one is able to walk in place," Fitzgerald says. "This is the same idea of a roller system, so that the platform allows the wheelchair user to propel without going anywhere."
The platform is interfaced with the computer and a racing software system that gives the wheelchair participant the illusion of racing while manually rolling the wheelchair in place on the platform.
GameWheels suitable for exercise
"We are able to elicit an exercise response by use of the game," Fitzgerald says. "Our research has shown that a person’s heart rate, as well as their oxygen consumption, have reached levels that are considered exercise thresholds."
Investigators then assessed whether the participants could maintain that level of exercise for 20 minutes or longer, and they demonstrated that people playing the GameWheels system were able to maintain their exercise and maintain cardiovascular levels that are beneficial to promoting fitness over an extended period of time, Fitzgerald says.
Participants in phase two of the study included 10 manual wheelchair users whose mean age was 41.9 years and who had either a spinal cord injury, multiple sclerosis, or a spinal cord disease.1 In another study, fifteen volunteers of a mean age of 36.6 years worked out with the device, using their own wheelchairs, and participating in tests that required them to propel to 2 mph followed by 20-minute rest periods.2
Investigators were concerned that participants might sustain some secondary injuries, such as carpal tunnel syndrome, if they were to propel the wheelchair using incorrect posture. So they developed a device called SmartWheel to evaluate the kinetic forces being used to propel the wheels, Fitzgerald says.
"By putting these SmartWheels on the wheelchair, we were able to get a sense of what the forces were acting on the person’s shoulder and wrist joints," Fitzgerald explains.
With the feedback from the SmartWheels, investigators have determined that the wheelchair biomechanics work fine while participants are playing the video game, and it seems to be a safe way for people to exercise, Fitzgerald says.
The next step is to manufacture the machine and make it available for rehabilitation centers, Fitzgerald says. "We have found a manufacturer, and GameWheels will be available for purchase sometime in the next year or two."
Future research might involve looking at the device as a training mechanism for the newly injured, Fitzgerald says.
• Acetabular studies: Investigators at the Rehabilitation Institute of Michigan have been looking at physical and functional outcomes of patients with hip fractures after surgery.
The acetabular studies mainly involve people who were injured in motor vehicle accidents in which their knee was rammed into the dashboard, causing the femur to go backward into the hip socket and then fracture, Dunleavy explains.
Trying to prevent arthritis
"Specifically what we’re looking at is the amount of forces going onto the hip during functional activities, like going up and down steps, normal walking, and standing on one leg," Dunleavy says. "One of the problems with long-term outcomes is that they have a major tendency to develop arthritis."
Arthritis may occur when the muscles around the hip are not absorbing much of the forces impacting the joint, Dunleavy adds.
"Because of the injury and surgery, the muscles might not absorb the forces," Dunleavy says. "So they normally go through rehab for at least a year afterwards, but even at that point there is some residual weakness."
Using a passive motion analysis system that records muscle activation patterns, researchers are trying to determine what the muscle activity is and what types of forces are being taken by the hip joints in a variety of outcomes, Dunleavy says.
"If we can determine exactly which muscles are functioning well and which are not, and the type of forces being absorbed by the hips, then we can adjust protocols to prevent those forces or to maximize the muscle function," Dunleavy says. "We’ll probably be finished with data collection by the end of the year on the first piece of the study, and then the next step is to determine treatment protocols."
• Intentional focus: If researchers can determine what it is that people are thinking about when they perform a new skill, they might have a good idea about what type of concentration results in the best outcomes.
At least this is the theory behind intentional focus research conducted at the Rehabilitation Institute of Michigan. Investigators have examined the process using healthy patients and now will be working with stroke patients to see how well intentional focus works with that population, McNevin says.
So far, investigators have a theory that rehab patients who think about the consequences of their actions will learn new skills much faster than if they are thinking about the movement itself, she says.
"If you picked up a golf club and focused on the arms as the coach tells you to do, then you will not do as well as if you focus on what the club head is doing or the anticipated trajectory of the ball," McNevin explains.
Intentional focus is a skill in which a person focuses on the consequences rather than on the body. For example, if a person’s goal is to stand still and the person concentrates on the feet, then that will disrupt the performance, she says.
"It makes sense when you think about it, but that’s not what we do in rehab," McNevin says. "With the clinical population, there is much more focus on the body, what the body does, and as soon as you have the patient focus on impairment, then it disrupts the coordination of the entire body."
Need More Information
- Kim Dunleavy, PT, MS, OCS, Assistant Professor, Wayne State University, and Clinical Associate, Rehabilitation Institute of Michigan, 261 Mack Blvd., Detroit, MI 48201. Telephone: (313) 745-1100.
- Shirley Fitzgerald, PhD, Associate Director of Research, Department of Veterans Affairs R&D Center of Excellence for Wheelchairs and Related Technology, VA Pittsburgh Healthcare System, 7180 Highland Drive, 151R-1, Pittsburgh, PA 15206. Telephone: (415) 365-4840.
- Nancy McNevin, PhD, Kinesiologist, Director of the Brasza Motion Analysis Lab, Rehabilitation Institute of Michigan, 261 Mack Blvd., Suite 239, Detroit, MI 48201. Telephone: (313) 745-8306.
References
1. O’Connor TJ, Cooper RA, Fitzgerald SG, et al. Evaluation of a manual wheelchair interface to computer games. Neurorehabilitation and Neural Repair 2000; 14:21-31.
2. O’Connor TJ, Fitzgerald SG, Cooper RA, et al. Does computer game play aid in motivation of exercise and increase metabolic activity during wheelchair ergometry? Medical Engineering & Physics 2001; 23:267-273.
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