Putting Tech to the Test

The clinical and research teams at Baylor Scott & White Institute for Rehabilitation (BSWIR) are committed to exploring emerging rehabilitation technologies and improving patient outcomes by integrating the most promising tools into regular practice.

Among the promising projects underway:

Stimulating individual recovery

Functional electrical stimulation cycle ergometry (FES-CE) programming uses an electrical current to stimulate peripheral neuromotor units of paralyzed muscles to perform a functional task. At the right dose, FES has been shown to activate and re-educate the neuromuscular system below the injury level in people with a chronic injury. There are no established clinical practice guidelines, so the BSWIR team is working to collect evidence on the optimal dose of FES-CE programming for individuals during inpatient treatment.This evolution engages patients earlier and builds on the time-tested benefits of functional electrical stimulation (FES) in people with chronic spinal cord injury (SCI).

“We know FES can improve cardiovascular conditioning and overall health outcomes in people with long-term SCI, but the benefits of this treatment in the early phases of recovery are unknown,” said research scientist Chad Swank, P.T., Ph.D. “We want to tap into the principles of neuroplasticity already at work in this stage of recovery and accelerate the trajectory of functional improvement during inpatient rehabilitation.”

Rehabilitation Therapy Manager Christina Fazio, P.T., ATP, added, “In 2020, patients with SCI who averaged nine sessions of FES-CE during their stay were observed to improve in daily function and have reduced pain.”

The clinical and research teams are continuing to examine FES-CE dosage parameters and its impact on patient outcomes. That data will help determine when and how to integrate this technology into the rehabilitation process for optimal recovery, creating a clinical practice model for use by programs nationwide.

Opening the “gait” to improved outcomes

For the last four years, the BSWIR clinical and research teams have been evaluating the most effective ways to incorporate robotic exoskeleton technology during inpatient rehabilitation for those with neurological injury-based mobility impairments. A review of 800 completed robotic exoskeleton gait training (RGT) sessions involving more than 200 patients suggest integrating an RGT program is not only feasible, but less physically burdensome on therapists and more engaging to patients and does not increase the risk of injury.

“Our team’s training and clinical knowledge allowed us to adopt RGT as a safe and beneficial experience for patients during inpatient and outpatient rehabilitation,” said BSWIR’s lead RGT therapist Molly Trammell, P.T., CBIS.

In 2020, the National Institute for Disability and Independent Living in Rehabilitation Research (NIDILRR) awarded the BSWIR research department a three-year grant to develop an SCI patient-centered RGT program and examine its impact on functional outcomes during inpatient rehabilitation.

 

“This project will allow us to build an evidence base around a ‘first of its kind’ program. We anticipate being able to link RGT session intensity with the functional outcomes achieved by SCI patients,” said principal investigator Dr. Chad Swank.

Initial data suggests this technology may offer better gait-training approaches compared to traditional methods, leading to increased flexibility and earlier mobility. RGT also addresses common clinical obstacles such as muscle tone, incontinence, and communication.

“The goal is to optimize inpatient rehabilitation time and improve patient outcomes. Based on our initial findings, we believe RGT is helping us do so,” said Dr. Seema Sikka, director of spinal cord injury research and quality.

“Xciting” approach to muscle activation 

While many studies are conducted at BSWIR’s Dallas research hub, all of our rehabilitation hospitals and many outpatient centers are actively involved in a variety of technology projects in an effort to advance patient care. At our Frisco hospital, the use of Functional Electrical Stimulation (FES) systems is moving into a new realm. FES systems are typically two-channel units that use electrical currents to produce a single muscle contraction in a location that may inefficiently contract on its own, allowing patients to work on a myriad of functional tasks, such as neuro-muscular re-education, relaxation of muscle tightness, prevention of disuse atrophy and maintaining or increasing range of motion.


 

The Frisco clinical team is now using Xcite, a 12-channel battery-powered cyclical stimulator, which allows simultaneous proximal and distal muscle group activation. This increases the number of muscle groups firing at once, improving functional activity effectiveness. Task-specific, pre-programmed motor patterns improve outcomes in stroke, spinal cord injury and neurological condition patients. The settings also provide proper sequencing of basic motor skills like forward reach, grasp and release, sit to stand, postural correction and daily living activities such as grooming, feeding and brushing teeth. Integration of more complex actions, such as handwriting, toe tapping and lateral stepping, are also possible.

“There has been limited research regarding this type of FES in stroke patients during early rehabilitation,” notes Caitlin Boyd, OTR/L. “However, the research team plans to initiate a study this year to help determine whether the use of multi-channel FES, along with task-specific training, will improve upper extremity function in unilateral stroke patients with hemiplegia versus traditional rehabilitation.”

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