Looking at today's stroke rehabilitation programs, there is only one conclusion that can be made: There is a tool for virtually every condition a clinician needs to address. This is particularly helpful, since stroke affects each patient—young or old, male or female—in very individualized ways.

And the equipment PTs have at their disposal reflects the unique nature of each neurological trauma, offering a plethora of ways to measure, chart, and adjust each patient's progress—returning them to their highest level—making it patient-friendly and clinically objective at the same time.

The extent of the arsenal available to clinicians can be indicated by looking at two stroke rehabilitation programs: Walton Rehabilitation Health System, Augusta, Ga, and Burke Rehabilitation Hospital, White Plains, NY.

SIGNIFICANT TREND

Even though they are in very different parts of the country, the two stroke rehab programs have seen the development of a very similar trend in their treatments.

The use of robotics and unweighing systems in gait training is probably the biggest treatment trend at the moment, according to Carol Helmerich, MPT, CBIS, stroke center administrator at Walton Rehabilitation Health System. "It works on the theory of facilitating normal functional movement and capitalizing on the neuroplasticity of the brain," she says.

Though noting that "trends" depend more on the individual patient than any sort of global change, Lisa Malcomson, PT, MS, physical therapy supervisor at Burke Rehabilitation Hospital, agrees that the use of unweighing systems has helped her staff "ambulate the patient on solid ground immediately."

The Biodex Unweighing System is used at Walton. The system is a wheeled frame that allows the patient to be partially suspended. An off-loading mechanism maintains constant force, and a readout—that can be set to either pounds or kilograms—shows how much weight is being off-loaded at any time. The patient is suspended with a harness that keeps them stable but is connected at a single, overhead point allowing for pelvic rotation and versatility when walking (such as side-stepping, retro-walking, and turning). The open design is offset to allow for easier access. The unit can accommodate adults and children. Because of its open design, it can be used either with treadmills or gait trainers. The unit can support up to 40% of a patient's body weight.

The Offset Unweighing System by Biodex offers improved access to manually assist patient footfall and weight shift.

Using the unweighing system with the gait trainer is of great advantage to the therapists, Helmerich says. "It frees up their hands during training," she says.

Malcomson's staff uses Easy Walking Inc's Up n' Go Walker. It also is a partial weight-bearing device. It looks a little like a traditional walker, but it has several features that make it ideal for gait training, reducing weight on the lower extremities but providing trunk control. The unit's lifting arms provide support while the patient raises and lowers their center of gravity while walking. The wheels roll freely on any flat surface, eliminating the need for a treadmill. The unit has several features that help reduce therapist injury, including support arms that extend behind the patient.

Though the two organizations use different unweighing and gait-training strategies, they do have something in common: They both use the NuStep® system. The advantage of the NuStep system is that it has the patient "using all four limbs," explains Lee Wymbs, PTA, of Walton Rehabilitation Health System.

In addition to helping patients recover from a life-altering stroke, the unit—in Wymbs experience—has another benefit. "Most of the patients that use the NuStep have shown improvement in their blood pressures," he says.

The NuStep system features an ergonomic design that allows for easy transfer and can accommodate most body types. The design also includes a large, easy-to-read display, and the machine can be set to a variety of resistance levels, step length, pace, and duration, which can be controlled by either the therapist or the patient.

Though the two organizations have this piece of equipment in common, their differences point to the individual and unique needs of patients and staff.

WALTON: DIGITAL OBJECTIVITY

When a stroke patient is brought to Walton's 15,500-square-foot outpatient facility or their 58-bed inpatient rehabilitation hospital to begin their therapy, they are first evaluated using a variety of tools. For instance, if the patient has balance problems, they will be evaluated using the Balance Master from NeuroCom. According to Wymbs, the data collected will be compared to a baseline, for instance against a 5-foot-2-inch, 50-year-old woman. "We can get that printout and see the patient's limitations and set multiple goals in the therapy," he says.

The Balance Master is part of that therapy. It has a readout that shows the patient how they are doing; and it is designed to offer several training options, including seated balance/strength training, standing balance/weight-bearing training, mobility training, and closed-chain training.

But balance is only one of the areas possibly affected by the stroke that the Walton stroke rehab program addresses. For instance, the department uses Baltimore Therapeutic Equipment (BTE®), a work simulator machine. "It gives an objective measure of strength," Wymbs says.

Among the functions the BTE can perform is a functional capacity evaluation that produces standardized evaluation reports, including four static/isometric tests, a daily treatment chart, and treatment-progress charts. These reports can be used throughout the patient's treatment to chart their progress.

Helmerich says that ultimately what makes Walton stand out is not the technology alone, it is her staff of PTs. But technology is a big part of what makes Walton special. The organization has a research division, and all of the therapists eagerly employ the use of technology in the treatment of stroke patients. "They really embrace doing whatever they can to help the patient," she says.

Echoing Helmerich, Malcomson sees technology clearly as a useful adjunct to the work being done at Burke Rehabilitation Hospital.

BURKE: ADJUNCT TECHNOLOGY

When a patient first comes to Burke's 30-bed inpatient stroke unit, they will receive old-fashioned, hands-on care for the first couple of days before technology enters the equation. "We start with manual techniques first, then we'll use technology," Malcomson explains. "The technology just makes our job easier. We still need clinical hands-on skills."

The patient demographics at Burke skews to the older population—with an average stay of 27 to 28 days. Many of these patients have comorbidities and may be transferred to a care setting once their initial therapy is finished. The staff includes the patient's family during the rehab process.

Among Burke's facilities is a gym that includes weights, NuStep machines, standing frames, and mats. The facility has a treadmill, but that is in another room where it can be closely supervised.

Though Malcomson definitely sees the tools at her disposal as simply an extension of her skills, she does point to the MOTOmed by Great Lakes Medical as a piece of equipment that has gotten quite a bit of use at the facility. The MOTOmed is a cycling system that is driven by the patient's muscle power and can provide movement for legs and arms. For Malcomson, one of the best aspects of the MOTOmed is that it is ideal for the spastic patient. "It stops if it senses a patient is having a spastic [episode]," she says. This prevents the patient from getting injured either from falling off the machine or from it continuing—if it's in the passive mode.

There is no doubt that technology is a key element of stroke rehabilitation, but it will never replace the therapist. "It kind of helps augment what we're doing," Wymbs says.

C.A. Wolski is a contributing writer for Physical Therapy Products. For more information, contact .