Robots are no longer futuristic concepts; at MossRehab, they actively participate in treatment. MossRehab is the first institution to incorporate the promising ReoTM Therapy robotic system, by Motorika Ltd., into clinical practice and research for upper limb rehabilitation. Robotics is one of many innovative treatments that physiatrists at MossRehab research and employ to provide optimal rehabilitation to patients after a stroke or traumatic brain injury (TBI).

Several other groundbreaking initiatives underway at MossRehab’s Drucker Brain Injury Center include implementing a subacute inpatient rehabilitation program, developing a comprehensive program for patients with concussions sustained during athletic activity or other trauma and analyzing treatment sessions to help objectively define rehabilitation’s “active ingredients.”

Highlighting MossRehab’s increased focus and programming on TBI research and care is the recent appointment of Thomas Watanabe, MD, as clinical director of the Drucker Brain Injury Center. According to Alberto Esquenazi, MD, Chairman, PM&R, MossRehab and Albert Einstein Medical Center, Dr. Watanabe is ideally suited to lead and expand upon the Drucker Brain Injury Center’s influential work. “Dr. Watanabe is one of just a few physiatrists in the nation specializing in TBI, so MossRehab is extremely fortunate to have his expertise,” says Dr. Esquenazi.

Robotic Upper Limb Rehabilitation Increases Fugl-Meyer Scores

The Reo Therapy robotic system now under review at MossRehab is demonstrating positive benefits. “Its flexibility allows multiple treatment modes,” says Dr. Esquenazi. “Exercises include setting patient arm motion targets, moving arms in therapeutic patterns and initiating movements that patients complete. Even hundreds of repetitions are tightly controlled and repeatable.” Further, the system is mobile, delivers patient feedback and automatically sends information such as number of repetitions, frequency, patient performance and mode of exercise to a master database. This data is then analyzed to evaluate patient progress.

MossRehab began research in May 2006 with 10 hemiparetic subjects. The research program follows a pilot study design with patients acting as their own controls; researchers measure patient performance using a variety of clinical and robotic tests before and after treatment to gauge improvement attributed to robotic therapy versus traditional techniques. For study participants, Fugl-Meyer scores rose as much as 11 points and Ashworth scores dropped with lower perceived exertion and reduced shoulder pain.

Study objectives include assessing patient efficacy and determining patient inclusion/exclusion criteria. Researchers are analyzing data for an upcoming conference and are encouraged by the initial positive results that indicate the system is safe and effective for clinical use.

MossRehab Pursues Subacute Inpatient Rehabilitation

Dr. Watanabe is spearheading the development of a program to meet the critical need for inpatient neurologic subacute TBI rehabilitation. He and the TBI team will begin by partnering with Albert Einstein Healthcare Network and local skilled nursing facilities to provide broader access to these rehabilitation services. The program will consist of training nursing facilities’ staff on rehabilitation techniques and instituting a schedule for MossRehab therapists and brain injury physiatrists to visit the facilities on a routine basis.

Currently, most patients in the subacute recovery phase do not receive coordinated brain injury-specific rehabilitation care, as they are often placed in skilled nursing facilities based on non-medical factors such as insurance contracts or family proximity, and therefore do not have access to the necessary rehabilitation.

The inpatient subacute rehabilitation program proposed by MossRehab accommodates shortened lengths of covered treatment for acute inpatient TBI care by shifting some aspects of the rehabilitation continuum of care to skilled nursing facilities. Improvement in the quality of care during this stage of recovery curtails cognitive, behavioral and physical problems. “This expert attention ensures that patients maintain steady progress toward more active rehabilitation and maximizes cognitive recovery while avoiding problems like joint contracture, decubiti or lack of safety awareness which can result in injuries – all of which can delay discharge and complicate and prolong future treatment plans,” Dr. Watanabe explains.

MossRehab Increases Focus on Concussion Dangers

Each year, sports injuries result in over 300,000 concussions with 62,000 concussions affecting athletes in undergraduate contact sports. In addition, emerging research in the sequelae of concussions, especially multiple sports-related TBIs, indicates that these injuries have a substantial impact on people’s lives. Concussions have been linked to memory problems and impaired thinking as well as to disease processes such as clinical depression.

Recognizing the need for a higher level of care and awareness for this type of TBI, the Drucker Brain Injury Center is working closely with Moss Sports Rehab to expand its program for mild TBIs and concussions sustained through athletic participation to also encompass individuals who sustain concussions by other means. The athletic component of the program, which currently focuses on students of high school age and older, will broaden its scope to educate athletic trainers, emergency room staff and others on how to carefully identify, evaluate and treat concussions. A key tool used in the program is ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), a computerized assessment of neurocognitive functioning such as attention, memory, reaction time and visual processing speed. Currently used by professional sports organizations, MossRehab introduced ImPACT to the Philadelphia region for the assessment and treatment of young athletes.

Effective prescription for TBI Rehabilitation

The Drucker Brain Injury Center promotes a constant flow of fresh ideas that expert staff study and administer. “Excellent programs result when care is based on science and science is based on care,” Dr. Esquenazi concludes. “It’s an inseparable relationship that continues to be very fruitful for our patients, their families, our clinicians and our researchers.”