Physical Therapist Diane Nichols watches a Stroke patient's gait as he walks with the assistance of the ZeroG robotic device.
One of the unique opportunities at NRH for Physical Therapists (PTs), Occupational Therapists (OTs) and Speech Language Pathologists is the ability to participate in the many research projects conducted here each year.
One such project was to develop the world’s first over-ground body-weight support system that would allow patients at NRH to practice intensive walking therapy early after injuries such as stroke, spinal cord injury and traumatic brain injury. This device, called ZeroG, has evolved from a concept on paper to a commercially available device now being sold across the United States.
Early in the development stage of ZeroG, Senior Research Scientist Joe Hidler, Ph.D., of the Center for Applied Biomechanics and Rehabilitation Research, turned to physical therapists Kathy Brady, Diane Nichols and Marlena Pelliccio to find out what would help them enhance therapeutic outcomes and make walking therapy safer for both them and their patients.
“While many concepts were discussed in those meetings, the over-arching theme was that the therapists wanted to train their patients with a system that provided the highest level of safety and encouraged patient-therapist interaction,” says Hidler. “ I believe that ZeroG is a direct result of our engineering group working with therapists who were in the trenches each day treating patients.”
The original concept for ZeroG was based on extensive literature showing that unloading an individual’s body weight, called partial body-weight support, is helpful in getting stroke patients walking sooner. All of these studies, however, had patients training on the treadmill.
“To be a functional walker,” says Nichols, “one needs to be able to walk over different types of surfaces, different grades and learn to recover one’s balance.” It became apparent to Hidler and his fellow engineers that the field of physical therapy needed a body-weight support system that allowed training over ground that would allow patients to practice Activities of Daily Living (ADLs), since these are the tasks they would face when they left NRH and returned home.
“We wanted patients to be able to walk over a flat surface, but we also wanted them to be able to climb stairs and to step up and off a curb,” explains Brady. “That way their dynamic body weight could adjust as they ascended and descended. We also asked if we could stand next to the patient, rather than having to support them. This would allow the patient to figure things out on their own in a safe environment. We could then step back and watch their movement more carefully and give instructions and suggestions for improvement. We even asked if the patient could be able to trip a little bit, so that they could learn how to recover their balance.”
Kathy and Diane divide their time between studying patients in the ZeroG and using it to treat patients in a clinical setting. “We’re using it for a number of diagnoses, including stroke, traumatic brain injury, leg fracture, amputation, weakness as a result of spinal cord injury, multiple sclerosis -- or any other problem that is impacting walking ability. They are also heading up a research study looking at the effectiveness of ZeroG gait training in acute stroke patients.
Right now, Kathy and Diane are the only PTs trained on the ZeroG, but they are anxious to share their knowledge with their colleagues. Kathy is currently working on a grant that will help develop protocols for training therapists with robotic devices like the ZeroG.
While some therapists might find this “gear-switching” between research and clinical care to be challenging, Kathy and Diane are happy to wear both hats. “Most clinicians simply don’t get the opportunity to do clinical research and treat patients," says Diane. “We feel extremely fortunate.”