Media Coverage

Virtual rehabilitation improves patient compliance and therapeutic outcomes

By Gina Brockenbrough ORTHOPEDICS TODAY

Oct 29 2009

"Beth Abraham Hospital has been so impressed with GestureTek’s Interactive Virtual Rehabilitation & Exercise System (IREX) that they have purchased four units over the past few years". Vincent John Vincent, President, GestureTek.

Some health care facilities are using virtual rehabilitation systems in conjunction with traditional modes of rehabilitation to help patients regain function.

Using the systems can help patients simultaneously improve balance, coordination, muscle strength and range of motion, while providing quantitative data for physical therapists.

“We put the patient in a computer-generated world that allows for isolated or combined joint movement or even full-bodied functional movements,” Randy Palmaira, corporate director of rehabilitation for Beth Abraham Family of Health Services, told Orthopedics Today. “The system also compiles data based on these movements for the therapist.” His center is the first health care facility in New York City to offer virtual rehabilitation.

Cognitive, functional skills

The facility uses the Interactive Rehabilitation and Exercise System(IREX, GestureTek Health) which features several different clinician-selectedprograms, such as soccer, snowboarding and laundry-sorting games, which targetspecific muscle groups. The system also uses gesture-sensing technology tomeasure patients’ movements.

Randy Palmaira said virtual rehabilitation could be useful for patients with neurological impairment or amputees. Images: Palmaira R

Unlike traditional rehabilitation where the therapist must interrupt patients’ movements to take goniometric measurements, the virtual system incorporates a virtual goniometer that is displayed on-screen. Programs can be set for a bell to ring when patients have reached a specific functional target, such as 90° of knee flexion. The system also has a deflection mode whichdetermines the amount of force a patient is exerting. In addition, a report isprinted at the end of each session detailing the patient’s accuracy duringthe program.

While virtual reality entertainment systems display animated characterson-screen in the place of the patient, Palmaira noted that the IREX systemprojects a real-time camera image of the patient. Programs that requirepatients to sort items, such as colored and white laundry, also focus onexecutive functioning.

“It is something that is cognitive, functional and physical rolledinto one and that makes it different,” Palmaira said.

Indications

He noted that virtual rehabilitation systems can be beneficial forpatients who have neurological impairment, have undergone an amputation or havehad any surgical procedure that resulted in weight-bearing restrictions, suchas fractures and total hip and knee replacements.

Virtual rehabilitation systems similar to the IREX cost between $10,000and $16,000, Palmaira said. The number of necessary therapy sessions varies onan individual basis.

“Oftentimes, what we observe is that after three sessions, thepatients will improve their balance,” Palmaira said.

During sessions, it is crucial that therapists explain to patients howthe movements used during a simulated game, such as leaning forward and weightshifting, can be used transferred to daily functional tasks like ambulation andbalance.

“The transfer of knowledge and the transfer of function are fasterfor the patient to see and understand,” Palmaira said.

Patients have a great time watching themselves on a large plasma screen during therapeutic work sessions using the interactive virtual rehabilitation and exercise program.

Benefits for therapists, patients

“It is a comprehensive, clinician-controlled exercise system,”Palmaira said. He noted that the system allows the therapist to control theregion of the body that will be targeted during the simulation, whether thefrontal or sagittal plane is engaged. The therapist is able to increase ordecrease the level of intensity based on the patient’s capabilities.

“It is fun for the patients,” Palmaira said. “It promotesa greater compliance and increases the therapeutic output.”

He also noted that because the system does not have an external device,like a remote control, it does not support cross-contamination betweenpatients.

“Virtual rehabilitation encourages patients to use their bodyweight to perform closed kinematic exercises, as opposed to open kinematicexercises that require external resistive devices, such as dumbbells,”Palmaira said. “As a result, it is safer and the transfer of movement to afunctional task is faster and more enhanced than with traditionaltherapy.”

For more information:

• Randy Palmaira, can be reached at Beth Abraham Family of Health Services, 612 Allerton Avenue, Bronx, New York 10467; 718-519-4000; e-mail: rpalmaira@cnrhealthcare.org. He has no direct financial interest in any products or companies mentioned in this article.