St. Charles Hospital is at the forefront of a number of emerging technological advances in the field of rehabilitative medicine with promise of vastly enhancing the lives of those with physical and cognitive disabilities, thanks to the efforts of a team led by Dr. Semel.
Since 1907, when four French sisters representing the Order of the Daughters of Wisdom founded St. Charles Hospital to provide care for 27 children with physical and developmental disabilities, St. Charles Hospital has been the leader of rehabilitative care on Long Island. No strangers to the path less traveled, St. Charles Hospital’s Physical Medicine and Rehabilitation team has made great strides to remain true to the hospital’s original mission of providing care for those living with disabilities or requiring rehabilitation by employing forward-thinking approaches to care. With Jennifer Semel, MD, physiatrist, Medical Director of Physical Medicine and Rehabilitation at St. Charles Hospital, at its helm, her team — comprised of physiatrists, rehabilitation nurses, physical, occupational and speech therapists, social workers, psychologists, and nutrition and recreational therapists — collaborates to create personalized therapy plans for each patient. In between caring for adult and pediatric patients with injuries or disabilities — including spinal cord injuries, stroke, multitrauma injuries, traumatic brain injuries (TBIs), amputations, hip fractures and nerve disorders, among others — the team actively searches for innovative rehabilitative technologies that hold promise of improving patients’ lives.
“From our physicians to our therapists to our support staff, we are all highly dedicated to what we do,” says Dr. Semel. “It’s in our DNA, so to speak, given that our hospital was founded with the mission of caring for individuals with disabilities, and we aim to remain true to that. When we want to invest in our rehabilitative services and purchase leading-edge devices, our hospital’s leadership and auxiliary lend their support to our endeavors to stay ahead of the curve.
“Particularly in the last five years, our field has rapidly changed, with the advent and increasing availability of ultramodern robotic technologies,” Dr. Semel continues. “Our team strives to get in on the ground level of these technologies so we can offer the best therapies available that have the potential of changing our patients’ worlds.”
Specially trained St. Charles Hospital physical therapists assemble the hospital’s FDA-approved exoskeleton prior to each therapy session and ensure it is fitted properly. The exoskeleton model purchased by St. Charles Hospital is a streamlined version, weighing 26 pounds.
Enhancing Outcomes through Technology
Nearly a decade ago, St. Charles Hospital began using groundbreaking rehabilitation tools to improve patient outcomes, including specialty electrical stimulation devices. One example is a stationary bicycle designed to help maintain muscle mass, lung function, bone density, and overall health and quality of life for paraplegic patients who have sustained spinal cord injuries. Through electrodes that attach to the patient’s calf muscles, electrical impulses stimulate the muscles in the leg, allowing the patient to pedal.
More recently, Dr. Semel and her team utilized two electrical stimulation devices recommended for patients who have suffered a stroke. The first is a noninvasive hand rehabilitation device designed for patients who have lost hand mobility and function due to neurological disorders, including cerebral palsy, multiple sclerosis (MS), stroke or TBI, helping them carry out activities of daily living they previously couldn’t. The second employs electrical stimulation to assist patients in performing coordinated movements of the hand, helping them regain more natural function.
In addition, St. Charles Hospital’s Physical Medicine and Rehabilitation team has employed an award-winning rehabilitative appliance created to enhance the outcomes and lives of those struggling with life-limiting conditions affecting the lower extremities, such as cerebral palsy, MS, stroke or TBI. Led by Dr. Semel, St. Charles Hospital was one of the first sites in the U.S. to offer this therapy in a clinical trial capacity, primarily using the technology to help improve function in patients with foot drop following stroke. The system distributes electrical stimulation to the leg, activating leg and foot muscles that have been adversely affected by stroke or injury, thereby enabling the patient to perform controlled movements. Over time, exercises with the device strengthen muscles that have become weak, curtail muscle spasms, increase blood flow to the area and enhance the patient’s range of motion. Patients using the device have the potential to walk with a corrected gait, thereby minimizing or phasing out the need to use a plastic brace.
“Technology is the future of rehabilitation for people recovering from physical disabilities, particularly those following spinal cord injuries and stroke. Recent technological advances in our field are merely the beginning of empowering these patients with the tools they need to gain better control of their world.”
— Jennifer Semel, MD, physiatrist, Medical Director of Physical Medicine and Rehabilitation at St. Charles Hospital
Innovation on the Horizon
As part of the hospital’s strategic plan to continue to invest in technologies that improve patient outcomes, St. Charles Hospital, in November 2016, became one of just nine centers in the country to participate in a multicenter clinical trial of a new rehabilitative therapy, Indego. Indego is a mechanized lower limb exoskeleton for people who are undergoing treatment for spinal cord injuries and are between 5’1” and 6’3” and weigh 100 to 250 pounds. The FDA approved Indego in March 2016, following a large, multicenter clinical trial evaluating the device’s safety.
Michele Galante-Adams, PT, Lead Physical Therapist, St. Charles Hospital (left) and Mark Schmalzle, PT, St. Charles Hospital (right), guard Greg Durso (center), as he walks while wearing the hospital’s exoskeleton.
The robotic exoskeleton is attached to the waist and sides of the legs, allowing the patient to walk with the assistance of crutches or a walker and perform over-ground gait training. When the patient wants to stand up, he leans forward and the device enables him to stand; if he wants to walk, he leans forward slightly, and the device begins the walking motion.
“Part of our strategic plan for investing in and investigating upcoming state-of-the-art rehabilitative technologies focuses on innovative robotic technologies with exoskeletons in particular, and Indego is one of those devices,” Dr. Semel says. “We looked at numerous exoskeleton technologies, but our team felt the Indego was the most advanced. It’s lighter weight than most — at only 26 pounds — whereas others tend to weigh more than 100 pounds, which can throw off the patient’s balance, making it more difficult to walk.
“Additionally, other exoskeleton devices tend to have upper-body packs, or apparatuses, and external cables that can be quite cumbersome,” Dr. Semel continues. “All machinery in Indego is built into the device, which spans the waist down to the ankles, making it much more patient-friendly.”
Another advantage of Indego is it allows patients who use wheelchairs to wear it while sitting in their chair and then standing. Similar exoskeleton devices are often too bulky to allow such easy access and use.
Clinicians store the frame and stride measurements for each patient utilizing an app, which connects with the exoskeleton via booth technology. The app will record the time and number of steps a patient has taken in each session.
Putting Indego to the Test
Greg Durso, a 31-year-old senior credit analyst from Stony Brook, who is paralyzed from the chest down after suffering a spinal cord injury while sledding down a mountain on New Year’s Day in 2009, is St. Charles Hospital’s first patient to use Indego. Following the accident, Mr. Durso had a spinal cord fusion and completed acute care rehabilitation shortly thereafter. He continued his rehabilitation at St. Charles Hospital’s outpatient rehabilitation network location in Port Jefferson.
“St. Charles Hospital has an excellent reputation for spinal cord injury rehabilitation, and it was close to home — it was a perfect fit,” Mr. Durso says. “I’ve always enjoyed being active — skiing, cycling, swimming, wakeboarding, boating and competing in triathlons — and I want to compete in the Paralympics. Fortunately, through a number of rehabilitative therapies, Dr. Semel and her team have helped me remain active, as well as sustain a high level of independence.
“I’ve only used Indego for a few weeks, but it has been an incredible opportunity and experience,” Mr. Durso continues. “Until Indego, I hadn’t walked in almost eight years. There’s great hope knowing there’s now technology available to help me walk again.”
Mark Schmalzle, PT, St. Charles Hospital (right) helps Greg Durso (left), maintain his balance as he walks while wearing St. Charles Hospital’s exoskeleton. The exoskeleton completes the walking motions for the individual who wears it.
While Indego has been indicated primarily for patients with spinal cord injuries, the novel device also holds great promise for those who have suffered a stroke.
“St. Charles Hospital is the largest acute inpatient rehabilitation facility on Long Island, serving more than 1,000 patients annually, the majority of whom are stroke patients and those living with lower limb disabilities. We also provide 100,000 patients visits annually through our eight outpatient rehabilitation centers,” Dr. Semel says. “This new clinical trial gives the makers of Indego an opportunity to have a large population evaluate their device while also providing hope to patients recovering from both spinal cord injury and stroke patients.”
Though Dr. Semel is pleased with the early success of this technology, she is most excited about the next generation of Indego, which will employ functional electrical stimulation (FES).
“Right now, the device drives itself,” Dr. Semel explains. “However, the electrical stimulation capability in the upcoming design will stimulate the patient’s leg muscles and enable him or her to drive the machine. The electrodes will attach to the quadriceps muscles, causing the patient’s legs to extend, and giving the impulse required for the muscles to make the machine move.
“Aside from giving the patient the power and ability to move the machine instead of vice versa, we theorize that the electrical stimulation will also help keep muscles active, thereby preventing muscle atrophy, which is very common in patients with spinal cord injuries or strokes,” Dr. Semel adds.
Parker Hannifin Corporation expects research trials for Indego with FES will begin fall 2017.
Greg Durso, a St. Charles Hospital patient, competes in a bike race following a 2009 sledding accident which left him completely paralyzed from T4 down.
Tapping into TMS
In addition to seeing promising benefits from Indego, stroke patients receiving care from St. Charles Hospital also have the potential to see gains from transcranial magnetic stimulation (TMS), a noninvasive means of activating the brain via electromagnetic induction. TMS has been shown to improve symptoms of depression in people who have not found relief from other treatments. However, Jun Zhang, MD, Director of Brain Injury Rehabilitation at St. Charles Hospital, is currently spearheading a clinical trial to evaluate the effectiveness of TMS in helping stroke patients recover certain motor skills.
“Specifically in patients with stroke, we can facilitate the side of the brain that was affected with high-frequency magnetic stimulation, while simultaneously emitting a low-frequency magnetic stimulation on the opposite side, thereby changing the way the brain functions,” Dr. Semel says. “A number of studies have shown TMS improves recovery of function and language skills, for example, as well as depression, which is a pervasive problem in people who have had a stroke. Our study is geared toward evaluating TMS effects on both motor recovery and depression in stroke patients in our unit.”
Jun Zhang, MD, Director of Brain Injury Rehabilitation at St. Charles Hospital, applies Transcranial Magnetic Stimulation (TMS) on a post-stroke patient as part of St. Charles Hospital’s investigative study exploring how specific areas of the brain may respond.
Technology appears to be the future of not only physical rehabilitation but neurologic rehabilitation. In the first quarter of 2017, St. Charles Hospital plans to begin using Bioness Integrated Therapy System (BITS), a multidisciplinary, multi-pronged therapy designed to improve visual and motor functions in individuals who have experienced disabilities from TBIs and movement disorders. The therapy system offers software housing six primary therapy categories, 24 total therapy programs and four standardized assessments. BITS incorporates this complex software with a large interactive touchscreen display to provide patients with various activities to improve visual motor skills, visual and auditory processing skills, cognitive skills, and endurance skills.
“As with the other rehabilitative devices we’ve adopted, our team looked at several similar devices to BITS, but across the board this was the one our therapists rated highest for its ability to work well for stroke patients, as well as those who have sustained concussion and TBIs,” Dr. Semel says. “BITS was unanimously selected by our team for its capacity to not only improve patients’ abilities to scan their environments, but to also help draw their attention better than we had observed from former, more rudimentary methods, which is an important part of recovery, as stroke patients tend to struggle with attention deficits.”
Sunia Choudhury, MA, Research Assistant, St. Charles Hospital, assists Dr. Zhang (not pictured) during a Transcranial Magnetic Stimulation (TMS) session and views placement of the TMS paddles.
Evolving to Meet Patients’ Needs
St. Charles Hospital not only strives to offer patients the most advanced technologies available to optimize outcomes, but also takes great care to provide the best care possible. As the first provider on Long Island to be accredited by the Commission on Accreditation of Rehabilitation Facilities for both outpatient and inpatient rehabilitation for adult and pediatric patients, as well as stroke specialty care, St. Charles Hospital aims for the gold standard in all areas of rehabilitative care.
“I truly believe it’s our hospital’s and team’s dedication to remaining cutting-edge that sets us apart,” Dr. Semel says. “Our greatest asset, however, is our team: We have a well-developed, highly and specially trained team of professionals — each of whom is dedicated to not simply helping our patients get home, but to helping them be as happy and functionally independent as possible.”
To learn more about St. Charles Hospital’s rehabilitation services visit stcharleshospital.chsli.org.