Editor's note: Flashback is a new recurring feature in the newsletter that will take a quick look into the last century with a focus on rehabilitation developments from a MossRehab perspective.
Beginning in the 1980s, the American public became more aware of the value of medical rehabilitation. The work that physiatrists were doing with patients was resulting in an increase in patient functional independence and a general improvement in their quality of life. The growth of rehabilitation centers was on the rise and more PM&R residency programs were training doctors to join the ranks of the physiatric community. The demand for medical advancements and improvements in technology was fueling the change. This was a new era of challenge for physical medicine and rehabilitation.
It was in the 1980s that MossRehab established the Drucker Brain Injury Center (DBIC) for treatment of patients with traumatic brain injury. This was a decade of great change for head injury rehabilitation and marked the beginning of a period of increased public awareness for the nature and causes of head injury. DBIC stood out as one of the first centers in the country to use a functional approach to brain injury rehabilitation. Nathanial Mayer, MD founded the center and is widely regarded as a respected pioneer in the field of brain injury rehabilitation. His groundbreaking work has been emulated in many other rehabilitation facilities around the world.
The DBIC’s Day Program, another first, was modeled on the type of patient-centered, self- determined approach originally used for psychiatric care. At DBIC, the Day Program promotes personal progress and encourages self-sufficiency for people living with brain injury. This patient-empowering program features work-directed activities that prepare patients to re-enter the community. Because it’s built on specific patient needs and peer support, it gives patients the ability to direct the program in a way that best meets their needs and abilities. As a focus-on-abilities-first concept, every patient contributes to the overall program.
DBIC is well recognized and regarded for its brain injury treatment and research. As a world-renowned center for traumatic brain injury rehabilitation, DBIC is one of 16 federally designated Model Systems of Care and contributes significant information on traumatic brain injury care and treatment to one of the federal government’s most valuable clinical programs—a national database designed to stimulate more rigorous research and improve outcomes for persons with brain injuries.
Funded by the National Institute on Disability Research and Rehabilitation (NIDRR), Model Systems of Care exist in spinal cord injury, traumatic brain injury, and burn injury. The Model Systems share information and support research in order to improve the quality of life for patients.
This decade ushered in a new generation of research activities designed to improve quality of life for people with disabilities. While MossRehab joined Einstein Healthcare Network in the 1990s, we also founded the Moss Rehabilitation Research Institute.
MossRehab opened the Motor Control Analysis Laboratory, which addresses upper extremity muscle dysfunction that occurs due to brain injury,Dr. Mayer working with a patient in the Motor Control Analysis Laboratory stroke or spinal cord injury; the Stroke Center, which helps patients in the recovery phase learn to regain function and reestablish community ties; and the Sheerr Gait and Motion Analysis Lab, which focuses on evaluating and treating gait dysfunction in patients with neuromuscular and orthopedic injuries.
In the 1990s, MossRehab was the only rehabilitation center in the region with onsite prosthetic and orthotic fabrication facilities. And in the late 1990s, MossRehab began full-service treatment of athletic- related injuries through Moss Sports Rehab.
Growing to Serve a New Century
In the first decade of the new century, the Moss Rehabilitation Research Institute moved into a new research building on the Elkins Park campus. With the introduction of the Right Hemisphere Stroke Center, MossRehab became the only U.S. facility dedicated to treating all aspects of right hemisphere stroke syndrome.
MossRehab was one of the first Stroke Centers in the nation to be accredited by the Commission for Accreditation of Rehabilitation Facilities (CARF). Along with that recognition, the Sheerr Gait and Motion Analysis Laboratory became the first in the region to be fully accredited by the Commission for Motion Laboratory Accreditation.
The skilled professionals in MossRehab’s Aphasia Center are known for the quality of their research and for the successes they’ve achieved in individual treatment programs. Pioneering work in this area by Myrna Schwartz, PhD; Ruth Fink, MA; Adelyn Brecher, MA and others led to the introduction of MossTalkTM Words, a user-friendly computer-assisted treatment program that gives patients practice in comprehending and producing words, phrases and sentences. With key features such as multimodality cueing and feedback and automated record keeping, users can draw on a large vocabulary to customize the program. When introduced to these computer-based technology tools today, even some patients who experienced onset of aphasia years ago have achieved significant levels of recovery.
In addition, our research scientists have developed a variety of diagnostic tools for assessment, some of which include: MARS, the Moss Attention Rating Scale for measuring attention deficit in impaired patients (T. Hart, J. Whyte); VRLAT, the Virtual Reality Lateralized Attention Test for measuring hemi-spatial neglect after stroke (L. Buxbaum); QIBA, the Quantitative Individualized Behavioral Assessment tool for determining the state of consciousness in severe brain injury (J. Whyte); NAT, the Naturalistic Action Test for assessing disorders of complex action after brain damage (M. Schwartz, L. Buxbaum); and PNT, the Philadelphia Naming Test (short form) for assessing the nature and severity of naming disorders (M. Schwartz).
C.R. Sridhara, MD, Clinical Director of the MossRehab Electrodiagnostic Laboratory, recently developed an innovative educational DVD on the assessment of uncommon nerve entrapments. This tool has helped doctors and therapists around the world better understand techniques for evaluating and diagnosing less common nerve entrapment disorders.
Transforming Technology into Therapy
With the advent of the 21st Century, MossRehab has emerged as a leader in the use of robotic technology in the rehabilitation continuum of care. When MossRehab opened its Center for Robotic- assisted Rehabilitation in 2005, it was the first facility of its kind. The use of robotics represents one of many innovative treatment methods used by the MossRehab rehabilitation team to help patients on the road to recovery. Placing patients in a robotic environment gives the therapist greater control and reduces the risk of injuries for the patient.
MossRehab was one of the first sites in the region to introduce robotics for rehabilitation and the first U.S. site for the original trials for the Reo Therapy upper-limb robotic device. The patient sits facing a video screen and uses a robotically assisted joystick (Reo) to target images on the screen. Initially, the Reo moves the joystick and facilitates arm movement as patients attempt to achieve a target. As time goes by, the patient builds strength through repeated movement and begins to control the joystick independent of the robot.
The Center for Robotic-assisted Rehabilitation was the first site in the Mid-Atlantic region to use Lokomat, the world’s first gait-driven orthotic device to feature a robotic exoskeleton mounted above a treadmill. Through robot-assisted walking therapy that uses a harness and a computer-controlled mechanical suit, Lokomat helps train the body to learn how to walk again. The device performs precise patterns of repetitive walking that are valuable in gait restoration.
MossRehab was also the first facility in the United States using the G-eo System Evolution, which was developed by RehaTechnology of Switzerland. This robotic device, which looks something like an elliptical machine, helps patients walk and provides the motion to train in step climbing and descending.
Introduced to clinical use in 2010, the Tibion Bionic Leg was the world’s first wearable, battery-powered robotic orthosis designed for patients recovering from stroke. MossRehab was one of first facilities to use Tibion for gait retraining in the stroke and TBI population.
And, MossRehab was the first to introduce the Armeo and ArmeoPower robots. People recovering from strokes, traumatic brain and spinal cord injuries have used these robotic arm exoskeletons during their rehabilitation to aid the recovery process of their arms.
Many patients with balance disorders were first introduced to the SMART Balance Master at MossRehab. This biofeedback device measures the responsiveness and mutual cooperation between the eyes, inner ear, muscles and joints to help patients relearn balance.
Continuing to Make Great Strides
MossRehab’s invention of the first molded plastic leg braces in the 1970s marked one of the most significant developments for the mobility impaired. Nearly 30 years later, MossRehab became the first U.S. site for clinical trials of the ReWalk device, another significant development in the form of a lightweight motorized exoskeleton suit. As one of the first commercially feasible upright walking devices, ReWalk gives people who were once utilizing wheelchairs an opportunity to stand, walk, and, in some cases, even climb stairs.
While using crutches for stability, a patient with paraplegia can control movements using “body language” or a wireless keypad worn on the wrist. On patient command, motors at the hip and knee joints initiate the action. Sensors detect the motion and prompt the computer to issue the action that moves the leg. Before long, a patient formerly restricted to wheelchair mobility can walk across a room.
MossRehab was selected as the exclusive U.S. clinical trial site because of our international reputation for comprehensive clinical rehabilitation and research programs. MossRehab is known for its special focus on medical and cognitive rehabilitation and its ability to solve movement-based problems. The MossRehab clinical and research staff consists of some of the world’s foremost experts in rehabilitation medicine, including Alberto Esquenazi, MD, Chief Medical Officer and the John Otto Haas Chair of Physical Medicine and Rehabilitation. Dr. Esquenazi played a supporting role in the development of ReWalk and his innovative leadership in rehabilitation research has helped keep MossRehab at the forefront of leading- edge therapies.
Naturally, MossRehab’s ongoing goal is to decrease the time it takes to transform its research discoveries into practical clinical treatments. MossRehab is currently measuring and investigating many research initiatives in the hopes of identifying treatments to test in clinical trials. Some likely areas for greater clinical investigation include: treatments for pathological gait after stroke; treatments for skilled-action problems involving the hands; electrical stimulation- based treatments for language, movement and consciousness problems; and additional drug studies for cognitive and movement problems.
The Key to a Bright Future
Behind each era of MossRehab history, you find teams of researchers who continue to expand the horizons of scientific research. MossRehab’s undeniable track record of success points to an open environment in which people are encouraged to imagine new possibilities through innovative thinking. Since no one knows where the spark of innovation may originate, MossRehab continues to search for new ways to improve patient outcomes through rehabilitation.
Day to day, patients continue to choose MossRehab for its exceptional clinical practice, its innovative research, and its inspired rehabilitative care. Whether it has been a technological breakthrough or an inventive piece of research, MossRehab has added value for the patient population it serves by sharing the knowledge and advancing the science of rehabilitation.