Bob Gailey, PhD, PT, a physical therapist and a professor at the University of Miami Miller School of Medicine, talks about a new app that is helping amputees get moving to the music.
Interview conducted by Ivanhoe Broadcast News in December 2016.
Give us an idea of why this even began and as a physical therapist what you were seeing with the patients that you were working with, the amputees?
Gailey: If you go back it was just after 911. I was asked to work with the folks at Walter Reed, they were putting together their amputee program and one of the things I noticed is the service members coming back wanted to desperately to walk well, but they were a different generation. They all walked around with ear bugs in their pockets, or in their ears and they were listening to music all the time. So how do we incorporate that generation needs into what therapy is today. About five years ago we brought together a team that wanted to incorporate today’s technology into rehabilitation. If you could walk around your town, your workplace, place of work and you can listen to music but that music was also giving you a sense of how you are walking, how you are doing people respond to that. We love to dance, we like to move and so it becomes easy to walk right when you are getting the right information.
What are some of the challenges then?
Gailey: After a person loses a limb the primary goal is to get back to the life of the way they did before; back to their family, back to the job, back to school back to the things they enjoy and unfortunately, rehabilitation kind of gets in the way. The average person has to think about each step that they take and are they doing the things they learned in physical therapy correctly, so if we can give them the ReLOAD system which is simply putting music or like we like to say, a physical therapist in your pocket, the person doesn’t have to be taken away from their everyday life; they can have that therapy while they are walking around. ReLOAD will do a number of things, one is as you are walking it doesn’t just work with music. What it does is tell you what you need to tighten your buttocks, you need to roll over your toe, you need to move your hip, and it gives you one or two verbal queues and then the person knows what to do and then that will make the music work. What we found is people inherently without thinking can walk correctly and if they are trying to match the movement it becomes intuitive; it is too mechanical. Probably one of the best examples of why the music works is think about if you are learning a new tennis stroke, or a new golf swing and if you think about it mechanically it looks mechanical. Same thing walking with a prosthesis, however, as you begin to relax and you let the music go and then it just becomes natural and you can figure it out. You’ve been walking all your life and it is just a matter of getting a few queues to let you walk the way you walked before. One of the things about the real knee it is a microprocessor knee and it is very sophisticated so the engineers who designed the knee made this work just the way you walk. What we added was a little bit of feedback to teach a person how to use it correctly, so if we take the thought out of it; if we just let them walk naturally the knee will take over with the rest and that’s where modern technology is coming today with prosthetics. If you look at the millions of dollars that have been spent in research and development since the beginning of the wars, or over the last 15 years this is an incredible amount of technology that is available. We just need to teach the people who are using it how to use it correctly and you can overthink it and that is what we are trying to do, was to reduce the thought and just let them use the knee naturally. This is the ReLOAD chip that allows the person to be able to listen to the music. It takes the information as a person is walking and it goes wirelessly up until the tablet or to the iPhone and then it is communicating to the patient how well the prosthesis is working and how well they are using it and it talks to them through music.
Do you think, from your experience as a physical therapist, there is a big difference between just telling someone to do this, walk this certain way, hold your body, this that and the other, as opposed to them hearing it with the music.
Gailey: Everybody learns in different ways, some people are audio, some people are visual, and some people are tactile. The neat thing about the ReLOAD system is it can give you the audio feedback, but you also look at the tablet and it can tell you how many steps you are walking per day, what the quality of the steps where it also has the capability of vibration in our next generations. In other words a person can learn different ways on what they are doing correctly and what they are not doing. The beauty of ReLOAD is that when a service member or an everyday patient comes into the therapist, the therapist is going to capture how they walk that day then they go home. This doesn’t have to be perfect, it is their best walk and what the ReLOAD system will do is reinforce that they are walking the same way not getting any worse, if they do then they will hear the warped music or something of that nature and it reminds them that they need to walk a little bit better. That way when you go home you don’t lose what you learned that day in physical therapy. One of the neat things about ReLOAD that if a person is living a great distance from the hospital, it takes them two hours to get back and forth to the hospital they can take the system and the therapist can capture how well they walked that day, send them home. On the tablet are exercises, there’s screen shots so they can see how well they are walking. It has the different feedback modes that are on there so the therapist can log on and at the end of each day and see was the person exercising, were they walking each day, are things getting better and if they are they give them new exercises. If things aren’t going so well, then they can give the person a call and find out what is going on; if things are declining they can say hey, you need to come in and you need to see the doctor, your progress for the therapist so you get the right attention.
You guys have been working on this for at least five years and on the app itself, but there is a real science behind it. You are seeing the success.
Gailey: What we have created here at the fore center is this is real collaboration not only from the clinicians, from the physical therapy, but also from music engineering where their knowledge is embedded in everything that we do. Biomechanical engineering is embedded. What we are doing here at the fore center is a true collaboration, what we are bringing together is the science and the clinical aspects for the patient. We are working with music engineering; we are developing the apps and the engineering that goes behind the system. In the clinic or the clinicians are giving the clinical aspects of what goes into this program; so the patient is getting the best of both worlds. The technology expands well beyond, in just simply having music in your ear. One of the neat things about the ReLOAD system is that every time somebody walks that information is going into our database. That database filtering through good walks, poor walks, something in between and it is creating artificial intelligence so that person benefits not only from how they walk, but how every other amputee walk so that information can help them to become better walkers. To be able to move to physical therapy at little bit faster and as a result, the entire medical field is going to benefit from what we are doing here from the ReLOAD system.
What can happened to many of the amputees later in life? What can they deal with and how if their walking is not accurate or proper?
Gailey: Conceptually, one of the goals of ReLOAD was to decrease the adverse events that can happen to people who wear prosthesis. We know that if you wear prosthesis you either double or triple the risk of arthritis on your sound or your intact limb. We also know that you have an eight percent risk of back pain, and for those who are diabetics they run a very high risk of losing the other foot with insult or injury. If we could teach the person how to walk right, remind them that when they are walking in their community or in their home with the ReLOAD system of what’s right and what’s wrong can we help that person preserve the contralateral limb and what we call their good leg and keep them from back pain and having to use the health care system that will only drive up the cost for everybody,
What is the hope as far as the technology, the app? As far as the study, how much longer do you think the study will go and when might this be available?
Gailey: Currently we have concluded a number of studies and we know that the system works. We are now working with the Department of Veterans Affairs and the Department of Defense putting it on our veterans and service members both here in Miami, and up in Bethesda, Maryland. As they come into the system we are using their data so they are serving us once again in order to help the general public. We hope to within the next eighteen months have the first commercially available product so that everybody can benefit, including the brave men and women who have served us throughout the years.
This could help anyone who has lost a leg?
Gailey: Yes, the neat thing about what the engineers have developed here is not only do you need the sophisticated knee in order to take the computer chip but we have also developed knee sleeves that can use our sensors on somebody that has a below the knee amputation and above the knee amputation. As we move forward, if somebody that hasn’t had an amputation, or is just somebody that is older, or somebody that has some other kind of gait deviation from another injury they can use this system as well. There is so much down the road we just have to move forward a little bit by little bit and it is people like our service members and people like our Kelly that make it happen.
END OF INTERVIEW
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