James Crew, MD, Chair of Physical Medicine & Rehabilitation at Santa Clara Valley Medical Center, talks about a new robotic device aiding spinal cord injury patients through physical rehabilitation.
OK. So first of all, this is kind of starting from the beginning. Can you tell me about Praveen and when he first came here to Santa Clara Valley Medical Center?
CREW: Well, Praveen was injured in Hawaii and had an initial acute care in Hawaii, including a spinal stabilization surgery for his spinal cord injury. He came to us after his acute care was finished so we could work on multidisciplinary inpatient rehabilitation.
So, how would you assess, for the layman, the extent of his injuries? Were they severe?
CREW: His injury was fairly severe. He had paralysis of his upper and lower body. He had impaired function of several organ systems, including bowel and bladder function.
So, with that in mind, so how long did you think his initial rehabilitation would take before he kind of got back on its feet? I mean, did he exceed expectations type of thing?
CREW: I would say he did. You know, initially we were just wanting to get him up in a wheelchair for a few hours a day. Soon that progressed to seeing him up in a wheelchair all day long to even start to work on standing in therapy. And I know initially we weren’t sure if he was even going to be able to stand and walk when he left our rehabilitation unit. We ordered bracing for his legs, which I think happily he was able to take off very soon after going home. And now he’s walking without even the need for braces on his legs or using a walker or a cane or anything.
And I understand in addition to his that his arms were also affected. Would you tell me about that?
CREW: Yes. His spinal cord injury syndrome that he had, a type of spinal cord injury that we see fairly often, is called central cord syndrome. That’s where the central part of the spinal cord is more affected than their peripheral parts. And what that equates to is a loss of hand function more so than upper arm function or lower body function. So that can be very frustrating for patients because they have a fair amount of strength in their shoulders and elbows, but less strength and less dexterity in their hands, which makes them more dependent on other people.
So typically, how do handle patients rehab from that type of condition?
CREW: Well, patients with central cord syndrome and other types of spinal cord injury really need acute rehabilitation by a team of specialists that have trained and are expert in care of paralysis. Fortunately, here at Santa Clara Valley Medical Center, we have such a team. I’m fortunate to be a part of that team as a physician, but we have very skilled physical therapists, occupational therapists, even speech therapists that are very accustomed to seeing people with spinal trauma like Praveen.
So, tell me about the Armeo. The thing kind of like looks like you were saying like something out of the Terminator. So kind of tell me the kind of, you know, why does it make such a big difference?
CREW: I think the Armeo is another example of innovative care we have here at Santa Clara Valley Medical Center rehabilitation. It is a specific robotic system directed to improve function in people with upper body limitations. Like Praveen’s spinal cord injury, it affected his upper body function more than his lower body function. And the Armeo allows the therapist to guide therapy directed at muscles and movements in his arm that he might not have much strength in currently, but hopefully over time will recover more and more independence in.
OK, so with all that in mind, how soon did you start to kind of see an improvement?
CREW: Praveen, it was, you know, it was maybe a little quicker than expected. Generally, I tell people who are under my care and the inpatient rehab unit, don’t expect changes day to day. Expect changes week to week after spinal cord injury. We know, especially after an incomplete paralysis type of injury like Praveen’s, that time is on people’s side. Generally, people recover over the course of six to 12 months before they plateau in their neurologic recovery. In Praveen I think we saw improvements a little quicker than we might have initially expected, given the fact he had not done much rehabilitation. He had not been in a wheelchair much. He was very limited by pain early on, as many patients are after the kind of trauma he sustained and the type of surgery he went through.
Do you think that that was kind of one of the factors that helped quicken his rehab process?
CREW: I think towards the end of his inpatient rehabilitation stay, Praveen was becoming more independent and was getting more strength back in his hands and being able to use a device like the Armeo system probably accelerated his hand recovery.
So, is he pretty much recovered? What’s his current prognosis? Is he still working at it or … ?
CREW: Praveen is still going through multidisciplinary care with therapies coming out to the house currently to improve his independence in both mobility, you know, walking. He even went for a jog, he just told me fairly recently, which is amazing to consider where he was about two months ago when I met him when he came back to California from Hawaii where his injury occurred around Christmas. So his recovery has been pretty remarkable over the last one to two months. But, yes, to answer your question, there is more rehabilitation in his future. I think there’s a lot more recovery that he’s going to have over the course of the next four to six months.
Have you had other patients use the Armeo?
CREW: Well, I can say that the Armeo is a relatively new system that we’ve adopted for people with incomplete spinal cord injury like Praveen. And we’re very excited to be able to utilize this technology on more patients because we see hundreds of people every year with spinal cord injury at our center. And I think a large number of them might be candidates to use this type of system in the future.
So do you think this type of system, this robotics, is more effective than just using the typical, you know, bands and things that people think of with physical therapy, like the traditional medicine physical therapy?
CREW: I think the Armeo is an exciting tool that we have here in our rehabilitation program because it allows patients to do a type of virtual learning and robotic activity that we just didn’t have access to otherwise. While traditional therapies and more traditional older therapies might be helpful, a system like Armeo might help someone even more and they might find more interest in it as part of their rehabilitation treatment. I can try to make that more concise or maybe Lindsay can. But, again, I don’t want to add too much hyperbole. I want to make sure that I’m saying something that’s factual. But I don’t know if I can say for sure that someone wouldn’t recover as well without the Armeo, but I do think it’s a great option and a great tool that we have.
I’ve also known like, you hear all these stories about a lot of people who have these similar type of injuries. And, you know, they’re stuck in wheelchairs for a very long time…
CREW: Yeah. After spinal cord injury, we never can fully predict where someone’s going to end up neurologically. We always hope for the kind of recovery that Praveen has had over the last two months. But not every patient obtains or achieves that type of level. And I can say, I think with some of the rehabilitative tools that we have here at Santa Clara Valley Medical Center, including the Armeo, we’re affording more patients I think the best chance at a good recovery.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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