Compiled by Physical Therapy Products staff
Restoring the ability to walk and remain balanced are central to rehabilitation, and technologies that help therapists effectively evaluate the issues that impair mobility are continuing to improve. In this roundtable discussion, representatives from some of the nation’s top equipment manufacturers share insights with Physical Therapy Products about developments in their companies’ technologies that can help therapists evaluate and treat problems that affect gait and balance. The following Q&A provides detailed discussion about the latest technologies to appear on the market and the advantages they provide over what traditionally has been available to therapists. Product features and functions that clinicians say they have found most useful in evaluating or treating gait are also shared, in addition to manufacturer summaries about what distinguishes each technology in the gait and balance category.
Participating in this Q&A are: Jay Everett, national sales manager, Clarke Health Care Products; Karen Toepper, vice president, sales & marketing, GAITRite / CIR Systems Inc; Patrick Bruno, global vice president sales, rehabilitation, Hocoma Inc; Nechama Karman, PT, MS, PCS, chief clinical educator, Mobility Research; Arik Avni, co-chief executive officer, Motorika; Michael Rowling, chief operating officer, ProtoKinetics; Alyssa Rubino, medical product manager, Tekscan; and Andrew Frank, chief operating officer, Vista Medical.
Q. Describe the latest technology your company has developed to help evaluate or treat gait impairment.
A. Jay Everett, Clarke Health Care Products: The Dynamic Stair Trainer is our latest technology, and it was engineered to make it possible for gait training, stair training, and incline training to be monitored and documented. The Computerized DST monitor tracks and displays patient’s performance in past and current sessions with a Personal Chart of Progression, generated by the DST-System.
A. Karen Toepper, GAITRite / CIR Systems Inc: The WiFi-based GAITRite CIRFace was developed to allow for an infinite number of layouts of active areas including elevations, complex turning, and other testing protocols, including custom-tailored protocols. GAITRite also announced a simple, easy 3D Video option to record and display upper body movement with a single 3D camera synchronization to the GAITRite. Additionally, GAITRite introduced SAFARI, a new solar power-based system for use in the field that removes restrictions of hardwire power.
A. Patrick Bruno, Hocoma Inc: Hocoma offers solutions across the continuum of rehabilitation for gait and balance, arm and hand, as well as strength, coordination, and endurance. Regarding gait rehabilitation, the continuum ranges from early mobilization to intensive locomotion therapy (Lokomat) to secure overground gait therapy (Andago V2.0) and gait adaptability and balance training (C-Mill). The latest addition is the Andago, which was introduced in 2016. The Andago is a mobile gait robot with a body weight support system, and enables overground gait and balance training in patients with walking or balance disabilities, caused by conditions of neurological, orthopedic, muscular, cardiovascular, or other origin.
A. Nechama Karman, Mobility Research: GaitSens 2.0 is an instrumented treadmill that features an Android tablet that performs spatiotemporal gait analysis in real time as users walk on the treadmill. It can generate reports in seconds, and can overlay reports between sessions to compare walking conditions’ effects on gait, evaluate the effectiveness of specific interventions, or track progress over time. The integrated user feedback module uses patient data to identify goals and provide biofeedback to the user while they walk.
A. Arik Avni, Motorika: The Optimal G PRO is a high-level gait robotic training platform incorporating the new ELITE technology for proactive, adaptive, and personalized rehabilitation. The platform is designed to enable the therapist to conduct a comprehensive gait and balance re-training process to accelerate the rehabilitation of both adults and pediatric patients post-neurological trauma and orthopedic injury. It incorporates a body-weight support treadmill with ergonomic harness, active neuromuscular facilitation capabilities, virtual reality multitasking features, alongside dual-camera recording and visual feedback.
A. Michael Rowling, ProtoKinetics: Our Zeno Walkway’s wide surface allows for the capture of assistive device performance in addition to the loading patterns of the patient’s footsteps. PKMAS software’s updated footfall labeling automatically eliminates walker tracks while expertly identifying overlapping steps, which is crucial for implementation in clinical care. ProtoKinetics consistently reviews updates in literature in order to automate additional valuable measures and protocols, such as the recent implementation of the enhanced GVI and automated Four Square Step Test.
A. Alyssa Rubino, Tekscan: Tekscan’s Strideway system is a modular pressure measurement platform used to provide actionable insights into gait abnormalities, inefficiencies, or imbalances. Data collection is quick and simple. A patient simply walks across the pressure-sensitive walkway, and key gait parameters are automatically calculated. Information provided includes pressure, force, spatial, temporal and kinetic data. The flat and wide surface area accommodates nearly any patient type and reduces trip hazards. The Strideway is available in different resolutions and configurations.
A. Andrew Frank, Vista Medical: The BodiTrak Balance System by Vista Medical is made to be a clinically useful and easy-to-use assessment, training, and reporting system for balance and gait training. We pooled our 25 years’ experience in developing our rehabilitation tools with our new IOT electronics and stretch sensor design to create BodiTrak balance as a tool with assessment flexibility, connectivity, and portability—and all at a price that aims to be affordable to the rehab clinic. BodiTrak is available in stand-on flexible sensors and treadmill sensors.
Q. How does your technology help therapists improve outcomes for the people they treat?
A. Jay Everett, Clarke Health Care Products: Our DST allows the therapist to conduct gait training as they normally would, but then it can provide other training tools (exercises) with one device; and through the documentation process it can further help the therapist to evaluate and communicate with other health care professionals about the patient’s status and progression. Being a multi-tool, it helps gym space become more cost-effective as it offers multiple exercise potential from one device.
A. Karen Toepper, GAITRite / CIR Systems Inc: GAITRite’s ease of use and extremely quick evaluation and reporting of objective data of the degree of impairment and the progress being made allows a clinician to tailor the treatment protocol being utilized. If an intervention is not achieving the progress expected, the clinician can quickly revise the treatment protocols. In this era of take-home rehab exercises, the patient is more likely to comply with the treatment recommended for achieving optimal outcomes.
A. Patrick Bruno, Hocoma Inc: The Andago senses the patient’s movement intention and follows that person’s activity, all the time providing the necessary body weight support and safety from falling. Therefore, the Andago can bridge the gap between treadmill-based gait training and free overground walking. With the Andago, patients can safely and confidently train overground walking without fear of falling, and therapists can monitor the patient’s gait without having to physically support them, increasing the potential to deliver therapy with limited personnel.
A. Nechama Karman, Mobility Research: The integrated user view uses patient-specific data collected while the user walks on the treadmill to assist in identifying specific gait goals for each individual. Once the goal has been selected and success thresholds have been identified, patients receive immediate feedback with each step they take, indicating whether they have met the goal. By customizing patient goals and providing immediate, specific feedback, patients correct their gait patterns in keeping with behavioral-shaping best practices.
A. Arik Avni, Motorika: Based on clinical principles of brain recovery in gait rehabilitation, the Optimal-G Pro supports the therapist to deliver neuromuscular re-education and brain retraining to improve outcomes. The system facilitates intensive and repetitive reciprocal motion, recovering normal gait patterns and improving ambulatory capabilities, balance, stability, and posture. Through a safe, controlled method alongside multiple operational modes, the Optimal-G Pro can help teach natural gait patterns and support the therapist to personalize rehabilitation therapy and optimize patient recovery.
A. Michael Rowling, ProtoKinetics: The Zeno Walkway System provides granular data, describing the spatiotemporal and pressure-related parameters of gait. This in-depth, accurate data allows therapists to recognize and track gait deviations, limitations, and asymmetries. Objective outcome measures coupled with clinical knowledge and experience can assist in focusing treatment to solve specific gait deviations. Additionally, goal-oriented therapy can incorporate our measures to educate and motivate patients to adhere to treatment plans.
A. Alyssa Rubino, Tekscan: For many clinicians, gait analysis is done visually without the use of any technology. By implementing a system like the Strideway, clinicians can identify asymmetries that might otherwise go undetected. The objective information obtained from the Strideway system can be used to guide and develop treatment plans. Clinicians can test the patients progress during rehabilitation to confirm they are progressing as expected or if it’s necessary to make adjustment to the treatment.
A. Andrew Frank, Vista Medical: BodiTrak Balance is available in a flexible floor sensor or a treadmill sensor. This flexibility allows the therapist to assess and train on flat surfaces and gradually increase both the surface perturbations and the cognitive challenges for their patients. The system offers mCTSIB structured assessments, custom designed assessments, and an interactive training mode with clinician-set goals.
Additionally, there is a growing list of games that patients can be challenged with to improve their performance. In short, the system was designed to help the therapist quickly assess a patient’s challenges, benchmark the data, and compare for improvements as the patient proceeds through rehabilitation.
Q. What product features do your customers say they find most helpful in evaluating or treating gait?
A. Jay Everett, Clarke Health Care Products: One feature we hear about with the DST is a movement tracker for the user. There are sensors embedding into the floor of the DST that track the user’s movement and speed, recording this patient’s data, to develop a progress report, showing the progression of each training attempt, in ascents and descents, for each session.
A. Karen Toepper, GAITRite / CIR Systems Inc: Users find GAITRite’s objective data allows them to effectively determine the degree of impairment on initial evaluation. GAITRite provides a simple way to involve the patient in the treatment plan and allows them to understand the detailed goals during the intervention period. The patient’s understanding of these goals helps improve not only outcome but their satisfaction and compliance.
A. Patrick Bruno, Hocoma Inc: Our customers report that they appreciate how the Andago enables a quick and easy therapy start. They also like that patients are empowered to challenge themselves without fear. In addition, fewer resources are needed while safety is increased.
A. Nechama Karman, Mobility Research: The immediately visible, user-friendly gait data readout on the tablet screen while the patient is walking helps therapists to tweak their interventions in the moment to achieve the “best gait possible.” The intuitive user interface and immediate summative report generation provides “hard data” without significantly increasing therapist time. Therapists learn to use it in minutes, without reading extensive manuals to become proficient. Software communicates with webcam to add video input, allowing therapists to visually compare gait to report data.
A. Arik Avni, Motorika: Our customers say they like the technology’s ergonomic design and fast set-up. This provides maximum comfort and security throughout the rehabilitation process to enable correct posture, and longer and consistent ambulation sessions. We also hear that customers like our large, pre-programmed gait patterns that enable therapists to create dedicated gait profiles personalized to diverse patient needs (age, height, children, and adults). And third, dual-camera recording and visual feedback also seems to be popular. It allows therapists to identify abnormal gait patterns and direct in real-time corrective positioning, while enhancing patient engagement and learning.
A. Michael Rowling, ProtoKinetics: Our intuitive hardware and software design leads to simple and efficient implementation. Our customers appreciate that. Also, the system is versatile and can be customized for specific protocols, allowing the user to broaden or limit the scope of analysis as necessary. When customers are unsure of which protocol or measures will be most descriptive for their needs, they can turn to our team of gait experts with years of experience analyzing gait in a clinical setting.
A. Alyssa Rubino, Tekscan: Strideway software includes many time-saving features, which are beneficial for clinical customers. An auto-calculated symmetry score allows clinicians to easily determine if a patient is favoring one leg or if there are differences in forces between sides.
The software provides the ability to segment the foot into regions for a deeper analysis, auto identifies the area of peak pressure, provides insight into Center of Force (CoF) movement, and more. These features can provide insights into balance, foot function, and even ulceration.
A. Andrew Frank, Vista Medical: Most really like to use the interactive mode once the structured mCTSIB test is done. This helps them structure challenges for specific parts of the body and allows for easy comparison to assess improvement. The flexible system allows you to use it in standing mode for patient A, and next use it for upper body while hanging on the wall for patient B. The system is made to be cost-effective enough to be where day-to-day therapy needs to be done and not be limited to research departments due to cost.
Q. What distinguishes your technology in this category?
A. Jay Everett, Clarke Health Care Products: This therapy equipment combines parallel bars, stair training, and incline training in one. Additionally, it offers a way to track and show progression through a computer monitoring software system that documents and allows sharing with a doctor or to billing.
A. Karen Toepper, GAITRite / CIR Systems Inc: GAITRite systems has worked to provide its clients with technological excellence for the last 26 years. More than 200,000 physical therapists in 54 countries around the world have been trained on human gait using this simple tool. Many universities are now using textbooks that include GAITRite as part of their educational program. GAITRite stresses it’s easy to use and features readily understood output measures that do not require elaborate training.
A. Patrick Bruno, Hocoma Inc: Our products are designed to optimize treatment quality and effectiveness as well as increase patient and medical staff motivation. We place great value on research collaborations as well as customer feedback, to ensure both the usefulness and safety of our products and the implementation of product enhancements. We strive to maintain long-standing, constructive relationships with our market partners—ie, our customers, investors, collaborators, and suppliers. We also promote close collaboration and open communication to prevent errors.
A. Nechama Karman, Mobility Research: The GaitSens 2.0 is a device that was designed to excel in its ease of use, intuitiveness, minimal implementation time, and portability. It is also built to be affordable. Portable models can be brought into patient rooms or even into their homes to collect reliable quantitative data to measure patient performance and progress. Our aim is to see that a customer’s relationship with Mobility Research begins—not ends—with a purchase. Personalized customer support is provided to GaitSens users, with educational resources always available to offer insight and recommendations.
A. Arik Avni, Motorika: Distinguishing features include: ELITE’s proactive clinical program, natural gait pattern (18 physiological gait profiles), less than 10 minutes’ set-up (lifting from sitting position) and ergonomic design, virtual reality multitasking exercises for motor and cognitive re-training, real-time camera recording and visual feedback to reinforce proper gait biomechanics, passive to active participation therapy for improved motor learning success, muscle resistance monitoring to adapt an optimal therapy session, and all-in-one solution for a wide spectrum of patients.
A. Michael Rowling, ProtoKinetics: Our technology is currently being integrated into the NIA/NIH, US Food and Drug Administration, and numerous clinical facilities. Our standard and wide-width Zeno walkway, along with our powerful PKMAS software, allows our customers to design a single protocol or multiple protocols to streamline their objective gait and balance assessments. The ability to collect transitional and non-linear gait, such as gait initiation, turning, and gait termination, allows for diverse protocol implementation.
A. Alyssa Rubino, Tekscan: The Strideway provides a complete picture into gait analysis. In addition to the traditional spatial, and temporal parameters, pressure and force data can provide insights into potential areas of ulceration, stress fractures, and pain points for the patient.
Additionally, the Strideway platform is comprised of tiles that connect together to form the walkway. It is transportable, modular, and flexible in length, allowing a clinician to add-on length at any time. There are two end caps to help patients reach comfortable gait prior to capturing the data, reducing the risk of targeting.
A. Andrew Frank, Vista Medical: Twenty-five years innovating sensors for rehabilitation, and 6 years helping to change the way sports training is done with our BodiTrak Sports system, especially in golf. Also, a driving purpose to make pressure mapping and balance sensing systems available cost-effectively in medicine to reduce patient and suffering and to improve their quality of life or an athlete’s performance. BodiTrak is used in on-field real-time concussion-sensing helmets, operating room pads, intensive care unit bed monitors, complex rehabilitation seating and balance rehab, and a growing list of consumer products such as the ReST Smart bed, which is a true sense and respond bed. PTP