Myomo' Amy Boos Interviews Dr. Gerry Fluet
Interview of Dr. Gerry Fluet by Myomo's Amy Boos: Gerry Fluet PT, DPT is an Assistant Professor in the University of Medicine and Dentistry of New Jersey's Department of Rehabilitation & Movement Sciences. He has been a Research Associate in NJIT's Robot Assited Virtual Rehabilitation (NJIT-RAVR) Lab since 2007. Gerry has published and presented extensively on the topic of robotically facilitated rehabilitation for the upper extremities of adults with hemiparesis secondary to stroke and children with hemiplegia secondary to cerebral palsy.
1. Please describe the research that you are currently conducting at NJIT/UMDNJ.
Our lab group is a collaboration between the PT Department at UMDNJ and the Biomedical Engineering Department at NJIT. We have designed a suite of virtually simulated rehabilitation activities using two commercially available robots, the Haptic Master(TM) which is manufactured by Moog and Ascension's Cybergrasp(TM). We are in the process of testing these systems ability to (re)habilitate hand and arm function in adults with strokes and children with cerebral palsy.
2. What kind of results are you seeing as you analyze your data?
Both groups are producing impressive results. Our subjects with strokes have performed comparably to those who have performed constraint induced movement therapy. Our kids with cerebral palsy are making measurable changes in active range of motion, particularly forearm rotation, and we are also seeing them pick up some new functional skills with their hands.
3. Do you feel it is helpful to use robotics to treat the hemiparetic upper extremity?
Theoretically, it is important to perform a lot of repetitions of movements that produce meaningful results. The robots interfaced with virtual environments can turn a tiny bit of forearm rotation into a hammer driving a peg. They can turn ten degrees of finger extension into a pong paddle moving across a screen, to hit a moving target. These would be very difficult transformations to achieve in a therapy gym.
Specific to the upper extremity, facilitating movement of the shoulder and elbow releases a bit of hand function that can be used to practice functionally meaningful activities. We have found that harnessing this extra hand movement can be very effective.
4. Based on your clinical and academic experience, do you feel it is better to treat the arm separately from the hand, or at the same time?
We are not seeing a big difference in these two approaches. The two important things we are seeing is that you must perform a huge volume of work, literally thousands of repetitions of work. Much more than you see happening in typical inpatient and outpatient rehabilitation sessions.
The other thing we are seeing is that you absolutely cannot neglect the hand and fingers. The hand and fingers can be trained with integrated movements or isolated hand movements, but there needs to be some activity for shoulder elbow, wrist and fingers in every session.
5. Do you think robotic therapy will continue to grow in the rehabilitation field?
I think that robots have important potential because they can accommodate a wide variety of ability levels. The use of commercially available gaming platforms for home rehabilitation is an important trend, but there are many people that cannot move well enough or quickly enough to use them productively. I feel that the development of affordable robotic technology that patients can utilize fairly independently in their homes will sustain the growth of robotics in rehabilitation.
6. What do you think is the ideal therapy protocol for a stroke survivor?
This is a bit of a loaded question. Normal human movement abilities are varied and unique to individuals. This variation expands when the brain is injured and the body starts moving atypically. One single approach to rehabilitation cannot possibly be "ideal" for every human body and every damaged brain.
This said, I think that the ideal approach to rehabilitation following a stroke is a life-long approach. The people I see regaining the most function are the people that continue to work at their motor abilities the longest. With hard, sustained effort, I have seen people make meaningful improvements in function years after their strokes.
The second part of this approach is flexibility. Each approach to rehabilitation; outpatient PT, outpatient OT, repetitive task practice, yoga, weight training, cardiovascular exercise, VR, robotics, mental imaging, spasticity management, etc. will all offer a stroke survivor certain benefits. It is seldom that one single approach will be the definitive answer to every difficulty a stroke survivor is experiencing. Constantly trying new approaches, enjoying their benefits and retaining the most effective components of each approach, is the way to go in my opinion.