Computer assisted rehabilitation environment

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After losing a leg to infection, Terry Lewis found himself having to learn to walk again at 43. But he has two powerful allies in his corner — his one-year-old granddaughter, Cortlyn, who inspires him as she learns right along with him, and Alberta Health Services.

“The people at Glenrose Rehabilitation Hospital have given me my life back,” says the Hinton man, who now walks 10 kilometres a day as he builds strength and endurance. “I’m looking forward to getting out into the woods again for some hunting this fall.”

Lewis’s newfound vertical confidence stems from his participation in virtual-reality research now being conducted at the Glenrose, where amputees learning to walk with a prosthetic leg are gaining the skills to do so thanks to sessions on the CAREN (Computer-Assisted Rehabilitation Environment) — the only clinical virtual reality simulator of its kind in Western Canada.

Patients at this Alberta Health Service’s facility are getting care specific to their challenges as they help University of Alberta researchers devise new approaches to therapy.

“We’re looking at what a person with a single prosthesis usually does when they’re thrown off-balance,” says Dr. Jacqueline Hebert, Medical Lead, Adult Amputee Program at the Glenrose, as well as associate professor, Division of Physical Medicine and Rehab in the Faculty of Medicine & Dentistry at the U of A. “On the CAREN, we can actually study the biomechanics of how they’re walking, what their balance reactions are, then look at that and help them train better for the real world.”

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CAREN’s twin-treadmill platform, motion hydraulics and circular surround screen can be programmed by therapists to deliver a rehab program precisely tailored to each amputee’s needs.

Sensors placed on patients are tracked by overhead cameras to give objective feedback and measure progress on gait, stride, speed, weight-shift, balance and more. A patient becomes part of the simulated environment, interacts with it and changes it through their body movements.

“We’re developing an assessment tool on the CAREN system that can be used to determine how amputee gait and balance are affected, and whether we can change this with therapy or other interventions,” says Dr. Hebert. “This tool also may allow us to compare other therapies that may be more accessible to people without access to a CAREN system.”

As part of a national collaboration, Dr. Hebert’s research partners include lead co-investigators Dr. Edward Lemaire and Emily Sinitski of The Ottawa Hospital Rehabilitation Centre, where Canada’s only other clinical CAREN system is located.

At the Glenrose, patients walk through virtual reality scenarios to build skill and confidence.

“We can have the CAREN system in a self-pace mode, so patients can walk as fast as they’re comfortable walking,” says Dr. Hebert. “And then they suddenly have to go up inclines, or down inclines, or over ramps — and then we can simulate a bumpy surface where it’s like walking over rock, as the platform jolts them and bounces them around. That’s something that we can’t do in therapy on a level ground surface. And here, it’s safer than having them do it in the real world.”

Says Lewis: “If it wasn’t for the Glenrose and this research, I wouldn’t be able to do what I’m doing now. I think it’s fabulous. You’re hooked to a harness, so you’re not afraid to fall. When you come out, you still have the confidence that you can do it without falling. It’s helped me with my balance.”

To date, 16 single-limb amputees have taken part in the national study, with more sessions and subjects expected next month. Helping amputees with lower-limb trauma also promises better rehab for military veterans wounded in action, says Dr. Hebert.

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Gordon Wilson, Chair of the Glenrose Rehabilitation Hospital Foundation, says the CAREN system is one of the many interventions that keep the Glenrose at the forefront of rehabilitative care and is an example of what the Glenrose Foundation makes possible.

“Our foundation exists to support the outstanding work done by the hospital and its exemplary team of physicians and staff. This includes Dr. Hebert’s research, which is instrumental in our continuous pursuit of care improvements that allow patients to positively shape their quality of life,” says Wilson.

Funding for CAREN came from the Government of Canada ($1.5 million) and the Government of Alberta ($250,000). Through the Courage Campaign, the Glenrose Rehabilitation Hospital Foundation also raised more than $4.5 million, which led to the 2011 opening of the Building Trades of Alberta Courage Centre and the creation of the Courage In Motion (CIM) Centre, which houses the CAREN system. Alberta Health Services provides the clinicians, facilities and logistical support to ensure the system will reach its full potential.

The CAREN at the Glenrose is the result of the hospital’s partnership with the Department of National Defence. It can be used to rehabilitate Canadian Forces personnel and civilians with physical injuries, such as amputations, Parkinson’s disease, stroke, brain injuries, spinal cord injuries and cerebral palsy, as well as psychiatric disorders such as phobias and post-traumatic stress disorder.