REAL® System: Supporting The Rehab Patient Journey
Cooper University Health Care Experience
David E. Owens, MS, PT, MBA
Director, Rehabilitation Services
Cooper University Health Care, Camden, NJ
Director, Rehabilitation Services
Cooper University Health Care, Camden, NJ
Thank you Dr. Kumar and thank you Dr. Jovin, for teeing things up for me. I appreciate the opportunity to talk with everyone today and the partnership that we’ve had thus far with the REAL System and the support of our physicians.
So I’m going to take the group through a little bit more detail about using the REAL Immersive System and the experience that we had with our occupational therapists and our physical therapists here at Cooper.
Just my only disclosure, thank you for modest compensation in preparation for the webinar.
Just a little bit about our rehab department here, as Dr. Kumar mentioned, we’re primarily providing acute care and outpatient rehab services, and we’re offering occupational and physical speech therapy and my background is as a physical therapist, I’ve had the opportunity to work in a multitude of different rehab settings, everything really other than pediatrics and, before being exposed to this type of technology, the virtual reality technology, I really hadn’t been exposed to it as a therapist until Dr. Kumar and Dr. Jovin started to introduce us to it, and it’s been on a couple of field trips and we had as Dr. Jovin mentioned, the opportunity to be a testing site with Penumbra and it’s been an excellent experience.
As Dr. Kumar mentioned, one of the things that differentiates the REAL Immersive System is that it’s designed for healthcare, as opposed to a gaming system. And it’s based on evidence that Dr. Kumar just went through, of how we can support our patients and again it’s been cleared by the FDA, and it’s for rehab in a seated position, under the supervision of rehab professionals.
I think one of the things that I would say from our experience here at Cooper, in the time I spent before I came on-site, in having conversations with the team at Penumbra, of trying to understand, well what is this going to be like as a therapist, and how can we utilize this tool, for folks that have had strokes. It really wasn’t fully evident to me until the system got here and I had it on and tried it myself. And then, really the world opened up as to how this technology can be useful to our patients. And I’ll show a few short videos in a few moments that I think will give people a little bit better understanding of that as well.
So I want to go over a little more detail on how we set up the system for a patient, as has been mentioned. The headset goes onto the patient and that’s what’s going to transport our patients into that virtual world.
The bands and the sensors are utilized and are necessary to be able to track that movement and range of motion. It was mentioned that the bands are single-patient use, so from an infection prevention standpoint, there’s a set of bands that will belong to that patient. Sensors can be wiped down and cleaned, and those will be used across all the patients.
And then the tablet is really the control center for the therapist. We’re able to then see all the activities, it displays all the data, we are able to see exactly what that patient is seeing and experiencing through the headset. I think the other thing that stood out to me as our therapists were using it, there’s no wire, so there’s nothing getting in the way of the patient, nothing to get tangled up during our treatment sessions with them.
Setting up the system is super easy, I think that was one of the bigger concerns of our therapists, is, for those of you that are in acute care, time is of the essence and there’s a lot of patients to see and we need to be able to help move them through the continuum, so there’s a lot of concern, well how long is this going to take me to set up.
Just like anything, with a little bit of practice, you become really proficient at it. The therapist puts the headset on the patient, the bands are fastened, the sensors go into the little slots on the band, and that’s what’s going to help all those that are connected will transport the patient into Happy Valley™, which is the setting that we’re going to transport folks into in their virtual world. Literally it takes two minutes once you get a little bit proficient at it, of the setup. So it’s really not a big lift in getting the system set up to utilize for the patient.
Again that command center, the tablet for the therapist. What that does, and Dr. Kumar mentioned this a little bit, that’s where we’re going to set up the avatar, and you can see we can customize it, different skin tones, different heights, so when the patient has the headset on, they begin to see their arms, and we can adjust things to the different body types.
And again on the screen, the therapist, on the right-side of the image, you can see, you’re seeing what the patient is seeing when they have the headset on. We can then, across the top of the screen there’s different activities, which I’ll get into detail in just a moment. We see the different activities that we want to take the patient through, and one of the great things about it is that we can customize the intensity. So for patients that are having a harder time or are a little more low-level, we can set it so that they can be successful, which again helps with them becoming engaged in their rehabilitation. It encourages them, they can also then see their progress. Conversely, if you have someone that’s a little more high-level, we can adjust it so they can see the same progress.
In the REAL System, multiple activities, therapeutic activities that focus on the upper body, clinical applications, so anything from balance, cognition, all of the different upper extremity activities you see here, and I think once you have the system on, again the system we’re talking about neuro rehab, specifically today. But then as a therapist, that’s when your world opens up of how can I apply this for other patients that have upper extremity impairments and be able to utilize this as a tool for them as well.
Again the different activities are in the control center that iPad, and I’m just going to run you through a few examples, that will hopefully help start to click of what it may look like.
So in this activity again the patient is seated and you see there’s a red fish being thrown, and in this case, the red fish, the patient needs to identify that it’s a red fish, and they are to lean their trunk to one side or the other to avoid being hit by the red fish. You saw the blue fish, with that they have to react and utilize their upper extremity to bat at the fish at the appropriate time so that then they are hitting it over to the character in the boat. You can see the patient with bilateral shoulder flexion and as they do that, that helps to raise the sun. If they were doing it in an asymmetrical way, the sun would actually tilt, so it’s going to provide them that visual feedback and repetition, and you’ll see in a few moments how that gets tracked.
And we can again show improvements for the patient and the last clip that I’ll show you real quickly is this Hide and Seek. So now that blue beam that’s coming out of the screen there as the patient is rotating their head, looking up, looking down, that we’re coaching them to find these different objects so they have to follow commands. There are different colors that you have to ask them to look for. Again everything that you’re seeing, that the patient’s seeing, we’re seeing as well on that screen.
I mentioned that the system is collecting data for us so that we can utilize that to show objective improvement for the patients, we can use that as well to help us justify ongoing therapy and appeal when that takes place. But from the engagement for the patient, they’re going to see themselves objectively improve.
The big challenges that we all face when we’re working with patients is that patient engagement, we need them to participate, we saw in several of the patients that we utilized this with at Cooper, where they weren’t really engaged with the therapist while they were in the hospital. They were either dealing with depression, they were frustrated with their situation, and when we introduced the system to them, patients were like well when’s the therapist coming back. So we absolutely saw that, they were clearly all focused on the early mobility, the early recovery and I see this as a patient satisfier as well, especially across the continued mode of care.
I’m going to talk quickly about a couple of case examples that we experienced with our therapist, again focusing on that early mobilization, so we were working with a patient in their 30s, had stroke diagnosis, you can see their challenges that they were having from a stroke.
As I was reviewing these videos, I want to disclaim, this is all pre-COVID, because I was this and I was like why isn’t anybody wearing a mask, so back in the old days when we didn’t wear a mask 24-hours a day, this is one of our therapists and some of the team from Penumbra that were here.
So here, the patient has the headset on, has all of the sensors on and our therapist is actually asking her, this is that last activity I showed you where she’s trying to find something but it’s to her right, and he’s coaching her along, and he did a great job of come towards my voice. So then she actually overshot it and eventually she found the object that they were looking for. You can see how he’s looking at the screen and you can see exactly as the patient is successful, not successful. This is the very first session for this particular patient.
She struggled a little bit, and then here was a subsequent visit, I think the next visit with her. And here is a good angle where you can see the sensors there on her hand, and the tablet that the therapist has, and he’s able to coach her along with the activity that they are working on.
Just in that one session, the patient being more comfortable with it, her ability to follow a command, move smoothly where it was awesome to see. Again that this allowed us to target specific areas and really engage that patient in her care.
The similar situation of a patient in their 30s, stroke survivor with some challenges. For the sake of time I’m going to move past that video. But again that full immersion, the avatar, the patient, and when you experience it yourself, you’re totally surrounded and transported to this other world.
I want to make sure I touch on this because this was a really great feedback. So this was a patient that actually was seen in one of our outpatient clinics and this was somebody who received some rehab, but they’d had their stroke months prior, but was coming for some ongoing therapy to us, they sought it elsewhere prior. When the patient started using the REAL System, our therapist and the patient noted improved balance, range of motion, strength in that affected limb and the feedback that that patient provided, they loved, loved the REAL System and similar to the letter that Dr. Jovin shared earlier wish they’d had the opportunity earlier in their recovery to be able to use a technology like that.
One of the things that really jumped out at me was feedback from our therapist, who has been a therapist for 30 plus years and you can see here what he had to say. Never seen anything like it, the technology was amazing, and really saw the impact that it made for the patient. So, to me, that spoke to me a lot as a therapist but also as a leader that we were able to take somebody that may have been skeptical about this technology and they really saw the impact that it had on their patient. So that was great to see.
In summary, why the REAL System, like many of you out there we want to have satisfied patients, we want to be able to provide the best outcomes, we want to have people engaged and have that early mobilization so they have the optimal recovery and the REAL System is another tool in our toolbox to really support that for all of our therapists and this works with all of the disciplines, OT/PT, speech and we’re really excited to be able to have the opportunity to have it here at Cooper.
With that I’m going to turn it back to Dr. Jovin, see if there’s questions, we have time for that.
Video recording used with permission. Consent on file at Penumbra, Inc. The opinions and clinical experiences presented herein are for informational purposes only. The results may not be predictive for all patients. Individual results may vary depending on patient-specific attributes and other factors. Any treatment decision must be made in consultation with a healthcare provider based on a complete discussion of risks and benefits. The views and opinions expressed herein are those of the presenter and do not necessarily reflect the views of Penumbra, Inc. or its ailiates. The featured presenter is consultant for Penumbra, Inc.
Caution: Federal (USA) law restricts this device to sale by or on the order of a healthcare provider. Prior to use, please refer to the Instructions for Use (IFU) for complete product indications, contraindications, warnings, precautions, potential adverse events, and detailed instructions for use. Please click here for the complete IFU. Please contact your REAL Care Specialist for more information.
18662, Rev. B 05/21 USA