REAL® System: Supporting The Rehab Patient Journey

Cooper University Health Care Experience


Tudor G. Jovin, MD

Chief of Neurology

Rohini J. Kumar, MD


David E. Owens, MS, PT, MBA

Director, Rehabilitation Services

Cooper University Health Care, Camden, NJ

Webinar Transcript

[0:00] Dr. Jovin: Thank you, Dave and Rohini for these excellent presentations. We were happy to keep going, there are some questions that I’m seeing here on the screen. He’s asking whether there is a standard VR activity protocol to begin with as a baseline assessment, and then which activities of the system do you begin with and how long before you begin to personalize it for the patient? Rohini or Dave, I think this is something for you guys.

[0:39] Dr. Kumar: So at this time, we are developing a protocol, to better understand the patients that have upper extremity deficits, and for trunk control and difficulty with neglect. Those are the patients that we are going to start with. In terms of the activity, there are the sunrise activities for upper extremity movement, there is a scanning activity, so depending on the patient’s deficit at the time of evaluation, then we will see which activity they can use at that time.

[1:19] So the protocol we are going to be writing a protocol to address that, and you can start customizing once you see their performance on their first round, then you can increase the intensity or decrease the intensity.

[1:37] Dr. Jovin: Next question is do you find the patients are put off by cartoony nature of the games? I could see some of my patients enjoying it and others feeling like it was silly or childish.

[1:51] Please correct me if I’m wrong, Dave or Rohini, but we have not come across, I’m sure if you start doing it with a lot of people, you can’t make everybody happy, and there’s gonna be some people who may be put off. I think the nature of the games is also evolving, from the standpoint of the company. I think this is something that they decided has appeal to most patients and I think that country specific, population specific games are probably gonna follow, but I don’t think that this is a big problem personally and in my experience, so far.

[2:39] Dave Owens: I’ll back you up on that Dr. Jovin, I think we’ve gotten that feedback more from the therapists that that’s their perception of how the patients may feel about it, but we have not received any feedback and I distinctly remember one of our therapists in the outpatient setting who used it with a younger patient, which is where I would expect them to be more, you know, compared to what video game technology is today and they actually liked it. So no, but definitely it’s crossed minds but I’ve heard that more from our therapists, and similar, and I see another question there about again the acceptance of patients that are older, we have not seen any issues or challenges with that.

[3:27] Dr. Jovin: And now a really, really important question, is it safe to use the headset during COVID? What is the effective cleaning procedure? I wonder if anybody from Penumbra can comment on this, it’s a really, really important question. Hopefully COVID is gonna go away at some point, but until then we need to, you know, confront this issue, and I do think this is a very relevant question. I suspect there will be some recommendations from the company on what the exact procedures are. In the meantime, we just have to use our best judgment as to how to you know, clean these devices.

[4:22] Jennifer Wong: I work for Penumbra in the marketing group, and just to provide that information, the cleaning procedures, we have definitely information on that. We’re following your institution’s cleaning procedures. There are a number of wipes with information from the EPA site that they recommend specifically for Covid and so the cleaning procedure is per your institution, but our headset is designed to be wiped down with your institutionally-approved wipes as well as the sensors. The individual sensor bands obviously are for each patient and that obviously was designed to reduce the risk of propagating the infection. But the headset and the sensors are definitely designed to be wiped down again by the institution’s approved wipes. And we are happy to provide the information to anybody who needs that.

[5:24] Dr. Jovin: So thank you Jennifer for the other question, how’s the acceptance, I think that was addressed by Dave and I would say the acceptance is excellent. Is there a take-home system in the works? I think again, from what I know and it just makes complete sense, that a take-home system should make sense, the take-home system would be available. I don’t think it is now, again maybe Penumbra can comment but it would be a great idea, a very, very important component of this system, to be able to use it at home.

[6:08] So, Jennifer I don’t know if you wanna comment on how far we are with a take-home system.

[6:15] Jennifer Wong: Yes, thank you Dr. Jovin, obviously Penumbra has a history of working on clinical needs and we have an entire group at our studio and our hardware partners are hard at work continuing to push on new technologies and I’d be happy to share as those plans become a little bit closer to coming to market, but we’re always working on new ideas and products.

[6:42] Dr. Kumar: There were a few questions asked about utilization in OT so I just wanted to comment. This device can be used by any discipline. OT, PT, as well as speech. There are many exercises that can be used by all the disciplines.

[7:04] Dr. Jovin: And likewise there is a question as to whether the system can be used for other diseases or is it just for stroke? In terms of others, I mean I think the FDA and again I’d like Penumbra to correct me, I don’t want to give misleading information, I think the FDA approval is for stroke is that correct, Jennifer?

[7:33] Jennifer Wong: So the FDA indication obviously it’s for any patient with upper extremity impairments, which you see a lot of in your stroke patients, would be able to use the REAL System under the supervision of a professional medical personnel, but I would love to direct the question back to maybe Dr. Kumar and Mr. Owens, on the types of patients you’ve seen that would be eligible for upper extremity impairments.

[8:07] Dr. Jovin: Basically I’ll let Dr. Kumar and Mr. Owens comment on this but basically, you know, the sky is the limit as to the diseases that can benefit from this I think, so you know, you can imagine a lot of neurodegenerative conditions, and other conditions where there is potential for rehab, but I will let Rohini take it from here.

[8:42] Dr. Kumar: If we look at the traumatic brain injury patient, somebody that needs direction in their visual perceptual deficits, language development, if you look at the spinal cord injury patient that has upper extremity weakness of fine motor deficits, the application can be used for many diagnosis and the umbrella would be that if they have any weakness in any limb and for REAL System it would have to be the upper extremity in the trunk and core, I’d say anything that involves head, neck, trunk and shoulder movement would be where we can use it.

[9:25] Dave Owens: I’ll just add in I think the experience that our therapists had and just me personally when having it on, it could be used in an orthopedic patient. The indication is that we need to be seated, the patient, it says for seated activities, because we therapists want to jump to the next thing, so nobody’s ever seen, at least here in my group, seen anything like this, next thing they say is can we use it in standing and how can we get something in walking, so, we ask our friends at Penumbra to work on that next, but definitely orthopedic applications, cognitive, that would be my feedback, that the sky’s the limit, obviously with the safety of the patient in mind, so anything you can do with it seated, I think there’s other applications outside of stroke and outside of neuro rehab.

[10:20] Dr. Jovin: Another question is does the system come in other languages other than English? So the good thing is there’s not much language in the application, at least so far. The ones that most of them that are available, so the languages, the one that is used by the physical therapist and so on and so forth, but very interestingly, I was talking to a colleague from Japan who was visiting our center and he got to take a look at this and he said well, why don’t you do, in Japan, our patients would prefer, would like Japanese cartoons, and so yes, I think I can envision a scenario where there would be sort of cartoons and games that are specific to each country. But language-wise, right now, there is not that much language but perhaps there will be and all these things will be taken into consideration, I’m sure by the company.

[11:49] What is the ballpark price for this? I would recommend that you get in touch with the Penumbra folks, because I think it’s a bit of a more complex question and there’s different models and I think that’s beyond the scope of this exercise here.

[12:06] Is there carry over between sessions during ADL such as for visual fields? Maybe Rohini or Dave can take this one.

[12:20] Dave Owens: Sure I’ll jump in. Yes and what I’ll say is that the information that I’ve presented around the capabilities of the system, we were not because we were testing things, and from an IT perspective we weren’t on our network, so we were not capturing individual patient data yet, as we obtain the full blown system we will obviously be doing that and we will have the capability to do that. So any of the improvements, noted improvements were visual in nature, measured in more conventional ways that we would measure things as a therapist but the system will do that for us.

[13:11] Dr. Jovin: That’s great, well I think we’re gonna end here and I would like to thank everybody for attending. I think this is very exciting technology and we’re gonna see more and more of it, and I wanna thank Penumbra for organizing this event. If there are any other questions, you can send us an email or reach us through Penumbra folks and we’re happy to answer other questions. Once again thank you Rohini and Dave and the organizers of this event and be well everybody and we’ll end on this note. Thank you.

Video recording used with permission. Consents 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 presenters and do not necessarily reflect the views of Penumbra, Inc. or its ailiates. The featured presenters are consultants 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

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About Us

Penumbra, Inc., headquartered in Alameda, California, is a global healthcare company focused on innovative therapies. Penumbra designs, develops, manufactures and markets novel products and has a broad portfolio that addresses challenging medical conditions in markets with significant unmet need. Penumbra supports healthcare providers, hospitals and clinics in more than 100 countries.

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