Advanced Technology in Physical Rehabilitation
Within our combined team of physical therapists, occupational therapists, physical or occupational therapist assistants and speech-language pathologists, Younker Rehabilitation has over 175 years of combined clinical experience. Their expertise and understanding of patients' needs have helped transform Younker Rehabilitation into a facility rich with advanced and customized innovation, ensuring the greatest opportunity for patient rehabilitation. Not all of the following treatment tools will be used for your individual care. Your licensed therapist and physician will determine if the tools are appropriate in each person's particular case.
Jump directly to a section to learn more about the types of technology and equipment we use in rehabilitation:
Environmental Adaptation Equipment
Our patients at Younker Rehabilitation have experienced life-changing medical conditions, which limit their ability to complete basic activities of daily life. The assistive technology program uses low-technology (non-electronic helper devices) and high-technology (involving the use of technologically advanced equipment) solutions to allow a person to become more independent.
Low-Technology Adaptive Equipment in Physical Rehabilitation
Our therapists can use different types of non-electronic devices to help their patients become more independent. Therapists may customize a device or tool already available or they may fabricate or build a tool to meet their patient's needs. One example of a low-technology application is fabricating a velcro holder that will strap onto a patient's razor and allow a patient who is unable to hold his razor after spinal cord injury to hold it securely. Our occupational therapists may loan their patients certain adaptive equipment (like a reacher, dressing stick, or sock aide) to practice their skills with dressing. This allows our patients to determine if they want to purchase equipment for home after practicing with therapy. Occupational therapists will also assist patients to select equipment they may want to purchase to use at home.
High-Technology Adaptive Equipment in Physical Rehabilitation
Younker Rehabilitation is expanding their program to include the latest technology to increase independence and match the culture of technology. Our therapists work with patients to use their own smartphones, allowing them increased independence by use of various apps and functions not commonly known. One commonly used example is the use of voice dictation for those patients who are unable to use their hands to push the buttons on the phone. This may be the case for patients suffering from stroke, spinal cord injury, multiple sclerosis and fine motor weakness.
Patients can benefit from the use of technology to interact with their environment. When a person is not able to use their arms to turn on the lights, control the TV remote, or use the phone, technology can help bridge that gap. Younker Rehabilitation has invested in the Amazon Echo © Digital Assistant Speaker. The Amazon Echo is a hands-free speaker you control with your voice. Echo connects to the Alexa Voice Service to play music, provide information, news, sports scores, weather, and more—instantly. Plans are in order to create two rooms which are fully adapted to allow the use of voice to control the lights, television, call the nurse and control the temperature all utilizing voice commands and the Insteon© wireless connection. This allows the patient to test and learn how to use the device before returning home. This device can decrease falls and allow for increased independence.
The Apple iPad© can be used for both interacting with the environment and for therapeutic activities. Our therapists train clients in various applications that may allow them to contact their caregivers, to increase safety. Therapists can use the iPad© in therapy sessions and educate patients and their families in applications that can be utilized to address fine motor deficits, memory, attention, problem-solving, executive functioning.
Positioning Equipment and Technology
Wheelchair Mobility Program
Our wheelchair specialist collaborates with a certified Assistive Technology Professional (ATP) through UnityPoint at Home to evaluate and prescribe medically appropriate wheelchair equipment for patient use during their stay at Younker Rehabilitation and home discharge. Younker Rehabilitation maintains a manual wheelchair, power wheelchair, wheelchair accessories and cushion inventory with current equipment from leading industry manufacturers for patient education and equipment trials. The specialist completes simple wheelchair assessments and prescribes for short-term equipment rental, as well as more complex wheelchair assessments and prescriptions for long-term patient use. This evaluation may require pressure mapping. A pressure map is a computerized clinical tool for assessing pressure distribution allowing the therapist to determine which wheelchair cushion will reduce potential sources of pressure ulcers or wounds.
During our wheelchair assessment, the physical therapist will determine if a patient's home is wheelchair accessible and therapy staff will assist the patient in determining if home modifications are required to create a wheelchair accessible environment for home discharge. Equipment trials and education are provided to patients during their stay at Younker Rehabilitation to determine the most appropriate equipment to meet their individual needs for home discharge.
Therapists and ATPs work together with each patient to determine the most medically appropriate wheelchair equipment for patient discharge and long-term use. UnityPoint at Home has two ATPs who work with therapy staff to evaluate, prescribe, and fit manual/power wheelchairs and seating systems. Computerized seated pressure mapping is available for evaluation and prescription of the most medically appropriate pressure relieving cushion to maintain skin integrity. Additionally, pressure mapping is used for visual feedback and education for a patient learning to perform pressure relief techniques.
Prevalon® TAP System for Positioning
Maintaining a good turning and positioning program is important for preventing sacral (tailbone) pressure ulcers and wounds for patients who are not able to turn themselves. The Prevalon® Turn and Position system (TAP) helps to prevent sacral pressure ulcers by taking the weight off of the tailbone. It helps to manage moisture due to incontinence, which improves the health of the skin. It helps to minimize friction and shear, which can tear delicate skin. This system may be used for certain patients who are dependent on others for repositioning.
Sara Stedy®, Sara Plus®, and MaxiMove®
These devices are used to assist with rising, standing and transferring (moving from place to place) at multiple levels of independence. They are used by trained staff to provide safe transfers in your patient room as well as to assist with progressing to the next lower level of assistance.
Allows a patient to be safely transferred passively to a wheelchair, commode or bed. It can also be used to assist in supporting a patient's weight when working on standing and walking skills.
The Sara Plus®
A motorized device that can be used to assist a patient in rising to stand and transferring. It can also be used in physical therapy to support a patient while the therapist provides feedback and assistance for walking training.
The Sara Stedy®
Provides added stability to a patient who can bear weight through their legs. There is a seat that flips down behind the patient to allow for rest in a more upright position. This device allows patients who cannot stand more independently to perform grooming and other daily tasks in a more normal upright position. It is also used in transfers when a patient can stand with assistance but not to pivot or step to turn to a chair.
Combined Upper/Lower Body Equipment and Technology
Developed at the Madonna Rehabilitation Hospital and Research Institute in Lincoln, Nebraska, ICARE is a fully-integrated system that provides a safe, effective method for assisting patients with neuromuscular disorders resulting from stroke, traumatic brain injury, partial spinal cord injury and other injuries or diseases. The technology is designed to provide an "assist as needed" approach that is similar to what a therapist provides physically and intuitively while gait training a patient.
ICARE's leg movements closely mimic the kinematic and electromyographic (EMG) patterns of walking. Noted in development studies, ICARE training can help individuals regain or retain the flexibility and strength required for walking, particularly if the muscle demands are customized to those with weakness during rehab.
The NuStep® is a low-impact recumbent cross trainer (somewhat like a seated stair stepping machine with arm levers) that allows users to work both the arms and legs in a cardiovascular and strengthening workout. The NuStep® can be used by patients with orthopedic injury, neurologic injuries such as stroke or brain injuries, or cardiovascular/pulmonary injury such as a heart attack or debility.
Wii®, Wii Fit®
The Wii and Wii Fit provide motivating activity training to improve strength, endurance, coordination, core strength and postural control, balance and weight shift. It provides feedback, too, as participation in various training activities and games can be graded to increase difficulty as you progress. Activities can be performed in a seated or standing position.
Neuromuscular Electrical Stimulation
When a person has lost the ability to move muscles due to a stroke or spinal cord injury, electrical stimulation can be applied to the skin to help facilitate or encourage their movement. The electrical stimulation mimics the stimulation the muscles receive from the nerves, causing a contraction of the muscle. This is used in conjunction with active training with the therapist to help prevent disuse muscle atrophy/weakness or to strengthen muscle contraction when the brain is not able to activate all the fibers of a muscle. Electrical stimulation provides stimulation to the nerves after they leave the spine to assist in contraction of muscles, even when a person has lost some or all active control of the muscle. It is often called neuromuscular electrical stimulation (NMES) or functional electrical stimulation (FES). Our therapists have access to a variety of equipment that can provide electrical stimulation to assist in their therapy programs.
Bioness® L300 Plus
The L300 Plus Foot Drop System is designed to help patients with certain neurological challenges such as stroke, multiple sclerosis, brain injury and spinal cord injury to walk more naturally, with increased speed and improved balance. It delivers programmed, low-level FES targeting the peroneal nerve to enable foot dorsiflexion and accelerated motor recovery. In other words, it stimulates the nerve that helps feed the muscle that helps you bend your ankle up and lift your toes from the floor when you walk.
RT300 Arm and Leg FES Bike.
With the RT300 we can stimulate one or both legs or one or both arms with up to 16 muscle groups in the extremity and trunk receiving stimulation. The RT300 FES bike is accessible using a wheelchair or standard chair. It uses a program of passive, assisted, and active motion in a cycling motion to strengthen muscle groups working together. It also provides visual feedback on a monitor for the patient to encourage more interaction.
Lower Body Equipment and Technology
According to research, complications associated with remaining in a laying-down position include postural hypotension (blood pressure dropping when sitting up or standing), bone demineralization, contractures, skin breakdown and pneumonia, as well as a sense of helplessness for the patient. But the most apparent changes of immobilization occur in the muscles. Prolonged immobilization results in muscle atrophy and a rapid loss of strength, especially in the large lower body muscle groups. Upright position increases the level of alertness, promotes bladder drainage, reduces postural hypotension, and moves lung secretions, which enhances oxygen exchange in the lungs. Weight-bearing activities can increase the strength of the muscle groups that work against gravity, stretch multi-joint muscles to prevent contractures and decrease the rate of bone demineralization. At Younker Rehabilitation, we have options for physical therapists to choose from to best fit what each patient needs to provide support in an upright position.
EksoGT™ - Exoskeleton
The exoskeleton is a wearable robotic suit that enables patients to stand up and walk with the assistive technology. The exoskeleton is designed for stroke and spinal cord injuries. The exoskeleton gives the patient strength and helps restore the nerve signals between the patient's brain and legs that make walking possible. The robotic system, exoskeleton, is available to Younker Rehabilitation patients through a donation from the SoldierStrong foundation and the local Fraternal Order of Eagles to help patients recover from stroke and spinal cord injuries. The exoskeleton provides physical therapy and rehabilitation toward restoring correct step patterns, weight shifting and potentially modifying compensatory behaviors. Younker Rehabilitation is the first center in Iowa to offer this service to its patients and families. Early research suggests sessions with the exoskeleton may improve the patient's functional mobility outside of the device including but not limited to walking speed, walking safety, abilities with transfers, endurance for functional activities, improved bone strength, intestinal health and pressure related health.
A tilt table can be used with patients who have not been upright for a long time, to introduce an upright position gradually. The tilt table can be used for weight-bearing activities.
EasyStand Evolv™ Standing Frame
The EasyStand Standing Frame is designed to allow greater access to patients to transfer into the frame from a wheelchair. It has pivot points that match the body's so that it supports the patient and reduces shear, which can cause trauma to the delicate skin. The EasyStand standing frame provides a safe and supportive transition to standing. It allows the user to stand in three easy steps – adjust, transfer, and pump up. While standing, there is a tabletop attached to allow the patient to work with their arms while standing.
The EVA Walker is a functional assistive device designed to assist with gait training and walking exercise for patients who need additional support when standing. This device has sculpted adjustable padded armrests to allow the patient to put weight through the forearms for support. This allows the physical therapist to free their hands to facilitate and assist with the motion to return to walking.
The LiteGait® is a training device that supports a patient using a harness system and allows them to work on walking with a therapist's assistance on a treadmill or the ground. The LiteGait® allows patients to practice walking in a fall-free environment and frees the therapist to be able to facilitate aspects of movement to improve the quality of movement as the patient walks. Research in the past two decades has shown training using body weight supported treadmills enhance walking ability in adults and children with neurological injuries including stroke, brain injury, Parkinson's disease, spinal cord injury and cerebral palsy.
Physical therapy may use our therapeutic tricycle with a patient to work toward the goals of improving lower body range of motion, walking and increasing functional strength. Use of the trike can help improve balance, coordination and strength. It is also a very motivating activity for patients to participate in.
AlterG Bionic Leg™
The AlterG Bionic Leg™ is a wearable robotic device that is used in therapy to help improve walking and balance. It assists weakened or affected limbs, which lets you complete more exercises during therapy. It improves your balance and confidence during therapy, making it easier to practice walking, sit-to-stand, and stair climbing.
SMART Balance Master®
The SMART Balance Master® uses a force plate to measure weight shifts and center of gravity position and a dynamic visual surround to measure the patient's use of visual information to maintain balance. It can be used for assessment and training on either a stable (non-moving) or unstable (moving) surface, with either a stable or dynamic (moving) visual environment. In other words, there is a sensor in a plate on the floor of the device, which looks much like a phone booth. The device can measure the patient's ability to maintain balance and shift their weight. The floor or the walls can be made to move, to increase difficulty during assessment or training. For safety, the patient is supported in a harness system to avoid falls during balance training and assessment.
Upper Body Equipment and Technology
The mobile arm support (MAS) supports the arm to, in essence, remove the resistance of gravity for a patient who has a weak shoulder and arm. This can allow the person to work on functional activities and training that could not be accomplished otherwise. The MAS can also be used during tasks such as eating a meal to allow the person with a weak arm to begin to feed himself.
The Deltoid Aide is another device much like the SaeboMAS that reduces the effect of gravity on a weak arm. This device uses an overhead pulley system to support an arm. The arm is supported with two slings, one at the elbow and the other at the hand, and each sling can be adjusted with its own counterweight. This allows the occupational therapist to position your arm in the best way for the particular exercise or activity you are performing. Most typically this tool is used for patients who have had a neurological injury, such as a stroke, brain injury, multiple sclerosis, or Guillain-Barre.
The UE Ranger® is a simple device that allows a patient with weakness, decreased motion or impaired coordinated movement of the arm to strengthen that arm while it is supported against gravity. This tool allows the patient to move in multiple directions and the therapist can change the resistance to motion or the ease of motion by adjusting its position or the motions performed by the patient. The UE Ranger® can be used with patients who have had a stroke, brain injury, spinal cord injury, multiple sclerosis, Guillain-Barre, or orthopedic injuries to the arm such as frozen shoulder or pain.
This upper body ergometer (UBE) allows for resistive upper body exercise. It is a stationary bike for the arms. The seat is removable to allow for wheelchair accessibility. Because of the very low starting resistance, this treatment can be used even for patients with poor strength. A weak hand can be assisted to grasp the handle of the machine using a simple elastic bandage wrap or with a commercially available hand strap. The stronger arm can assist the more passive or weaker arm. This machine can be used with patients who have had a stroke, spinal injury, brain injury, shoulder injury (if a motion is allowed), and patients who need to improve their endurance.
Hoist® Fitness System
This weight and cable system allows a patient using a wheelchair to strengthen the upper body to build strength and endurance for transfers, wheelchair propulsion and completion of daily activities. It can be especially motivating to patients who wish to return to a more active lifestyle or who enjoyed working out in a gym before their injury.
Fluidotherapy® is a dry heat whirlpool. The patient inserts his/her hand or hands into the machine where there is ground corn cob material called Cellex®. This Cellex® is blown using a fluctuating air stream, creating a whirlpool-like feeling. This creates a convection-type heat and tactile stimulation to increase local circulation and provide pain diminishing effects to help increase joint motion. It can be used to help reduce hypersensitivity and pain as part of a desensitization program.
Occupational therapists are experts in creating custom splints for patients. Our occupational therapists have experience in assessing their patients' splinting needs and fabricating a custom splint or selecting a prefabricated splint or brace to improve function, support injured areas, or to a position in order to preserve motion. For example, a custom resting hand splint, which encompasses the fingers, wrist and forearm may be fabricated for a patient who has increased tone or tightness in the hand which causes their hand to pull into a tight fist. The therapist then can adjust this splint as the motion and tone improve or change over time, to provide the best fit and comfort for the patient.
Vision, Dysphagia/Swallowing, Cognitive and Speech Therapy
iPad Assisted Therapy
As people become more and more connected to the world through technology, therapy has also adopted technology as part of a treatment plan. There are a variety of applications that are used by therapists to enhance therapy for speech, cognition (thinking skills), vision and coordination. iPads can also be used as an educational tool for patients and families. Tablets can be a part of a system of technology used in environmental controls for a person who has limited strength and motion.
Vision is frequently affected by injuries to the brain (stroke, traumatic and non-traumatic brain injury) or can be affected by macular degeneration and the aging process. Therapists at Younker Rehabilitation provide screening of visual changes, educate patients and their families, and instruct patients in compensatory skills, methods to modify the environment to maximize vision and, in some cases, perform exercises to improve skills.
The Dynavision is the leading medical and sports training device used by occupational therapists to improve awareness and scanning skills in all visual fields (in all directions), visual attention, and response speed. It can also be used as a treatment method for patients who need to work on standing activity tolerance, as it is motivating to patients. The Dynavision D2 incorporates gross motor skills, improves attention and speed of processing, expands awareness of the patient's surroundings, and incorporates balance into an upper body activity.
Dysphagia is an impairment or change in the ability to swallow. There can be many reasons for this to occur and a speech therapist specializes in the ability to assess, educate and train for improved safety with swallowing.
Video Fluoroscopic Assessment
A speech pathologist and radiologist will perform a videofluoroscopy (also called a modified barium swallow study) to assess safety with swallowing. This test is like a video X-ray in which the patient eats and drinks different textures of liquid and food coated with barium. The therapist and radiologist can then see if food is entering the windpipe or lungs, even if the patient is not aware or coughing. This can help to prevent aspiration, in which food or liquid enters the lungs and can lead to a type of pneumonia.