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Clinical Assessment and Treatment
One important way that the Rehab R&D Center transfers the results of more basic research into tangible products that help the rehabilitation patient is by developing better methods for assessing and treating disorders. Some of our products are new devices, such as wearable accelerometers for assessing the stability of elderly patients. Other products are software programs for analyzing clinical data, such as programs for analyzing electromyograms. We also develop new therapeutic approaches, such as dynamic exercise programs for rehabilitating stroke patients. Although many of these products will be used primarily by physicians and physical therapists, the ultimate beneficiary will be the patient, who will receive better care and more effective rehabilitation.
Our approach is to develop assessment and treatment methods that are firmly based on a scientific understanding of the biomechanics, physiology, and motor control that underlie a particular disorder. This often means that the most appropriate properties on which to base an assessment are underlying properties that cannot be readily measured. For example, in assessing a stroke patient's ability to control a hemiparetic leg, we would like to be able to quantify the forces produced by each of the muscles of the leg during a dynamic task. We cannot measure these forces directly, but we can estimate them from the reaction forces and the motion of the limb segments, using a mathematical model of the musculoskeletal system. As another example, we cannot directly measure the strength of the femur of a spinal- cord-injured patient, but we can estimate it from the bone mineral density and the geometry of the bone.
This approach generally leads to measures of function or impairment that are objective and quantitative. This means that the measures can be accurately used to make diagnoses, to track the progress of a patient over time, and to compare different treatments. Moreover, since the measures are directly related to underlying physiological properties, they are useful in guiding the course of treatment. For example, knowledge of the percentage of nerve fibers that have regenerated across a nerve repair site can help determine whether new surgery is needed. And again, knowledge of bone strength helps determine whether the patient is at risk for a fracture.
The Rehab R&D Center projects related to assessment and treatment during the last three years are described in this section of the report.