When it comes to technology, Phil Bryant, DO, blends clinical nobility with a dose of pragmatism. Bryant serves as chief medical officer at Good Shepherd Rehabilitation Network, a 100-year-old organization with 26 facilities based in Allentown, PA. In recent years, Good Shepherd has piloted numerous assistive devices that can help stroke patients, the frail elderly, and other people with serious physical impairments.
But despite its technology orientation, Good Shepherd is careful about what vendors it will partner with. "We are not interested in gadgets or in technology just because it is new or looks fancy," Bryant says. "We are interested in technology with practical application to the frail and disabled that can help in improving function, safety and independence."
That philosophy puts Good Shepherd square in the middle of technology development. Frequently approached by device manufacturers seeking a testing ground, Good Shepherd has worked with more than 40 companies in the past three years developing technologies ranging from therapeutic devices that can improve motor function to automated wheelchairs that can enable independent living. Good Shepherd has evolved into a technological bellwether for rehabilitation organizations.
"When we assess new technology, we look at the driving forces behind the need," says John Grencer, administrative manager of assistive technology. "Right now you have an aging boomer population with aging parents. Nobody wants to go into a nursing home, so we focus on how we can use technology to keep people in their homes longer."
Grencer and Bryant cite three key areas of emerging technology that stand to accomplish that goal.
Technology-supported independent living
By using home and medical monitoring systems, as well as other assistive technologies, individuals can live at home longer and avoid having to enter a nursing home. Many systems on the market offer such capabilities as remote vital sign monitoring and videoconferencing with family members. The problem, Bryant says, is that the devices do not work in harmony with one another.
Moreover, consumers don't know what is available. To address those issues, Good Shepherd combined several formerly independent clinical divisions into a Health and Technology Center that opened in 2006. Good Shepherd is evaluating a home monitoring system that lets patients input data from glucose monitors but also poses questions to the patient. Data from peripheral devices can be fed into a central monitoring system.
Other emerging technology-based on motion sensor devices-can monitor patient activity, noting, for example, when a person gets out of bed. If the person doesn't, the system can call a caregiver with an alert.
Part of Good Shepherd's mission is to steer patients through the multiple technologies available, says Grencer. "We assess the home for safety and recommend modifications," he says. "We tell people what they may need and what it will cost." The rehab center operates a retail outlet, called Rehability, where consumers can review the various technologies.
A type of body armor strapped onto an individual, "exoskeletons" have the potential to assist the movement of weakened limbs. They could enable people with disabilities to be more independent, Grencer says. In addition, this technology could augment the strength of caregivers faced with moving bedridden or overweight individuals. The exoskeleton works with sensors that attach to the skin.
"As you start to move your arm, the sensor picks up the nerve impulse of you trying to move your muscle, goes to a computer, and fires a motor," says Grencer. Looking like a prop in a science fiction movie, the technology has been used in Japan for industrial purposes, Bryant adds. A smaller version of the technology exists that serves the arm only, but it is based on the same principles.
Good Shepherd is just beginning its review of exoskeleton technology. Despite its potential for both patients and caregivers, the technology poses numerous challenges, Bryant says. "The exoskeleton involves balance and kinetic energy," he says. "It may pose significant safety issues without further investigation and trial."
Wheelchair advance guidance systems
A combination of laser technology and voice recognition, "smart" wheelchairs can be pre-programmed to navigate specific areas. Instead of users wheeling themselves from room to room, they could give a voice command such as "take me to the kitchen," and the wheelchair would do the work, Bryant says.
Good Shepherd already serves as a training center for the "iBOT," a wheelchair that can climb stairs. The next generation of wheelchair will expand that capacity, sensing, for example, if an obstacle is ahead. "Intelligent walkers" can accomplish the same goal.
Good Shepherd is evaluating vendors of the high-tech wheelchairs and walkers, says Bryant. "We will consider the cost, the complications and the maintenance," he says. "We need to do our own due diligence and make sure the products are worth the expense. We don't want gadgets clogging our closets."
Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at firstname.lastname@example.org.
Research and Beta Testing
Good Shepherd has participated in several technology development efforts: