Wayne State University

Taking NuStep in new directions

EACPHS physical therapy professors Sujay Galen and Vicky Pardo have been provided with a rare and unique opportunity to collaborate with Michigan-based rehabilitation technology manufacturer NuStep. This new model of collaboration will allow physical therapists to directly impact the design and implementation of future technologies in order to maximize patient outcomes and satisfaction.

Galen, formerly a pediatric physical therapist, graduated from Christian Medical College in Vellore, India. Driven by a desire to improve patient outcomes, he earned his master’s and doctoral degrees in biomedical engineering from the University of Strathclyde in Glasgow, Scotland. Pardo began working as a senior physical therapist at the Rehabilitation Institute of  Michigan (RIM) in 1992. A graduate of the University of Ottawa in Ontario, Canada, she earned her master’s and doctoral degrees in health sciences from the University of Indianapolis. She has extensive experience in treating patients with a variety of neurological disorders.

Both are passionate about providing patients with quality care, preparing the next generation of physical therapists, and producing research that makes rehabilitation exercises more efficient and effective. Both are also aware of how their different skill sets complement each other.

“Vicky is the expert clinician and I am the engineer who does the technology part,” said Galen. “We have this dual strength of clinical and engineering expertise to bring the best clinically relevant technology to our patients.” The team’s current study, “Muscle Activity Analysis During Recumbent Stepping,” is the first to explore how seated, recumbent cross trainers — designed by the Ann Arbor based company — can be used to restore muscle function in individuals with neurological and musculoskeletal impairments.

“NuStep trainers are everywhere — in nursing homes, physical therapy clinics, gyms and patients’ homes — and no one has looked at how they can be used to target specific muscles more effectively,” said Pardo. “People have conducted similar studies with stationary bikes and elliptical machines, but what we are doing has never been done.”

The NuStep seated recumbent cross trainer was designed to provide people recovering from heart surgery and related cardiac challenges with equipment they could use safely and easily. The machine is used in all types of environments to provide an effective cardio workout or rehabilitation treatment.

“The NuStep is easy to set up. It can be used by patients who are unable to walk or who are in the very early stages of  rehabilitation. We want to promote muscle activity during the early part of recovery because it is very important for neurological recovery,” said Galen. “By better understanding muscle activity patterns during the stepping cycle, we can create better, targeted treatments for patients and help them get the most out of their exercises.”

Galen and Pardo use a wireless electromyography (EMG) system that allows patients to simulate exercises performed in a physical therapy clinic in their neurotechnology laboratory.

“We put EMG electrodes on their legs to see which muscles fire and when during the stepping motions,” said Pardo. “Based on our results, we hope to be able to share best practices for restoring and strengthening muscle function. For example, if a therapist is working with a patient who had a stroke and wants to build the hamstring muscle because it has gotten weak, we might put the seat closer, have them do it with a certain level of resistance or perform the exercise with one leg. We are testing different conditions so therapists are able to focus on helping patients engage specific muscles and use the machine more effectively.”

The first study, which began this summer, focused on how exercises performed by 30 healthy subjects at different speeds and resistance levels affected recruitment of lower extremity muscles. Galen and Pardo are currently exploring how seat position can be used to focus on and strengthen muscles. This study includes 20 healthy individuals and 20 stroke patients.

Galen and Pardo involve doctoral students in the physical therapy program in the research process. “Our projects provide students with the chance to learn more about physical therapy and human movement. It is a real-world experience that will enhance what they learn in the classroom,” said Galen.

Both researchers are excited about the partnership and believe their connection and collaboration with NuStep has potential to be a long-term, productive relationship. Their expertise, partnered with NuStep researchers, could open the door to new product innovations that can better help patients recovering from strokes and other conditions requiring physical therapy. That real-world impact drives both professors.

“We are fortunate that NuStep has provided us with their latest prototype,” said Pardo. “We can have stroke patients use the prototype and see what they think, then share that feedback so NuStep can optimize the product toward a better patient experience before it hits the market.”

“This is a fantastic opportunity to work with a company that is manufacturing products in the United States,” Galen added. “We have a chance to work in that interface between research and development before a product arrives at the market, so we are also looking at how we can partner with a manufacturer in driving innovation through our research. That is exciting.”

Photo: (from left to right) Sarah Maher, director of the physical therapy program; Sam Steiner, NuStep new product technologies; Dick Sarns, NuStep chief executive officer; Sujay Galen (seated on NuStep prototype), assistant professor of physical therapy; Carol Wilson, consultant to NuStep; Neil Cole, director of new product technologies for NuStep; and Vicky Pardo, assistant professor of physical therapy