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TECHNOLOGY

By David Marcarian, MA

o you ever ask, “Why isn’t there a better way to train patients to succeed with their exercise and rehab protocols?” You aren’t alone. Most doctors will agree that there are significant challenges complicating their efforts to achieve

effective muscular rehabilitation programs for their patients. We all know that patient compliance with exercise programs yields better treatment outcomes and sustained improvement. Active participation by patients in their care plans has become a requirement, making engaging and effective rehab protocols increasingly important.

Three major factors are responsible for patients failing with their rehab protocols. First, there is the lack of effective training methods for introducing patients to their in-home programs. Second is the absence of truly engaging exercise programs that patients will be motivated to continue. Finally, the third factor is the lack of technologically valid and ef-ficient methods for objectively evaluating patient progress. Currently, the determination of patient progress with in-home rehab protocols mainly consists of subjective reporting and a limited amount of objective findings. These limitations are

mainly imposed by the current lack of high-tech methods for evaluating the nuances of change, as could be ascertained with sophisticated analytical equipment.

As far as home exercise goes, technology has been sorely lacking with regard to both program design and outcome analysis. Stick-drawings produced by DCs and fuzzy, over-copied exercise pages have been around longer than most of us would like to admit, mainly due to a lack of appealing alternatives. It’s no wonder our patients lack enthusiasm. The instructions are boring. They can’t fully visualize what they are supposed to do, and they can’t remember much of what the doctor described. On top of it all, they have no accurate way to track their progress or the subtleties of their improvement. For patients, no discernable change equals no motivation. Studies have found that patients remember, at best, 15% of the information provided by their doctors1, making the prob-ability of success with these methods a marginal endeavor.

Effective, in-home rehab requires three components: in-office training, easy-to-follow and engaging exercises, and effective methods for collecting data and evaluating change.

D

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One proposal for achieving all of these goals is the use of three technologies: 1) video visualization for demonstrating the performance of the exercises, 2) audio instruction, and 3) muscle-activity analysis for personalized program design and for tracking patient progress with neuromuscular rehabilita-tion objectives. These methods could be applied in the office setting, for training, or for in-home use.

It goes without saying that higher-tech equipment offers multiple benefits to you and your rehab efforts. Sophisticated rehab technology offers patients more appealing exercise pro-grams, contributes to better treatment outcomes, and yields the objective data that both you and your patients have been craving. And let’s just say that it is light-years ahead of the fuzzy photocopies.

In related literature on stroke rehabilitation, statistically significant improvement in outcomes for these patients was achieved when mirror therapy (where the patient could visual-ize proper function in a mirror) was compared with traditional stroke rehabilitation2. Hence, the application of both comput-erized and video images for exercise visualization, rather than mirrors, can offer a higher-tech rehab solution for patients and their doctors. These technologies are also effective in over-coming many common objections from patients who derail their exercise programs. The benefits for doctors are obvious. It takes less time to upload a personalized exercise video for the patient than to print out sheets of “stock” exercises, or to

draw stick figures. For patients, the electronic exercise pro-gram has far more visual appeal, energy, instructional content, and longevity than mere paper pages.

Here is how this proposed technology would work by utiliz-ing simple but highly effective processes. Using scoliosis as an example, electrodes would be attached the lower lumbar and midthoracic regions. Utilizing video and muscle-activity tracking, patients would be able to see how well their muscu-lature is working during movement—symmetry, asymmetry or failure—and how they can improve function.

In the scoliotic patient, it may be desirable to increase muscle firing during motion in the left lumbar region beyond that of the right. This form of “chiropractic biofeedback” would be easy for patients to understand and implement using

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colorized computer graphs. In addition, the patient’s posture and movement are recorded, providing even more objective data for analysis.

In addition, you could provide the audio recording of your instructions to accom-pany the visual components of this rehab system. For distribution of the programs to your patients, you could upload via a HIPPA-complaint website with their personal exercises for home use. For your Internet-free patients, a flash drive could be provided. Both the website and flash drives could be marked with your logo and clinic information to maximize another marketing opportunity.

The key to success with this rehab system is that the patient can more optimally achieve normal function by visualizing posture, movement, and muscle activity, all in one simple and effective package. These methods enable patients to finely tune muscle use, whether it is the recruitment of certain muscles or muscle groups, or for decreasing their employment. The muscle activity biofeedback provided by the system allows patients to learn appropriate muscle function significantly faster.

Comparing the effectiveness of this rehab training system to exercise pages is like comparing a smartphone to the old paper cups and strings kids used to rig up for making “phone calls.” With this new rehab system, the patient goes home with a personalized video and audio recording showing him or her-self properly performing the exercises under the direction of the doctor. During this training session, data was collected on muscle activity to determine any necessary modifications to the exercise protocols or performance. The impact on patient com-pliance is clear. You have instantly invalidated the most popular exercise excuses that patients report (e.g., “I lost the pages,”

TECHNOLOGY

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or “I can’t remember what you told me to do.”). In addition, you have provided each of your patients with precise instructions for performing their home rehab protocols cor-rectly. Patients iden-tify strongly with their own images in the vid-eos and they are able to more easily follow the

instructions by recalling the in-office training session. Technol-ogy makes this rehab system both cost-effective and practical. Since most patients today have Internet access, downloading their exercises via their HIPPA-compliant web portal makes the process easy, efficient, fast, and portable. There are no materi-als to lose, they have 24-7 access, and it is available on any device. Although the value to your patients and your practice is clear, there also may be billing codes that apply. These may possibly include therapeutic activities (97530) neuromuscular re-education (97112) and E&M codes.

Once you have recorded baseline posture and muscle-activity data, you can easily track patient progress through subsequent training and reevaluation sessions in your office. The posture and muscle activity data, and exercise perfor-mance comparisons as provided by the video recordings,

easily allow you to review and analyze patient improvement. This data is valuable for your patient care and for maintaining motivation in your patients.

Keep in mind that regardless of your age or generation, the integration of technology is expected of businesses today by consumers and patients alike. Businesses are often considered, or excluded, primarily on how current or out of date they appear to be, based on their use of technology. We live in a very data-driven world with patients expecting their doctors to use the latest technology. By using the right technology for the job, and not merely improvising, you establish yourself as a “new-tech” professional whom your patients will respect and recommend.

References: 1. Thieme H, Mehrholz J, Pohl M, Behrens J, Dohle C. Mirror

therapy for improving motor function after stroke. Stroke. 2013 Jan;44(1):e1-2.

2. Thom DH. Training physicians to increase patient trust. J Eval Clin Pract. 2000 Aug;6(3):245-53.

Mr. Marcarian is a NASA-Trained Researcher and in-ventor of high-tech biometric instrumentation, including the patented Wireless DynaROM Motion sEMG System which graphs muscle guarding and ROM simultaneously. This technology has established chiropractors as the

leading experts in soft tissue injury. Upcoming CE Seminars can be viewed at www.myovision.com or by emailing david@myovision.com.

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