This figures to be a consequential year in rehabilitation. What are the most significant story lines?
Ringing in the New Year can mean major changes for the billions of people around the world. One thing is sure to remain the same despite these various resolutions and shifts: People will need rehabilitative treatment. Rehab Insider spoke with rehab professionals in multiple specialties to see where the future of healthcare will be headed in 2017 and beyond.
Where Will the Jobs Be?
While job security can be a worrisome topic, rehab professionals can breathe a sigh of relief. Currently, job growth can be seen across the board. While general health diagnosing and treating practitioners have an expected growth of around 17%, all rehab careers exceed this number by a significant amount.
The Bureau of Labor Statistics predicts that the rate of job growth for physical therapists lies at 34% by 2024, one of the highest averages for all careers. They also predict that PTs will be increasingly sought-after in acute-care and hospital settings as well as nursing facilities.
Equally as impressive are the outlooks for other rehab professionals. Occupational therapy ranks among the top 20 best healthcare jobs, according to U.S. News & World Report, and lies within the same growth percentage by 2024 at 27%. Look out for opportunities in school settings with an increasing number of children with autism reaching school age.
Audiologists can look forward to 29% growth within the same time frame. As the population of aging adults increases, audiologists will be needed to help with problems typically seen in this demographic. Expect more treatments and testing for hearing loss and balance disorders.
As stroke becomes more common, speech-language pathologists will be needed to help treat accompanying conditions. Also, as awareness surrounding speech and language conditions such as stuttering increases, parents will be looking to find treatment for children starting at a young age. The notable increase in job growth is also seen in this profession, with 21% growth by 2024.
Technology as Treatment
The knowledge and expertise of rehabilitation experts is needed for many patients, but what if treatment could be more effective, more engaging and more helpful for the healthcare professional? Technological advances in healthcare have given many populations a new look at life.
Robert Gaunt, PhD, assistant professor of physical medicine and rehab at the University of Pittsburgh, has spent 15 years researching how technology can help individuals regain independence. The most recent study he has taken part in involves the use of microelectrode arrays and a robotic arm created at Johns Hopkins University for a patient with a spinal cord injury. The patient had been paralyzed for 10 years prior to the study.
According to Gaunt, the patient can control five to seven degrees of freedom and quickly reach out, grab objects and move around using the robotic arm. In fact, he is able to perform some simple tasks with the speed of a normally functioning arm.
Microelectrode arrays have also been placed in the patient’s somatosensory cortex. While using the arm, the patient can also feel sensation through the arm.
“This type of prosthetic is more of an assistive device, and hopefully there will be more things like this in the future,” Gaunt said. “For SCI, it would be ideal to reanimate [the patient’s]own paralyzed muscle, but that turns out to be very difficult. We still have a lot more work to do to understand how to use these devices reliably. As a clinical therapy, were still far away.”
In terms of rehabilitation using robotics, Shriners Hospital for Children-Chicago’s rehabilitation team has joined the technological movement. Their facility regularly uses upper-extremity exoskeletons as a robotic rehabilitation tool. In addition to this equipment, Shriners also employs an upper-extremity functional electric stimulation (FES) cycle and an updated bilateral upper-extremity ergometer connected to a gaming system. Rachel Galant, MSNM, OTR/L, director of rehabilitation services at Shriners, says the facility will be receiving new technology for their department in the next two years.
The exoskeleton is generally used for patients with SCI and cerebral palsy, but the FES cycle and gaming system is not diagnosis-specific. Getting this type of equipment in a rehabilitation facility may be expensive, but Galant claims that the benefits of having “the wave of the future” in treatment outweigh the costs. In addition to attracting patients, the robotics and technology can act as a second set of hands so that the therapist can facilitate or help their patients in another way.
“I feel if you miss out on participating in [this advancement], you might be left behind. I only see it being used more as a treatment tool and something that patients seek out,” she said. “Patients find programs with this kind of technology attractive. They feel like technology is the answer. I’m not going to say that it is, but it is quite a beneficial tool to have in the toolbox if you’re lucky enough to have the means at your facility.”
Gaming and Apps
While video games might be a part of treatment for some rehabilitation specialists, researchers are in the process of finding out whether video games based on listening to and recognizing sounds, words, sentences and stories can improve cognitive skills in those who have suffered traumatic brain injury (TBI) and cognitive fog caused by chemotherapy, known as “chemo brain.”
“This is another tool that rehabilitation neuropsychologists or therapists can use in order to improve a patient’s cognition, which will consequently improve their everyday lives,” said Gerald Voelbel, PhD, cognitive neuroscientist and director of the rehabilitation sciences program at the Steinhart School at New York University.
Participants went through 40 one-hour training sessions doing six different modules. Some of these included listening to specific sounds and whether they change pitch, traditional memory matching games using sound or listening to an entire story and picking up details of the story. As they improved, training became more difficult. Some participants who experienced chemo brain noted that they could feel improvements after four or five days. Similar results occurred with those who have prolonged impairment from TBI.
While more research needs to be conducted, Voelbel said that these advancements cannot be accomplished without the collaboration of engineers and rehab professionals from all spectrums, including audiologists, speech-language pathologists, occupational therapists and physical therapists. “Engineers typically don’t understand what needs to be done for rehabilitation. They know how to build or program, but it’s the rehab specialists that understand how to improve and assess human functions,” he said.
Even though rehab professionals are using technology, Voelbel questions the amount of clinical evidence to demonstrate that these tools are actually helpful. “I want to provide evidence that this does work, but we don’t know if it works for everybody, and there are so many questions we haven’t answered yet,” Voelbel said. “It’s so brand-new. The evidence needs to be proven before we can start using it as a treatment modality. We need research, and we need research between clinicians and scientists.”
Those working with patients who are finding their voice also have an array of applications that can be used on tablets and other devices. Heather L. Cappel, MA, CCC-SLP, at Orlando Regional Medical Center, regularly uses tablet apps for therapy, to explain swallowing disorders and to provide augmentative and alternative communications (AAC). This allows patients who are not able to use their fingers to type. Instead, they use the gaze of their eye to direct the use of the app.
“When you’re in a hospital, the environment tends to be pretty sterile. But in real life, we’re very dependent on technology,” Cappel said. “It helps to break up the monotony while trying to reach those goals. When you bring a device in front of them, it increases buy-in and you get more participation.”
Cappel believes that eye-gaze technology is an up-and-coming innovation for rehab professionals and one of Orlando Medical Center’s biggest initiatives; however, there needs to be more research to prove the need for it. Her hope is to have this technology available to all patients that require it to communicate with their doctors and family.
Technology can never replace the need for quality rehabilitation. Behind impressive equipment lies the expert opinion and guidance of rehabilitation professionals across all areas. Collaboration with engineers and developers and acceptance of this progression can provide innovative healthcare for patients with a wide range of conditions, deficits and disorders.