MossRehab uses robot therapy to help the paralyzed walk

Jesus Feliciano is a man of few words. Fortunately, his actions say plenty about him.

Feliciano, 27, a patient at MossRehab's outpatient facility in Elkins Park, was shot multiple times in the neck near his North Philadelphia home in 2008.

"They told me I'd never walk again," he said.

But Feliciano is proving those doubters wrong with the help of the G-EO, a robotic walking training system that helps patients regain strength and movement to improve their ability to walk.

For the past six months, Feliciano has worked twice a week on the G-EO for 30-40 minutes at a time with John Feeley, one of a select group of physical therapists to operate the training system in general practice since its introduction late last year. MossRehab is currently the first U.S. facility using the latest technology.

The training system was cited by MossRehab workers during a survey by WorkplaceDynamics, an Exton firm that is conducting Philly.com's fifth annual Top Workplaces awards. MossRehab ranked 11th this year among large businesses with more than 500 employees in the region.

THE LATEST IN ROBOTIC THERAPY

In therapy, it is difficult to replicate the motion that a patient has lost, said Theresa Toczylowski, a physical therapist and supervisor of outpatient therapy at MossRehab. "There was a time that it took four to five therapists to get a patient to walk a few steps," she said.

The G-EO system uses a harness to suspend the patient while robotics replicate the motion of walking. As the patient regains muscle strength and control, the robot delivers less assistance. It measures how much of a patient's body weight is being supported, where the feet are making contact with the ground as well as the walking distance.

With the G-EO, it's really all about the footplates, known as end effectors, which allow the body to move more freely.

"The hip and knee move at their own desired rate or angle, whereas other robotic devices move your hip and knee for you," Esquenazi said. As a result, the system can help a patient regain his natural, pre-injury gait.

The robotic device is far from the first utilized at MossRehab. Tools such as ReWalk and Lokomat have been assisting patients for more than a decade.

"Finding these devices has been one of my great interests," says Dr. Alberto Esquenazi, M.D., medical director of MossRehab. "One of the major issues is the effort required to provide assistance for walking."

As director of MossRehab's Gait and Motion Analysis Laboratory, Esquenazi was first interested in the G-EO for research purposes. Last fall he approved it for clinical use.

STEPS ON THE PATH TO RECOVERY

On a recent visit, Feliciano was nearing the 35-minute mark on the G-EO, when Feeley told him to take a break. Feliciano simply nodded.

"Jesus' motivation is the biggest factor," Toczylowski said. "The G-EO has helped him to break through a number of barriers, but none of it would be possible if he wasn't motivated, and if John wasn't so enthusiastic about working with him."

Over time, Feliciano's performance on the six-minute walk test - set the clock for 6 minutes and patients walk as far as they can - has gone from 50 feet to more than 300 feet. "Even more impressive to me, he's been able to use his walker and walk independently for up to 18 minutes at a time," Feeley said.

While ReWalk, Lokomat and G-EO are linked as robotic devices, MossRehab patients and therapists view each as a different step on the patient's journey to recovery.

"I think all of the tools at our disposal over the years - from the G-EO to the hands of a therapist - have been useful and have added to our repertoire as therapists," Toczylowski said. "There isn't one modality that can help everyone, but the more variety and more options we have, the greater the benefit to the patient."

The technology at MossRehab makes it easier to help people, a common theme in the employees' responses to the Top Workplaces survey.

"I love my job because I get to do work that I enjoy with a great team of people around me," wrote one worker.

"I work with great people who do their best to give the best care possible to our patients," another employee wrote. "Working at Moss makes me feel like I make a real difference in people's lives."

Toczylowski, who started at MossRehab as a student, admits she, too, was drawn to the facility because of its name and reputation.

"But of course, the name means nothing without the experience," she said. "MossRehab really puts the needs of our patients first. And Dr. Esquenazi is always at the forefront of the technology that most benefits our patients."

"If you ask others, maybe I'm just a nagging guy who managed to convince administrators to spend money on these things," Esquenazi laughed. "But if you ask me, I'm very fortunate. I work in a facility that's very supportive. You don't get paid any extra money for using a robot - these robots can deliver therapy in a prompt, efficient manner, and that's the primary concern of everyone at MossRehab."