A new frontier in neuro-rehabilitation

Barrow Magazine Spring 2018

Happening Now

A new frontier in neuro-rehabilitation

Jovanna Calzadillas was swaying to Jason Aldean’s “When She Says Baby” when the bullets began raining down on the Route 91 Music Festival in Las Vegas. One tore through the 30-year-old mother’s brain, leaving her among the 546 people injured in the October 1 massacre that killed 58 people.

She was one of the first to arrive at University Medical Center, where doctors operated but were unable to remove the bullet. Her brain swelled.

She was unresponsive. Doctors advised her family to consider organ donation.

Her husband, Frank, refused. He knew his wife was still there. So they came home to Phoenix. Jovanna was transported to Barrow Neurological Institute and the Select Specialty Hospital, where a combination of intuitive medicine and robotic neurotherapy had her talking, joking and walking with assistance before Valentine’s Day.

The recovery story made international headlines, with global coverage focusing on how Barrow delivered a heartwarming miracle from the devastation of the Las Vegas attack.

But the story began with Dr. Christina Kwasnica, Barrow’s medical director of neuro-rehabilitation. When she meets a new patient, she starts by reviewing their imaging. If an injury is on the left side of the brain –as it was in Jovanna’s case – she knows language has likely been lost. So she looks for other ways to communicate.

“It’s like we’re speaking German and they’re speaking French. You have to give them time,” she says.

Jovanna’s eyes were open, and she could track with them in a small way. “This told me that she was unresponsive because of a language deficit, not because of the severity of her injury,” Dr. Kwasnica says. “She was not dying.”

As she examined Jovanna, the doctor was also thinking long-term, an advantage that exists at Barrow because of its unique ability to provide inpatient, long-term and outpatient therapy. “When I saw Jovanna, I was already thinking about each step. I saw us on a journey. If you’re dealing in silos, you’re not willing to go out there and take the risk.”

That journey included robotics, a new wave in neurotherapy where Barrow is leading. The center has invested $1.4 million in robotic devices and plans to rapidly increase its inventory. One Chinese company made Barrow the first American clinic to receive its innovative machine for regaining use of the hand and arm.

Customized robotic therapy is personalized medicine. Robotics can support patients as they learn to walk or help them relearn how to use an arm or hand, by providing resistance or completing the motion.

Robotics are helping patients relearn to use their hands, arms and walk

Some robotics look as if they’re from the pages of science fiction, including one that is helping Jovanna regain the ability to walk. It’s called an exoskeleton – a wearable robot.

Available for patients in the hospital or in rehabilitation, it attaches to the feet, leg and waist to support a patient and assist in walking. Like all robotics, it can be programmed to suit the needs of each patient, either providing all the motion or assisting and adjusting to what the patient can do.

Neurotherapy’s aim often is to retrain a different part of the brain to take over for the injured portion. This can require tens of thousands of repetitions, a job for which robots are well equipped. Combined with the right therapist at the right time in a patient’s recovery, robotics can help deliver higher levels of functionality and independence following a brain injury.

Jovanna’s experience is just the beginning. Barrow doctors and therapists are at the forefront of researching the capabilities of robots. They want to create a database to collect information and compare a patient’s needs to what has worked for others. Their work holds the potential to make miracles like Jovanna’s become commonplace.

Christina Kwasnica, MD, is the medical director of neuro-rehabilitation and the Center for Transitional Neuro-Rehabilitation at Barrow Neurological Institute. Dr. Kwasnica received her medical degree from Northwestern University and also completed her physical medicine and rehabilitation internship and residency there. She is a leader in the field of physical and neuro-rehabilitation, as well as treating patients with complex brain and spinal cord injuries.