By Dr. Elizabeth Ardolino, PT, MPT, MS, PhD
When a boy in our local Austin community sustained a spinal cord injury from a car accident, leaving him unable to walk, I was called to see how our school and students at the University of St. Augustine for Health Sciences, could help. As an associate professor of physical therapy (PT) at the University, I am always looking at real-life activation of skills and instruction for our students to use while serving members of our community. I invited the boy, Will, to come in for free treatment using the state-of-the-art mobility system housed on the Austin campus. My Doctor of Physical Therapy (DPT) students were able to observe and participate. That began a community-facing program that we are exploring and expanding.
Today, three children with disabilities participate in this program, which is now integrated into the Pediatric Physical Therapy course on the Austin campus. I co-teach this course with Megan Flores, PT, PhD, and Darryn Atkinson, PT, PhD. We guide DPT students in using the SafeGait 360°® Balance and Mobility Trainer® to help these children practice ambulating.
The program runs similar to a pro bono clinic. Will comes in five days a week, along with Martin and Nathan, who both have cerebral palsy. Each child spends an hour on the SafeGait, a body-weight support system that supports the patient like a crane as they walk on a treadmill. The SafeGait distinguishes between a patient’s intentional downward movement and an actual fall, helping patients gain strength and balance without the risk of falling. The University of St. Augustine for Health Sciences is one of the first higher education institutions in the nation to install this system.
The students begin by assessing each child’s nervous system function. With faculty supervision, they create a daily plan for the child and learn to manage the child’s behavior and expectations. They also work with caregivers to develop a care plan for the home. By the end of the course, the students are leading the sessions independently as their confidence grows.
For Will, who cannot feel or move his legs, using the SafeGait is a way to excite the spinal cord below the lesion. Along with neuromuscular electrical stimulation, this therapy promotes improved postural control and motor function, and anecdotally may also improve respiratory, bowel, and bladder function in patients. Each session also includes a half-hour of other activities focused on trunk control, balance, and mobility. It is important for Will and Martin, who play on the same wheelchair basketball team, to practice holding their bodies upright and engage with catching and throwing without leaning on their arms. This helps them improve trunk control and arm strength—and ultimately gain more independence at home.
For children with cerebral palsy, the traditional approach is to brace and immobilize their limbs, but kids naturally want to move and play. By putting them in an environment where they can do so, kids and their parents start to see hope for the future. The parents are incredibly grateful that their kids receive this level of intensive treatment for no charge. Word has spread to other parents, and we now have a small waiting list. We hope to expand the program to include more children in the future.
When the Austin campus closed in March due to the COVID-19 pandemic, our students reached out, asking how they could continue working with Will, Nathan and Martin. Students created virtual home exercise programs, and during the Summer trimester, the course included telehealth sessions. It’s difficult because the hands-on work is really needed. We are developing assignments related to the pediatric program in other DPT courses. We are also working on making this program interprofessional, involving faculty and students from the occupational therapy and speech-language pathology programs.
Typically, children only get one or two physical therapy sessions per week. We are studying how this more frequent and longer-duration practice makes a difference in children’s outcomes. We’re also collecting data on the impact of this program on students’ preparedness for their clinical experiences. The team has submitted proposals to present at physical therapy conferences, should they happen, in the fall. We also hope to share this theory and interventions through continuing education courses in the future. This type of therapy has been available for adults for more than 16 years but has only become available to children in recent years. Starting young can make such a difference. Our goal would be that this approach is not so unique—that it could be widely available to help more children in the future.
Elizabeth Ardolino, PT, MPT, MS, PhD is Associate Professor in the University of St. Augustine’s Austin Campus DPT program. Dr. Ardolino earned a MPT from the University of Scranton in 2002, and an Advanced Masters of Science Degree in Physical Therapy from Temple University in 2008. She completed her PhD in 2010 at Seton Hall University.