CAREN for the community

EDMONTON — As a veterinarian, Sarah Fryer is accustomed to the sudden movements and unpredictable shifts of large animals, and counts on her strength and sense of balance to do her job safely.

When a blood clot in an artery going to her spine left her a paraplegic earlier this year, it put her life on hold and her livelihood in jeopardy.

It would take a very specialized, high-tech therapy to recreate the conditions necessary to help the 53-year-old towards regaining her mobility and balance, but thanks to CAREN (Computer-Assisted Rehabilitation Environment) at the Glenrose Rehabilitation Hospital, Fryer has already progressed to using a single cane from a four-wheel walker in only a few months.

“It’s been wonderful. It’s been a life-changer the way they’ve catered an individual program for me to help me reach my goals. CAREN has improved my walking speed, my balance and my confidence,” says the resident of Gunn, located about 80 kilometres northwest of Edmonton.

Marking its first anniversary as the only clinical virtual reality simulator of its kind in Western Canada, CAREN is making great strides in restoring mobility to wounded military personnel and a wide variety of civilian patients at the Glenrose.

“This technology has vast applications and we are just in the beginning phases of discovering its full potential,” says Vickie Buttar, Rehabilitation Technology Leader at the Alberta Health Services (AHS) facility.

To date, CAREN has helped soldiers – as well as patients ranging in age from preschoolers to seniors in their 90s – and each month typically provides advanced rehabilitation to 30-40 patients, half of them new. The number and frequency of one-hour sessions varies based on patient needs.

“We can replicate most anything you can dream up. We can span all ages and many conditions,” says Darrell Goertzen, Technology Service Leader for Research and Technology Development. “We can bring in a 92-year-old, for example, and start CAREN off as a flat treadmill and project a nice park scene as she walks slowly. As she regains confidence, we can put some hills along the path. Bring in more distractions for cognitive issues. We can start out easy and just keep piling on the tasks as the therapists and clinicians see fit — to ramp it up to keep it fun and challenging.”

As versatile as an aircraft simulator, CAREN’s split-belt-treadmill platform, motion hydraulics and circular surround screen can be programmed to create virtually any scenario or game imaginable as it delivers a rehab program precisely tailored to each patient’s needs.

As well, sensors placed on patients are tracked by overhead cameras to give objective feedback and measure progress on gait, stride, speed, weight-shift, balance and more. A patient becomes part of the simulated environment, interacts with it and changes it through their body movements.

By virtue of its adaptability and flexibility, the $1.5-million device is also driving research at the Glenrose as health professionals and technology leaders explore new ways to help more kinds of patients and establish best practices on the system. As well, the Canadian Forces is currently collaborating with allies on research and treatment options using CAREN.

“Similar to a highly trained athlete, military personnel are in very good condition prior to being injured,” says Buttar. “After their injury, their goal isn’t simply to walk again — to be able to get up, make some toast and come back to the chair. Their goal is to get back to active duty, to perform again at that high athletic level, whereas most people, before injury, would likely function at an average level and have more modest goals. The beauty of this system is that we can help people from all walks of life while notching it up for individuals with more ambitious, complex goals.”

“My aim is to get back to my work as a veterinarian,” adds Fryer. “I’m halfway there. I can work now with small animals but I’m specifically trying to work on my balance with unexpected movements from larger animals, such as horses. With CAREN, they’ve been able to mimic that by having it do sudden, unexpected movements. I’ll be walking along, and suddenly they’ll shift it to try to throw me off balance. I’m training myself to compensate for that.”

The CAREN at the Glenrose is the result of the hospital’s partnership with the Department of National Defence. It can be used to rehabilitate Canadian Forces personnel and civilians with both physical and psychological injuries such as amputations, Parkinson’s disease, stroke, brain injuries, spinal cord injuries and cerebral palsy, as well as psychiatric disorders such as phobias and post-traumatic stress disorder. Canada’s other clinical CAREN system is located in Ottawa.

Funding for CAREN came from the Government of Canada and Alberta Advanced Education and Technology. Through the Courage Campaign, the Glenrose Rehabilitation Hospital Foundation also raised more than $4.5 million, which led to the 2011 opening of the Building Trades of Alberta Courage Centre and the creation of the Courage In Motion (CIM) Centre, which houses the CAREN system. AHS provides the clinicians, facilities and logistical support to ensure the system will reach its full potential.