Arkansas Children’s: Inspiring Innovations in Rehabilitation

In early 2024, a rocket ship landed at Arkansas Children's Hospital (ACH). The first-of-its-kind rehabilitation device with a colorful rocket ship exterior helps pediatric patients relearn how to walk after a stroke, strengthen muscles weakened by cerebral palsy or practice movements impacted by disease or injury. Arkansas Children's team members specialize in providing what we call 'right-sized care' - this means adapting everything from surgical procedures and medication dosages to the specific needs of a growing child. The Rise & Walk neurorehabilitation rocket ship demonstrates how our rehabilitation team provides right-sized care. One of the first patients to benefit from the new technology was John 'Johnny' Skinner. When six-year-old Johnny suffered a stroke on the playground at school, his parents brought him to ACH for treatment. 

What is Neurorehabilitation? 

There are trillions of neural pathways in our brains. Our brain sends electric signals along these pathways to deliver messages. For example, the brain will tell the muscles in our hand to jerk away quickly from a hot surface. The brain also uses these pathways to tell the body to do ordinary tasks, like breathing or blinking. The more we do a specific activity, like shooting a basketball, the stronger that particular pathway becomes. Sometimes, a child is born with a condition, like cerebral palsy, or has an accident that damages the neural pathways. Neurorehabilitation is a collection of techniques and treatments for rebuilding or creating new connections between damaged pathways.  

Arkansas Children's physical, occupational and speech therapists use rehabilitation activities to repair neural pathways and to strengthen muscles. They guide patients safely through repeated motions, like putting one foot in front of the other, so they learn to walk independently or do hundreds of other typical activities. When a physical or occupational therapist helps a patient move an arm, the brain activates the neural pathway to the arm muscles, aiding in repair. 

Rehabilitation activities often require multiple therapists and multiple pieces of equipment. The neuroscience team at Arkansas Children’s, is led by pediatric physiatrists Laura Hobart-Porter, D.O., chief of physical medicine and rehabilitation and associate professor of pediatrics at the University of Arkansas for Medical Sciences (UAMS) and Vikki Stefans, M.D., professor of pediatrics at UAMS in the department of physical medicine and rehabilitation. Their ongoing search for improving treatment led them to the Nashville-based medical technology company Healing Innovations and the Rise & Walk equipment. 

 

Right-sized Rehabilitation 

Shannon Wyatt, MSN, APRN, FNP-BC, CCRN, NE-BC, neuroscience service program manager at ACH, said the rehabilitation team liked the Rise & Walk because it combined the features of several different tools into one piece of equipment. It helps physical and occupational therapists as they guide patients through walking, balance and resistance exercises while seated or standing. 

"At Arkansas Children's Hospital, we see a lot of traumatic brain injuries," Wyatt said. "We also see spinal cord injuries. Both of those sets of patients benefit from this one piece of machinery. Instead of moving from one thing to the next to the next, we will use one piece of machinery and one therapist versus three machines and three care teams." 

The benefits were obvious: Arkansas Children’s could deliver better care to more patients. 

“If we provide more care in a shorter amount of time for somebody, they get to transition home sooner,” Wyatt said.

The drawback to the Rise & Walk was equally obvious: at the time, every Rise & Walk built was designed for an adult body. Patients under 5 feet tall or under 100 pounds - which many pediatric patients are - couldn't use the machine. Pediatric specialists at Arkansas Children's met with the engineers at Healing Innovations and collaborated to make the technology accessible for smaller bodies.  

Luke Benda, CEO and co-founder of Healing Innovations, said, "Arkansas Children's willingness to be the first innovator" led to the first pediatric kit that can quickly and easily transform the standard Rise & Walk into a device that now serves patients from 4- to 6-feet tall and weighing 50 to 285 pounds. Once Healing Innovations answered the engineering question and created a kit that would serve most Arkansas Children's rehabilitation patients, Benda said the next challenge was "Arkansas Children's desire for it to have a friendlier exterior." The standard Rise & Walk - a large, white piece of complex machinery - could easily intimidate a child. 

"We're mostly engineers, so that question threw us a little bit of a curveball," Benda said. "We were like, why would this matter? But it does matter. We looked into it, and there's research and growing support for making medical technology more friendly for pediatrics." 

Arkansas Children's team members suggested a rocket ship design on the exterior, and Healing Innovations delivered. The result is the world's first Rise & Walk rehabilitation rocket ship, with a kit specifically designed for pediatric patients like Johnny Skinner. 

 

First Patients 

Johnny Skinner was at school playing when a blood clot in his brain caused an ischemic stroke. The clot shut down many pathways between his brain and the right side of his body. He spent two days in the Intensive Care Unit at ACH while his care team provided emergency treatment. Once stabilized, work to retrain Johnny's muscles and neural pathways began. He was unable to walk for two weeks. 

One of Johnny's care team members was Arkansas Children's physical therapist Janet Moragne, PT, DPT. Moragne had been part of the collaborative efforts with Healing Innovations and trained on using new equipment with its pediatric modifications. Straps for supporting patients are color-coded to match a patient's weight, and a metal add-on allows patients under 5 feet tall to be fully supported. 

"It's a special piece of equipment that is going to impact a lot of families," Moragne said. "The Rise & Walk accommodates many different types of diagnoses and impairments that other pieces of technology cannot accommodate safely."  

Before Arkansas Children's and Healing Innovations teamed up to develop the pediatric kit, Johnny would have been too short and light to use it. Once the Rise & Walk arrived at ACH, his care team made it part of Johnny's treatment plan. He was able to relearn how to walk with the support of the equipment before transitioning to a walker. 

Within a few weeks, Johnny was walking and running on his own again. During a follow-up visit at ACH, he charges into the Rise & Walk room, clearly not intimidated by the large rocket ship. Moragne straps him in and takes him through the paces, literally. After they count 100 supported steps together, he is beaming at his accomplishment. His mother, Melissa, is too, as she recalls his first sessions on the Rise & Walk. "Last time you did this, you only had half a smile."  

The team at Arkansas Children's continues to collaborate with Healing Innovations engineers on ways to make the equipment even more effective for pediatric patients. Luke Benda said the pediatric kit inspired by Arkansas Children's is poised to benefit children's hospitals nationwide. Advancements like these are among the reasons the Arkansas Children's Hospital Inpatient Rehab Program earned the highest recognition award by the Commission on Accreditation of Rehabilitation Facilities (CARF) International. The accreditation means Arkansas Children's Hospital has met the highest standards in quality improvement, focusing on the unique needs of each patient and monitoring the results of care. 

*This blog was reviewed for medical accuracy by pediatric physiatrist Laura Hobart-Porter, D.O., chief of physical medicine and rehabilitation and associate professor of pediatrics at the University of Arkansas for Medical Sciences (UAMS).