October 30, 2024

Neuro-rehabilitation is a medical process defined by complexity, sustained effort, and continuous innovation. Today, advanced technologies offer new ways to tackle the challenges clinicians and patients encounter in neuromuscular recovery. We spoke with Lucy Redman, an Advanced Neuro-Physiotherapist and FES Consultant, who shares her insights on how emerging tools are reshaping neuro-rehab, improving patient engagement, and paving the way for the future of neurological rehabilitation.

**Lucy Redman**
*Advanced Neuro-Physiotherapist & FES Consultant*

Lucy graduated from Keele University in 2004 with a BSc in Physiotherapy and has since specialised in Neurological Physiotherapy. With her extensive experience in private practice and within the NHS, Lucy has been at the forefront of Functional Electrical Stimulation (FES) research and clinical application for upper limb rehabilitation. She has contributed to studies leading to FES guideline development and is a keen attendee at conferences. Passionate about technology’s role in enhancing patient outcomes, Lucy continues to drive innovative practices for neurorehabilitation, particularly within the home environment.

Challenges in Neuro-Rehabilitation

Question: Based on your experience, what do clinicians and patients in neurorehabilitation or stroke rehabilitation face the key challenges today?

Lucy’s Answer:

Access to services and ongoing therapy is limited, and managing spasticity—such as through Botulinum toxin injections to reduce spasticity and pain—is crucial for enabling rehabilitation.

Therapists are often constrained to service provision that prioritises discharge over the latest evidence-based practice. There is still the old mantra, only the first 6 months for improvement. Unfortunately, the outdated belief that improvement is limited to the first six months persists, despite evidence on neuroplasticity showing potential for longer-term recovery. Practitioners have many barriers preventing them from following the science and neuroplasticity.

Additionally, there’s often confusion about what tools to use for ongoing therapy. Clients and clinicians are often daunted by Functional Electrical Stimulation (FES).

Achieving the necessary ‘mass reps’ is also challenging, as the repetitive, task-specific practice required—often up to 1000 reps—can feel tedious and frustrating, leading some to give up.

Technology in Neurorehabilitation

Question: How do you see the role of emerging technologies like extended reality (XR) in addressing these challenges?

Lucy’s Answer:

Brain-computer interface technologies, when paired with other forms of stimulation, provide a stronger evidence base and greater success in improving outcomes. These technologies offer clients tangible, achievable goals and allow them to see their progress firsthand—whether it’s completing 10 extra reps or seeing a reduction in muscle tone. With so many of us already using smartwatches to track our steps, a similar device that monitors upper limb repetitions could be highly motivating.

Lucy is trying *eir bands* at Birmingham FES Clinic.

Firsthand Impressions

Question: After using Valkyrie's platform, what specific features or functionalities can have the biggest impact on patient outcomes?

Lucy’s Answer:

The ability to link eir bands to a mobile app could have a significant impact, as it allows clients to receive reminders throughout the day for short, five-minute exercises.

Even if they don’t have access to Botox injections for tone reduction, clients could still benefit from activities like virtual games—such as picking up a block—without the frustration of not being able to physically perform the task. Access to their data would also be invaluable for tracking progress.

Patient Engagement

Question: How important are patient engagement and motivation during therapy, and how do you think XR/FES solutions might enhance these aspects in rehabilitation programs?

Lucy’s Answer:

Patient engagement is everything. One of the biggest challenges is ensuring patients consistently use the device, which depends on having a straightforward setup and process.

Like Toyota’s 'lean' approach, it needs to be easy to use. For example, keeping eir band chargers in the same place as phone chargers, having a simple, reliable app, and making electrodes easy to apply. Battery life is also key—if it dies and the charger isn’t close by, patients may not use it. This applies to VR headsets as well.

Clients also need to see a difference quickly; if they follow a structured two-week program, some progress should be visible early on. However, the repetitions must be high, and the exercises should align with functional goals to be effective.

I’ve learned that if the device is out of sight, it’s out of mind. Setting reminders, like phone alarms, could help keep it in use. Adding similar features in the software would be a great support.

Therapist Experience

Question: How do you see technology like FES and XR easing the workload for clinicians in terms of managing patients, customising therapy, and improving overall outcomes?

Lucy’s Answer:

Technology like FES and XR could ease clinicians’ workloads by streamlining patient management and customising therapy. For example, it could enable upper limb groups to share experiences and even engage in friendly competition, possibly within a rehab unit setting, and then clients could access the software on their phones at home.

Virtual reality (VR) headsets combined with eir bands could free therapists to focus on more specific needs, such as improving a client’s posture or challenging their balance in sitting or standing positions.

Client intention of movement via sensor or EMG to trigger the device is ideal, but at a minimal, the therapist controlling the trigger can make the therapy session closer to the evidence-based treatment needed.

Future of Neurorehabilitation

Question: As someone immersed in neuro-rehabilitation, where do you see the field heading in the next few years, and how do you think innovative tools like ours can shape the future?

Lucy’s Answer:

In the next 5 years, I believe technology and personalised rehab programs will increasingly be available at home. This shift is likely to take place more in outpatient settings as the emphasis continues transitioning clients out of hospitals sooner.

Getting the software and tech right to provide future innovation at its simplest level for clients to use easily at home will increase market availability. Especially if the basics are right and the cost is affordable.

Over the next 10–15 years, further advancements in brain and spinal stimulation are likely. This will require integration with easy-to-use software, combining peripheral system stimulation (like standard FES) with brain stimulation via TCS or other means, and connecting to brain interface technology. Starting with the eir bands and related software now can lay the groundwork for a future where these advanced technologies are more refined and accessible.

Lucy Redman’s expertise and vision underscore the transformative potential of technologies in neuro-rehabilitation. With the right tools, clinicians and patients can access more effective care, enhancing mobility, independence, and quality of life. As we look to the future, innovation with clinical insight will continue to redefine what’s possible in neurorehabilitation.

From Challenges to Innovation: Insights from Advanced Neuro-Physiotherapist & FES Consultant Lucy Redman

Challenges in Neuro-Rehabilitation

Access to services and ongoing therapy is limited, and managing spasticity—such as through Botulinum toxin injections to reduce spasticity and pain—is crucial for enabling rehabilitation.

Achieving the necessary ‘mass reps’ is also challenging, as the repetitive, task-specific practice required—often up to 1000 reps—can feel tedious and frustrating, leading some to give up.

Technology in Neurorehabilitation

Firsthand Impressions

The ability to link eir bands to a mobile app could have a significant impact, as it allows clients to receive reminders throughout the day for short, five-minute exercises.

Patient Engagement

Patient engagement is everything. One of the biggest challenges is ensuring patients consistently use the device, which depends on having a straightforward setup and process.

Clients also need to see a difference quickly; if they follow a structured two-week program, some progress should be visible early on. However, the repetitions must be high, and the exercises should align with functional goals to be effective.

Therapist Experience

Virtual reality (VR) headsets combined with eir bands could free therapists to focus on more specific needs, such as improving a client’s posture or challenging their balance in sitting or standing positions.

Future of Neurorehabilitation

In the next 5 years, I believe technology and personalised rehab programs will increasingly be available at home. This shift is likely to take place more in outpatient settings as the emphasis continues transitioning clients out of hospitals sooner.

From Challenges to Innovation: Insights from Advanced Neuro-Physiotherapist & FES Consultant Lucy Redman

Challenges in Neuro-Rehabilitation

Access to services and ongoing therapy is limited, and managing spasticity—such as through Botulinum toxin injections to reduce spasticity and pain—is crucial for enabling rehabilitation.

Achieving the necessary ‘mass reps’ is also challenging, as the repetitive, task-specific practice required—often up to 1000 reps—can feel tedious and frustrating, leading some to give up.

Technology in Neurorehabilitation

Firsthand Impressions

The ability to link eir bands to a mobile app could have a significant impact, as it allows clients to receive reminders throughout the day for short, five-minute exercises.

Patient Engagement

Patient engagement is everything. One of the biggest challenges is ensuring patients consistently use the device, which depends on having a straightforward setup and process.

Clients also need to see a difference quickly; if they follow a structured two-week program, some progress should be visible early on. However, the repetitions must be high, and the exercises should align with functional goals to be effective.

Therapist Experience

Virtual reality (VR) headsets combined with eir bands could free therapists to focus on more specific needs, such as improving a client’s posture or challenging their balance in sitting or standing positions.

Future of Neurorehabilitation

In the next 5 years, I believe technology and personalised rehab programs will increasingly be available at home. This shift is likely to take place more in outpatient settings as the emphasis continues transitioning clients out of hospitals sooner.

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