This report originally appeared in the June 2010 issue of DOTmed Business News

There seems to be a divide in the physical therapy industry between physical therapists who rely on equipment and those who use manual therapy. The trend in the United States is more toward using equipment, while in Europe, Australia, and other areas globally, the emphasis is on manual intervention.

For those leaning towards equipment, there is an ever-changing landscape of new products.

"PTs, like other medical professionals, need to stay on top of technology advancements in order to provide the best level of care to their patients," says Richard Schubert, product sales manager for the Shirley, N.Y.-based Biodex Medical Systems, Inc.

Many of the physical therapy products out today that are newer are either advancement on an older design, more cost-effective or slightly more user-friendly for the clinician.

"The look and features have changed drastically," says Edmond Bright, general manager of Pilot Point, Texas-based Elite Biomedica. "Units now have the ability to remember patients, past treatments, loaded protocols, built-in teaching tools, and are very advanced. Unfortunately, there have been no big breakthroughs in new treatment devices, so they do the same things they did 10 years ago."

Looking at the equipment, most PTs can purchase basic items, such as tables and lifts, to more complex devices, such as testing and analysis systems. Modalities also require capital expenditures, and can include electrical stimulation, TENS, ultrasound, electromyography (EMG) equipment, biofeedback, paraffin, short-wave diathermy, infrared radiation, and hydro collator packs.

"The latest advancements in the PT equipment market have been centered on making modality equipment like ultrasound, electric stimulation and cold laser therapy more affordable and more user-friendly," says Christopher Lauretani, president of Pelham, N.Y.-based Symmetry Physical Therapy & Wellness, LLC. "Many of the modality units that can be purchased or leased today are combination units that are more portable than in years past."

Lauretani explains that because of advancements in computer technology over the last 5 to 10 years, many units come equipped with built-in therapeutic protocols that can be accessed with the touch of a button.

"In older models, a therapist would have to stand there with the patient and move an ultrasound head or laser over the therapeutic zone, but with newer models, an LED patch can be placed on the patient during the treatment and left there," he says.

Technology abounds
According to industry experts, computer-related equipment is becoming more popular as physical therapists are taking advantage of the ease of the technology. Even a technology familiar to many homes has found customers among physical therapists - Nintendo's Wii entertainment system. Although the Wii continues to be very popular, there are other computer-related systems tailored more specifically to handle physical therapy.

BTE Technologies, headquartered in Hanover, Md. and Greenwood Village, Colo., recently teamed with the Keiser Corporation to create the Tech Trainer, a bilateral cable system that provides physical therapists, athletic trainers, and strength conditioning specialists with intelligent objective data capture using pneumatic resistance technology.

"The Tech Trainer is an intelligent cable system. We've taken a high-end, expensive, sophisticated technology-that some would see as unaffordable or unattainable-and we've created a new product at the fraction of the cost of other systems," says Stas Obrebski, creative manager of BTE Technologies. "It uses a pneumatic bilateral pulley system providing a high tech treatment and exercise with real-time visual feedback and progress tracking."

The evolution of PT technology has resulted from more companies focusing on providing physical therapists with highly advanced assessment methods, tools for pinpointing problems and areas to focus on in training.

Like the Wii, many of these products weren't even designed for the PT industry, but manufacturers learned their equipment was being used by therapists so they shifted marketing efforts to address that interest.

Lars Barfod, CEO of AlterG, Inc., said its Anti-Gravity Treadmill was originally targeted at the athletic community and once the company discovered physical therapists had an interest, they made some adjustments.

"When you're dealing with an athlete, it's not a big issue for them to get in and out of a product. They're very athletic," Barfod says. "However, when you're dealing with people suffering from Parkinson's disease, stroke or a knee replacement . . . that's a different story."

The modifications resulted in the introduction last year of the M300, a restructured Anti-Gravity Treadmill, which is now being used in mainstream physical therapy clinics throughout the country.

Ara Uebelhor Knepp, a physical therapist with AthletiCo, which offers physical therapy, occupational therapy, work rehabilitation, and fitness services throughout Chicago and central Illinois, says the facilities have been using the AlterG treadmill with great success.

"It is capable of unloading your weight from 20 percent to 100 percent in 1-percent increments. It is valuable for acute patients or post-op patients because patients can be unloaded to their weight-bearing restriction or where exercise becomes pain-free," she says. "It allows them to practice functional activities, such as walking, much sooner than they would be capable of doing normally because of the AlterG's ability to unload the patient's weight. For athletes it is an amazing tool to use to keep their conditioning up while they are rehabilitating [from] an injury. It allows them to restore natural gait, range of motion and strength in a functional position while minimizing joint stress."

Mr. Cube by EMPI is another new piece of equipment that moves in a linear fashion, such as therabands or weight machines and can be utilized with existing gym or rehab facility equipment.

"It is a 7.5-pound small box that hooks up to your equipment and a laptop and then the patient does their exercise to video games on the laptop," Uebelhor Knepp says. "So it's fun for the patient but also more functional and beneficial in regards to neuromuscular re-education and strength. It has various video game interactions that you can customize for each patient."

For example, there is an isometric game for those patients who are recovering from more severe injuries and are just starting with strengthening, and there is a game that uses explosive movements for those patients who are returning to a sport, occupation or other activity that requires fast reactions and dynamic movement.

"It also can provide objective data for patients, doctors and insurance companies in regards to the patient's progress, strength, range of motion, speed and quality of movement," Uebelhor Knepp says. "Most importantly, it is a way to remove patients from the monotonous routine of three sets of 10 repetitions and allows them to have fun playing games while doing their exercises."

Biodex utilizes a similar piece of equipment for balance called the Balance System SD. It is used to improve balance, increase agility, develop muscle tone and decrease risk of falls. Clinicians use it to assess neuromuscular control with dynamic balance activities. There is a platform the patient stands on that moves in response to the training model chosen for the patient. There are six interactive games the patient can choose from with varying levels of difficulty. Doctors and insurance companies can also capture objective data to show a patient's progress over time.

"Biodex has incorporated these electronic advancements into physical medicine products that test and train strength, balance and gait and provide patients with real-time biofeedback of success and failures," Schubert says. "This audio and visual Biofeedback provides both the patients and therapists with instantaneous data relating to proper movement patterns, and then prompts the patient into correct movement patterns through a user-friendly graphical interface."

There are also a number of electronic devices for people with amputations (computer- controlled prostheses, such as the C-leg) or with conditions like foot drop, where a microcomputer triggers electrical pulses/stimulations so that a person can walk almost naturally. Many of these have limited applications, but for some, they are considered to be "must have" products.

Compression therapy
Another advance in PT equipment utilizes cold and compression therapy.

"With the increase in popularity in the game-ready, vasopneumatic compression devices, patients are recovering faster from surgical procedures because their edema is controlled earlier," says Lauretani. "These devices allow cold, almost frozen water to be circulated through a compression garment that the patient wears around the surgical site."

With the shift in health care reimbursements, patients' insurance plans are cutting the amount of time units are "borrowed" and clinics are having trouble getting reimbursed for treatments. Newer, more user-friendly and cost-effective units have surfaced such as the thermo-active compression units that cost the patient around $50 and offer hot and cold therapy with one unit. This enables clinics to carry multiple units and use them with a variety of diagnoses without having to worry about recovering money on a large capital investment.

Regarding reimbursement issues, many in the industry are still trying to put their heads around what the recent health bill legislation will mean to a physical therapist and the companies that serve them.

According to Bright, the new law contains some items that will stimulate the PT industry and some items that need more work.

"The [law] calls for payment for prevention services and programs. With that we should see an increase in patients, which should affect the bottom line for PT equipment providers," he says. "The limiter for growth in this sector has been Medicare. If changes are made to how Medicare pays for PT services I think you will see a huge spike in revenue. Most patients have to be referred currently; they cannot just seek out a PT because they believe they need therapy. In addition to that, the cap on services that Medicare will pay per year is not as high as it should be. As with anything, there are pros and cons to this bill and I think most companies are waiting to see how it plays out."

Seniors stay strong
For the past decade or two, many manufacturers have worked on developing products designed with seniors in mind. Physicians continue to report an increase in work done with senior citizens as the booming population of the over-60 crowd is prone to the chronic and debilitating conditions that require therapeutic services.

"The senior sector remains very strong. More people at an advanced age are more concerned about their health and living healthier lives," says Lauretani. "I have seen a larger number of people in their 70s, 80s and even 90s take part in regular exercise programs and realize having pain does not have to be a normal part of their lives."

Equipment designed for seniors include bikes and treadmills as two major focal points. Vendors such as HUR, Nautilus and Cateye are developing easier access to equipment so seniors and handicapped patients can utilize more of the exercise equipment in the clinics and at home.

"The one area that appears to have the biggest improvements recently has been in the home, commercial and light commercial exercise equipment," says Lauretani. "Companies are using lighter materials, more sleek designs and different mechanical configurations to make these strength and cardio units more advanced. Home units today, such as bikes, elliptical trainers and treadmills, that sell for under a thousand, 10 years ago, would have been considered light commercial grade and found in gyms and rehab facilities."

It seems as if new physical therapy equipment hits the market every day, but many experts warn that the changes are largely cosmetic and that customers should really focus on advancements in regards to what the machines can actually do.

"Over the past 10 years, there haven't been any breakthroughs on new equipment," Bright says. "Newer models have been released, but the functionality of what the device does, has not changed."

To keep up with it all, Obrebski says that BTE believes it's very important to have clinical expertise in-house and placements in research facilities.

"We always have our ear to the PT community's wants and needs," he says. "The need to understand our customers' requirements is a daily process for us. That's an integral part as we develop and expand our offerings in the physical therapy community."

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DOTmed Registered Homecare Rehab Equipment Sales & Service Companies
Names in boldface are Premium Listings.

Domestic
Lars Barfod, AlterG, Inc., CA
Amaury T. Agoncillo, Morigon Technologies, LLC, CA
Herbert Werker, Dow Medical, LLC, CA
Joe Avina, American International Medical, CA
DOTmed certified
DM100
Bradford Siff, Biowave Corporation, CT
David Gentile, Med-Tech Equipment, Inc., DE
Akhter Hussaini, ALM International, Inc., IL
DOTmed certified
Brian Roth, Hill Rom at Home, IN
Dave Anderson, Anderson's Medical Products, IN
Philips Healthcare, Philips Healthcare, MA
John Gladstein, Medical Device Depot, MD
DOTmed certified
Customer Service, Action Products, Inc., MD
Steve Horning, Scientific Equipment Liquidators, MN
Wayne Buchan, Dynasty Enterprises, MO
Tom Moorehead, Advantage Medical Systems, MO
Ray Carter, Hospital Equipment 4U, NC
DOTmed certified
Reuven Kohn, All Time Medical, NY
DOTmed certified
Noel Estrada, Advantage Medical Systems, NY
DOTmed certified
DM100
Chris Lauretani, Symmetry Physical Therapy, NY
Richard Schubert, Biodex Medical Systems, Inc., NY
Mark Reep, KLC Services, Inc., OH
Evan Good, Hocking Valley Medical Maintenance, OH
Al Hamel, Hamel Medical, OK
Jennifer Valle, Baxter Medical, Inc., TX
Jesse Arismendez, Tejas Medical Equipment Parts & Services, TX
Edmond Bright, Elite Biomedical, TX
Angie Griffith, Aria Medical Equipment, TX

International
Gerard Dromey, Gerard Dromey, Ireland

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