An occupational therapist at MossRehab for over 30 years, Joe Padova works with outpatients in stroke rehabilitation at Elkins Park. He is the creator of the RELEAS™ hand splint, a device that gives people who have suffered a stroke the ability to use an impaired hand during activities of daily living.
What inspired you to become an occupational therapist?
I started college as a psychology major. In my senior year, I did a research project on how children are trained on myoelectric (externally-powered) upper limb prosthetics. I tried to find physical therapists to assist me but found that occupational therapists did training with prostheses. That was my first experience with the role of an occupational therapist (OT). After meeting with one and observing the job, I developed an interest in the field. When learning more about it, I was hooked because the role combined psychology, biology, and neurology.
What is your educational background and training?
I graduated from the Allentown College of St. Francis De Sales (now DeSales University) with a degree in psychology in the early 1980s. In 1986, I graduated from Thomas Jefferson University with a post bachelor certification in occupational therapy. Over the years, I've attended courses on neurology, upper body and motor training, therapeutic interventions, and neurodevelopmental theory training.
In addition to my training, the research conducted at MossRehab impacts my treatment interventions. For example, the diagnoses method to assess stroke patients was developed through MossRehab's motor control and gait labs. I have applied other concepts developed by MossRehab to address different effects of upper motor neuron syndrome (damage to the nerves in the central nervous system), such as muscle spasticity (stiffness) and co-contraction (muscle overactivity that limits movement).
Where do you work within MossRehab?
In the late 1980s, I began working at MossRehab in Northeast Philadelphia. I treated outpatients with orthopedic problems and a large population with neurological problems including strokes, head injuries, and Parkinson's. I moved to Moss Tabor Road around 1991 as the upper limb amputee specialist for both the inpatient and outpatient clinics. The position had a contingency where I could continue treating patients having a stroke because I didn't want to lose those skills. Around 2003, I moved to Elkins Park when inpatient services for patients with amputations transferred here. I continued to develop my skills and training in treating patients having a stroke and eventually became a stroke specialist. So, I am a dual specialist in upper limb prosthetic training and patients with neurological problems due to a cardiovascular accident. Today, I work in stroke rehabilitation at the MossRehab Outpatient Center at Elkins Park.
How long have you been at MossRehab? What makes you stay?
I've been at Moss for 31 years. The hospital gives therapists opportunities for education that are valuable in treating patients and pursuing new interests. MossRehab also has one of the largest portfolios of robotics to enhance therapy interventions. I have the opportunity to use different technology in upper limb rehabilitation to enhance patient rehabilitation. On top of that, the clinicians are very approachable, which makes for dynamic care teams. Sharing information on patients makes collaboration easier among different disciplines.
Who are your patients?
I primarily work with individuals who have upper extremity, perceptual, and cognitive dysfunctions due to a stroke. I sometimes treat individuals who had a traumatic brain injury, but mostly for hemiparesis (body weakness or paralysis) effects. I may also work with individuals with an orthopedic injury that needs to learn how to manage activities of living using compensatory equipment such as a reacher (device to grab items).
What is the role of an OT in the rehabilitation of patients who had a stroke?
My role as an OT is to maximize a patient's function to resume their activities and life roles to the best of their ability. I look at the whole person after a stroke and assess what is limiting them to determine deficits and how they impact their daily activities of living. Is hemiparesis (body weakness or paralysis on one side) making it challenging to move their limbs, which, in turn, causes difficulties with daily activities of life or particular interests? In this case, my goal is to improve the upper limb function. Does the person have a cognitive, memory, or perception dysfunction after a stroke that limits their ability to perform tasks? If a person has cognitive or perceptual problems, they might not orient clothing correctly and put clothes on upside down or backward. So, my goal for therapy for that individual is to address the cognitive challenges by using memory strategies. Depending upon their level of social or emotional issues, I may refer them to other therapists or a social worker to find a solution. If the individual has problems with ambulation, I'll get them involved in physical therapy. If they show speech problems, I'll ensure they have time with a speech therapist. I address the whole person and not just rehab the upper extremities.
Can you explain your invention of the RELEAS Hand Splint?
About fifteen years ago, when still working as a clinical specialist for upper limb amputee training, I discussed with Nathaniel H. Mayer, MD, Director of the Motor Control Analysis Laboratory, how people with prosthetics only use the hand as a holder. Dr. Mayer asked if there was a way to make a splint for a person who had a stroke to use their gripping force to hold things. Many patients who had a stroke have an active grip force but can’t open their hands. It was a ten-year journey when designing the first RELEAS™ hand split to help patients functionally open their hands.
In design, the splint fits like a glove over an affected hand’s index finger, long fingers, and thumb. A spring-loaded outrigger opens the first two fingers while a neoprene support opens the thumb. Using their grip force with the hand splint, users can close their hand to hold things. When relaxing their grip, they can release it. I applied for a Albert Einstein Society grant, refined the splint and then got a patent. It is now commercially available worldwide.
Using the splint, individuals can learn to perform simple but important tasks like opening sugar packets, holding a wallet while removing bills, pulling up pants, tying shoes, or sweeping with a broom. Patients have been fit with the split anywhere from 6 months to 30 years after a stroke. Even for users who have severe deficits and tightness in movement, the splint gives them the ability to execute a modified hold and release to do some basic tasks. We fabricated a pediatric version of the splint for a child around the age of six who had a stroke invitro and couldn't use his arm. When training the child on its use, the mother wept upon seeing her son stack blocks for the first time using his hands.
Do you use any technology such as robotics to support OT?
MossRehab Elkins Park has several robotic technologies including the Armeo Spring, a hand and arm robotic trainer that provides exoskeleton support; the Amadeo, a robotic-assisted finger-hand trainer; and the Armeo Senso that supports self-initiated arm movement without an exoskeleton and provides feedback on movement patterns. Patients use these robots while interacting with computer games that simulate different scenarios to do a particular set of movements. While not the end-all for my therapeutic approaches, this technology is very important in making improvements to the upper limb.
For example, the Armeo Spring supports the weight of the upper limb for a patient who has a weak upper extremity after a stroke. We know from experience that a high frequency of correct movements helps improve an upper limb. A patient with a weak upper limb may barely move it against gravity. Support from the Armeo Spring can improve the strength of the arm, elbow, and even the hand to reach forward against gravity. Using this robotic, a patient can do more reps during a therapy session.
The robots also are useful in isolating motion. By picking games that require arm flexion and elbow extension, the patient can learn these motions within certain ranges by reaching for targets in virtual worlds without turning on the incorrect muscle groups. It's wonderful for a patient to reach the targets in the virtual world, but it doesn't mean they can grab a cup in the real world. OTs must still train patients on how to do it by using the right muscles, opening the hand enough, and reaching forward enough to grab a cup.
What are your interests outside of work?
Building robots has been a hobby since I was about 13 years old. As a kid, I took apart a TV to make a robot and then put the TV back together. For Christmas, my son got me a robot toy and challenged me to develop a robotic vision system to enable it to walk on its own. I also like outdoor activities like fishing, kayaking, and hiking. And I like museums like the Franklin Institute and Smithsonian Institute.
What is your favorite place to vacation?
Any place where I can camp. My favorite place is French Creek State Park.
What is your Favorite food?
Homemade spare ribs slow-cooked in the oven for about eight hours.
What is your life motto?
Your attitude guides your views. If you have a good attitude, you're going to have a good day.
Read more about how the RELEAS Splint gives patients with stroke a new grip on life.