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A Stroke of Genius Tailwind helps regain range of motion after stroke Lauren Fritsky Posted on: October 2, 2009

Vol. 20 • Issue 20 • Page 26 The path from conception to sale of the Tailwind, a stroke rehabilitation device that improves range of motion in partially paralyzed individuals, has been a long one. Sandy McCombeWaller, PhD, PT, NCS, and Jill Whitall, PhD, professors in the physical therapy department at the University of Maryland Medical School in Baltimore, first thought of the idea more than a decade ago. In February, their dream became a reality when Encore Path, a company that develops and commercializes devices and therapies designed by the school, unveiled Tailwind as its debut product. The device allows a patient to move two handles along tracks at different starting marks with the help of auditory cues. The Tailwind's mechanism is considered a "sound-to-brain," neural-pathway-retraining approach to help those with mild stroke symptoms regain function. ADVANCE: How would you describe the Tailwind? Dr. McCombe-Waller: The Tailwind is a training device developed for patients with hemiparesis. It was developed with principles of motor learning and motor control in mind. The device was originally designed for bilateral repetitive arm training (in which arms are not yoked) coupled with auditory cueing to improve the ability to control joint interactions, speed and movement extent of the paretic arm. The Tailwind is portable, lightweight, easily adjusted with one hand for patients starting out and permits training of the arm in several different positions. ADVANCE: When did you invent the device and how long did it take to hit the market from when you first conceived the idea? Dr. Whitall: We conceived the idea in 1996, and the U.S. patent was issued Oct. 17, 2006. The patents in France, Germany, Italy, Spain and the United Kingdom were issued April 18, 2007, and the Canadian patent was issued on April 21, 2009. Encore Path produced the first device for sale in February 2009. ADVANCE: What inspired you to invent the Tailwind? Dr. McCombe-Waller: Jill worked with the use of auditory cueing and motor control previously, as well as the concept of bilateral training. We had a small project looking at gait training in patients with hemiparesis with an auditory cue and thought the literature included very little evidence for best therapies for the upper extremity. We decided to apply principles of bilateral coupling, rhythmic auditory cueing and stable coordination patterns in designing a new intervention. We also incorporated motor-learning principles like repetition, goal-setting, feedback


and task-specificity. I provided ideas such as design of the handles from my clinical experience. A PT student built the first wooden version and contributed to its design. ADVANCE: What conditions or injuries is the Tailwind best used for? Dr. Whitall: It has only been tested on patients with hemiparesis from stroke, but may have other applications for individuals with conditions such as cerebral palsy. ADVANCE: What is a typical time frame for treatment using the Tailwind? Dr. McCombe-Waller: In our research, we have tested a six-week program with training occurring three times a week using two arm positions-reaching straight out with the arms level with the table and reaching uphill. More repetitions would likely be beneficial with a progression to reaching with the arm in different positions or directions. ADVANCE: Are there any contraindications for use of the Tailwind? Dr. Whitall: Our research found that individuals who have a flaccid arm are not able to use the Tailwind, and therefore we would not recommend it for them. ADVANCE: What was the process to obtain a patent for the Tailwind? Dr. Whitall: We worked through our office of research development, which facilitated the process. They did much of the leg work in consultation with us. ADVANCE: What are your thoughts about how the Tailwind has been received and the results it's achieved? Dr. McCombe-Waller: We think the device shows potential to improve arm function of individuals with hemiparesis and is a training device that has been developed based on sound principles of motor control and motor learning. We have found it can promote meaningful change in patients, particularly in bilateral arm functions, something that is often neglected. In our training studies, particularly those in which we did not progress the training on speed and resistance, we did find that not all subjects improved. We are still participating in research to test more progressive and intense uses of the device to determine parameters for its use. Preliminary results suggest there are fewer nonresponders to a more intense version of the training. ADVANCE: Are there any other comments you would like to add? Dr. Whitall: We'd like to mention that our research leading to the development and testing of the device has been funded by the University of Maryland, Claude D. Pepper Center and the National Institutes of Health (NIH). Lauren Fritsky is a freelance writer based outside Philadelphia.


A Stroke of Genius