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The Envision System Guided Technology

The Envision technology is novel, real time feedback which allows the patient to retrain in real time their balance, walking, postural and leg muscle control according to normal parameters.  The patient’s problems or impairments are evaluated and all exercise and training are based upon normal characteristics of the human body.

SnapShot Envision System image - walker.jpg
To learn more, read the description and watch the videos below.

Envision Guided Therapy System

         Rehabit Health's Envision guided physical therapy system was designed to be user friendly, intuitive, and adaptive.  The significance of an activity whether neurological, orthopedic or general medical can be challenging.  If the patient does not understand the relevance of the activity, compliance may be very low and the outcome poor.   Standing balance for example, is a very tedious and fearful activity and often is poorly addressed.  The Envision system allows the patient to see the balance field and to provide relevant and rich instant feedback during training.  This improves compliance and allows for understanding by the patient, caregiver and therapist. The feedback does not do anything to the patient;  It merely allows the user- whether patient or clinician- to visualize the mechanics and act/react upon those mechanics.  

     The feedback from the Envision system is in essence the physics which occurs “unseen” (unperceived). The feedback allows the users and clinician to become aware of the physics through three of the senses of the body, namely Visual, Audio and  Haptic (vibration). The insoles were further developed to allow for treatment of nearly any type of individual with standing, walking, running, posture or functional mobility deficits. The Rehabit Health Envision system is equally suited to orthopedic, neurological or general medical applications.

     The interface was developed to be intuitive for rapid training on the basic use of the system.   The device is highly “customizable” allowing for countless variations or permutations to facilitate or inhibit responses. In the case of assessment or research purposes, it will record the force pressure characteristics of any specific activity such as jumping, walking, running, static balancing, etc. 

     Gait Tracer function evaluates the symmetry of the patient’s walking pattern, with asymmetries in the normal bowtie pattern indicating a deviation from normal gait. Our feedback maps different pattern imbalances to respective disability factors, so that clinicians can customize PT exercises that optimize required ambulatory improvements to correct specific physical deficiencies. The image below      (figure 1) is an example of a normal walking pattern.   

     Walking (human ambulation) is in essence a dynamic balance activity. This fact is why the ability to balance and the ability to walk are inseparable . The walking pattern can be accessed via a tracer image and an image can  be generated as many times as desired. This could be a very objective method to track progress over time with both balance and walking improvement and correlated with traditional gait and balance testing methods.  I.e.  Berg and Tinetti scores. 

 Figure 1   
What a normal walking signal looks like 

Figure 2: 
The  normal walking Patterns path on the Balance Field 

Guided Gait(walking) training:  Mechanism of operation:  In real time, monitors the body’s Center Of Mass moving or vectoring over the Feet/Foot 

Figure 3 
How the Normal walking pattern is generated 

Figure 4:
Accurate retraining is possible due to the universal human walking pattern. 

Example of an actual patient use:  Reimagining walking training:   P7

     This patient spent a year of intensive therapy and the fact he was able to return home was a "miracle".  He can only walk with assistance, (250 feet with a front wheeled walker on level surfaces, his balance score is 28/56 (Berg Score) meaning a high fall risk and he has a 40 hour per week attendant to help his spouse care for him.  He will likely need physical therapy on an outpatient basis for the rest of his life because he would likely decline due to inability to get enough activity.  He would cycle through until his benefit is exhausted, stop and restart once he either falls and enters the Part A of his Medicare Benefit or when his Part B benefit allows him to restart. That is the present system.  Without Guided physical therapy, there is no other choice.  

      The next set of video's illustrates the training of the above patient,  a severe Traumatic Brain Injured subject (P7) when his formal rehabilitation was "completed".   Envision guided therapy enables restoration of the patient's walking and balance fields because now the patient and therapist can perceive them and use guided training to restore function, not just maintain it.  

Figure 1
Looks Good, Right?
Homecoming August 2020

Figure 2
This is the patient's walking pattern (Gait Tracer Pattern), after 14 months of intensive formal rehabilitation.

Figure 3
This is the normal universal walking signal or Gait Tracer Pattern (GTP). "Bowtie"

    The next series of photos demonstrate the results of training this patient to the ideal and normal walking pattern. 

Initial Walking Pattern  

Walking pattern Day 29 

Walking pattern Day 36   

Walking pattern Day 43

Walking Pattern - 15 months   

 These patterns are generated during both assessment and training sessions.  They are an objective way to track progress of walking, balance and ideal muscle responses.  The video to the below demonstrates the patient walking without assistance and his Berg Score at the time increased to 50/56.  A score above 47/56 is indicative of a low fall risk.  This video was taken 12 months after the start of Guided Physical Therapy.  Note that the cost was low because much of the therapy was performed by the patient and his caregiver at home.  The therapist worked with the patient at first 3 times per week then reducing down to 1 time per week and finally once every two weeks.  The patient worked on his therapy with the care giver 20 or more days per month for many hours.  The hired attendant was no longer needed after 3 months, saving the patient a great deal of money. 

This Video is
12 months after Guided Physical Therapy

Impairments Assessed Before Envision Guided Therapy P7

     Patient underwent a total of 14 month of traditional Neuro-rehabilitation and he received the best care available (unguided).  This physical therapist was involved in this portion of the recovery.  Below are some key impairments which were addressed with the Envision System Technology

Early in the patient's recovery:
2 months

Completion of Traditional Physical Therapy:
14 months later

Assessment and Treatment of P7 with use of
Envision Guided Therapy

 This is a post assessment used to identify

impairments and develop a treatment plan 

Guided Left Isometric quadriceps control -  strengthening & left lower balance field

weight bearing restoration activity. 

Addresses the quadriceps weakness

This is the exercise to correct for this patient's pusher syndrome

 a common balance deficit following brain injury.  

Guided Physical Therapy

 Left Stance Vector restoration exercise

Guided Physical Therapy -

Treadmill Training and progression

Guided Physical Therapy -

Outdoor Training and progression

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