Dr. Stephen Kanter has a vast resumé and is an avid NewGait Fitter at the International Multiple Sclerosis Management Practice where he is the Director of Rehab Services. In the interview, Dr. Kanter reflects on his "Dream" for the NewGait.
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BENGA: Thank you everyone for joining. Today We have Cathy Ruprecht, one of our NewGait clinicians, as well as Dr. Stephen Kanter. Dr. Stephen Kanter is a licensed physical therapist and athletic trainer in New York and New Jersey. Dr. Kanter works primarily with patients with balance, gait, and endurance impairments. He earned his Master's of Science and doctorate in physical therapy at Rutgers University. He is the Director of Rehabilitation Services at the International Multiple Sclerosis Management Practice in New York City. He is a nationally recognized expert in rehabilitation for people with MS and has worked to develop the AthCare MS Rehabilitation Professionals Network to promote education and clinical collaboration to improve the care provided to people with MS and their families. In 2015, Dr. Kanter was inducted into the National MS Society Healthcare Professionals Volunteer Hall of Fame. Dr. Kanter is a professor at Seton Hall University where he teaches Biomedical Ethics, Human Anatomy and Sports Pharmacology. Thank you Dr. Kanter, That's quite a resume you've got, thank you for joining us.
DR. KANTER: The short answer is that my father had multiple sclerosis. Neuro rehabilitation was not something that I thought I had enough skills to do. When I came out of physical therapy school, I had a stronger sense and background in sports health care, and became a certified athletic trainer working in professional sports. I really worked that route. After working in professional sports, and thinking about where I wanted my career to go, I had a couple of opportunities in home care in New York City. In that home care experience, I started to work with many people with neuro based disorders, including multiple sclerosis. During that time, developed the skill set that I did not feel like I originally had. In 2008, I interviewed for the job at the International Multiple Sclerosis Management Practice to take over the leadership of the department and develop it to what it is now. Cathy, your patient population was primarily neuro? Geriatric? Both?
CATHY: Primarily folks with chronic pain. A lot of them have gait abnormalities, but we work on some confidence engagement, and we work on changing up some parameters of gait and the most amazing thing is that they'll tell me, "My pain is gone."
DR. KANTER: Why do you think that is?
CATHY: Well, if you know anybody that wants to do research, I would like to know why that is. I have some ideas, based on my pain-neuroscience background, in that there's something about the device that creates a postural realignment, it depresses the scapula. I think it helps to change the breathing from that secondary musculature. I think it helps to create some step with confidence. A lot of people walk with a very narrow gait pattern and they seem unbalanced, with a very lateral trunk sway. A lot of times my people with chronic and persistent pain have had some sort of unresolved orthopedic or neurological issue. So someone that has no plantar flexion, you know, never has any sort of toe off. You've got to bring that leg through somehow and swing but there's something about getting that assistance and suddenly, the nervous system says, "Well, hey, thanks for figuring that out." Now, I don't have to use, my quadratus, or my back extensors, or whatever compensatory movement pattern I was trying to do to achieve that movement. They find pain relief with that. It's just been amazing.
DR. KANTER: That this is a key tool that you're using is very insightful. We'll definitely take that into consideration in our program. We are about to open up a big Wellness Center which will incorporate, not just the NewGait, but a lot of state of the art products that can help people with MS walk better and improve their balance. I've been on the road to improving the lives of people with multiple sclerosis, and bounce dysfunction ever since.
DR. KANTER: When I started working with people with multiple sclerosis, I started to identify a series of common mobility limitations. Foot drop is a very common one that most physical therapist's and movement professionals are aware of. Neuro physical therapist's have a little bit more insight to work with orthotist to manage foot drop, but using an AFO, I quickly found was not very useful. In thinking out of the box, we start to work with different products on the market. During that time, foot drop wasn't always the primary issue that patients needed to manage because it could be managed through an orthotic or a brace, but the hip drop or the hip weakness really became an element of impairment that we couldn't really solve. Strengthening it couldn't help it, and the hip flexion assist orthosis was a product that was developed, as well as a couple other products that became potentially useful for hip flexion weakness and hip drop. None of them really worked as well as I would have wanted it to, or there was a price limitation so patients weren't willing to try it outside of my clinic. My goal is always to provide something to a patient in the clinic that they can take home and use in their home program and in their day to day life if possible. A patient introduced me to the NewGait. When I saw the NewGait, it clicked right away that it would make sense for people for walking. Also the other major impairment, which is actually stairs or curbs, and ever since then, I've been using it with patients on a regular basis.
DR. KANTER: Once they get into NewGait and realize that their hip is engaging better through the energy that's created by the device and realize that they're able to move better. And then the conversation gets into where we go from there in regard to balance and gait training, and create some prognosis, which is within reason.
Dr. KANTER: We have a couple of patients who are on the road to getting it. I would be surprised if they didn't. Previously, I think I've had three people who either purchased it or expressed interest in purchasing it. Of those three patients, I know at least two of them have used it beyond just myself. Either in other facilities somewhere, or they have it on their own.
DR. KANTER: I've probably tried it on approximately 30 patients in the past year. The big holdup is obviously the past several months of having fewer patients because the clinical services sort of went down. When we started speaking, I went back and looked, and seemed to be about 30 patients myself, my colleague, tried in on five to eight patients. And then our occupational therapist has started to look into how she would integrate it into certain balance and standing activities for her ADL training.
DR. KANTER: I could definitely feel the forces that are being created, which is what my mind focuses on. How to create potential energy from end stance, to toe-off, to initial swing, even if there's a compensation. I'm not worried as much about the compensation if they can clear the foot, but to see that this can be more efficient, and obviously create a change in how the patient feels with that swing phase, which is really a limiting factor with gait, as you know.
DR. KANTER: The most rewarding were a couple of patients that I trialed it with. They took a step up on a curb in a simulation, that they hadn't been able to do in a very long time. It was much easier and they got a sense that they can do it without overly compensating, without overly circumducting, and without using their hands. The next step with it, at the MS clinic, is to work on a whole staircase with patients and to be a little more aggressive in their stair training. For patients who need to negotiate that in their house or work, this is the modality of choice for me. When you consider neuroplastic changes, there is a bunch of evidence out there, where, if you're going to have a muscle do something, it needs to do it in the specific way you want it to. Unfortunately, too many patients are doing sitting exercises, or laying on their back. They say, "I work on this muscle all the time, and I feel stronger, but why cant I do it standing." When they work with the NewGait, they're getting the benefit of more reps, rather than harder reps. Patients with MS, many times, are willing to work hard, but they obviously want to see results. You don't need to fatigue out by over-exerting, when it's unnecessary. With the NewGait, providing what is equivalent to an active assist at times, will, to me, create more contraction of the hip flexors, and obviously other muscles as well. But the hip flexors I focus on because it really is one of those areas of rehab in MS that we've had a lot of difficulty with.
DR. KANTER: If they see me, they can use it each week or every other week. We've had a couple of patients who have done that. The majority right now, come and use it for their first trial, maybe come for a second trial, with the intention that they'll get it on their own and integrate it into their home program. Or they will find a local PT who either will get it, or has it, or something similar. My dream is that many PT's out there, would have the NewGait, so that we can do the trial and then say, "Go to a therapist who can utilize the NewGait to perform their exercises with." Ultimately, I do believe getting it for a home based program is really what would make the biggest difference. It's not an expensive product in the big picture of rehabilitation modalities. Like I have said, there are other hip flexion products out there, some are reasonably priced, and some are not. The NewGait has variability that the others actually don't. Technological based FPS products for people with MS to help them walk are thousands of dollars. A neural based approach would be to incorporate this device and supplement it with a musculoskeletal and strengthening program. But if they only do the strengthening program, and don't do the neural based program, then they miss out. I hope if anything that patients therapists gain from this conversation, is to get a neuro based closed-chain, standing program, and if they have hip flexion weakness, then incorporate this device. My role at the IMSMP is to try to gain a network of therapists who are willing to accept referrals for patients with MS. After I see them and develop a plan of care, I'm looking to pass them on because I can't see them locally. The network was created for people who are in wellness and rehab, medicine, nursing, or social work, who want to get referrals from myself and our practice, to work collaboratively. I'm still looking for any physical therapists, occupational therapists, and wellness professionals who are looking for people to get referrals from people with MS. Let me know and we'll speak and hopefully get you on the network list. They can contact me directly, email is probably easiest at firstname.lastname@example.org. If you go to the International Multiple Sclerosis Management Practice site, you'll be able to call the number there. We've had good stuff so I'm looking forward to getting the word out there.
"A patient introduced me to the NewGait. When I saw it, it clicked right away that it would make sense for people for walking. Also the other major impairment, which is actually stairs or curbs, and ever since then, I've been using it with patients on a regular basis."
"My dream is that many PT's out there would have the NewGait, so that we can do the trial and then say, "Go to a therapist who can utilize the NewGait to perform their exercises with." Ultimately, I do believe getting it for a home based program is really what would make the biggest difference."
"It's not an expensive product in the big picture of rehabilitation modalities. And like I said, you know, there are other hip flexion products out there. Some are reasonably priced and some are not. The NewGait has variability that the others don’t."
San Diego, CA