Opinie

Robert J. McIver, PT, DPT, NCS

Director of Clinical Technology and Wellness

Brooks Neuro-Recovery Center Jacksonville, FL

We have had the ICARE at Brooks Rehabilitation for over 2 years now. It is one of our most highly utilised pieces of equipment. We use the ICARE to treat patients with any gait or balance impairments regardless of diagnosis; Orthopaedic, Neurologic, Geriatric, Bariatric, and Paediatric. The patients and staff love using the ICARE due to the versatility it provides as well as the ease of set up. The adjustability of speed and stride length ensure that training is customised to each patient and their specific needs. We have patients who come in just to use the ICARE in our independent programme to maintain their health and quality of life.

The staff that uses it enjoy that we can provide longer sessions of stepping with less assist from other staff and less need to muscle through a locomotor session on the treadmill. It also provides a way to increase stepping in a safe environment that we can work on functional tasks such as reaching and trunk rotations while the lower legs are moving to increase dynamic balance. Mostly, staff and patients like the fact that regardless of the level of function of the patient the ICARE provides the means to deliver a cardiovascular workout that no other machine can deliver.

We had a patient with a lumbar plexus palsy that was not able to generate a static EMG in his doctor’s office, but when using the ICARE at a higher speed was able to generate a dynamic EMG. After months of rehab using the ICARE the patient was able to return to running and playing with his children with no assistive devices. His prognosis prior to this discovery and intervention would be all standing and walking tasks would need a locking knee brace.

Overall, the ICARE is a very affordable piece of rehabilitation technology that allows any clinician to deliver a highly intense intervention that can be geared toward any patient population.

Liza Reidel

Executive Director

NextStep Orlando (Previously Project Walk Orlando)

Project Walk Orlando’s mission is to provide those living with spinal cord injuries the opportunity to achieve their greatest recovery potential and an increased quality of life. Our mission is fulfilled by providing specialised one-on-one, cutting-edge, aggressive and comprehensive exercise-based programmes. The ICARE system has played an integral role in helping our clients and staff achieve this mission.

The ICARE system is utilised on a daily basis during clients exercise programmes to provide an intensive cardiovascular and gait training workout. From a client and staff perspective, the ICARE has been a successful addition to our facility, allowing for an efficient setup and for the trainer to ensure the client is in a comfortable and safe position. Clients are able to achieve thousands of steps on the ICARE system which supports the repetitive movement science of SCI training. In addition to this, clients are able to make use of the feedback function where if they move the elliptical faster than the motor speed the machine lets them know. This function always increases their effort and motivation during the workout.

Various factors weighed into the decision to fundraise and purchase the ICARE System for PWO. These include the systems ability to improve our clients’ fitness, circulation and function in a manner which is less labour intensive on trainers. The ICARE can provide our clients with 1000’s of steps that would typically require multiple trainers, assistants and a lot of time.

Up to November 2020

SELECTED ARTICLES AND BOOK CHAPTERS

• Fallahtafti F, Pfeifer CM, Buster TW, Burnfield JM (2020). Effect of motor-assisted elliptical training speed and body weight support on center of pressure movement variability. Gait and Posture, 81: 138-143. DOI: 10.1016/j.gaitpost.2020.07.018 .
• Burnfield JM, Cesar GM, Buster TW (2020). Variations in plantar pressure variables across elliptical trainers in older adults. Available online ahead of print August 1, 2020;80:105142, Clinical Biomechanics. DOI: 1016/j.clinbiomech.2020.105142 .
• Cesar GM, Buster TW, Burnfield JM (2020). Comparison of plantar pressure profile of young adults during training on elliptical devices and overground walking: A pilot study. The Foot. 45: 101716. DOI: 10.1016/j.foot.2020.101716 .
• Cesar GM, Buster TW, Burnfield JM (2020). Cardiorespiratory fitness, balance and walking improvements in an adolescent with cerebral palsy (GMFCS II) and autism after motor-assisted elliptical training. European Journal of Physiotherapy, 22(3):124-132. DOI: 10.1080/21679169.2018.1536764 .
• Burnfield JM, Buster TW, Pfeifer CM, Irons SL, Cesar GM, Nelson CA (2019). Adapted motor-assisted elliptical for rehabilitation of children with physical disabilities. ASME Journal of Medical Devices, 13(1):011006 . DOI: 1115/1.4041588.
• Burnfield JM, Pfeifer CM, Kwapiszeski S, Irons SL, Buster TW, Cesar GM (2019). Impact of ICARE training speed and motor assistance on cardiovascular response. Cardiopulmonary Physical Therapy Journal, 30(3):115-122. DOI: 1097/CPT.0000000000000098.
• Pfeifer CM, Rowen D, Buster TW, Cesar GM, Irons SL, Burnfield JM (2019). Design and validation of a heart rate and speed monitoring device with the ICARE. ASME Journal of Medical Devices. 13(1):015002. DOI: 1115/1.4041337.
• Burnfield JM, Cesar G, Norkin CC (2019). Chapter 7: Examination of Gait. Susan B. O’Sullivan, Thomas J. Schmitz, George D. Fulk (Eds). Physical Rehabilitation, Seventh Edition . F.A. Davis, Philadelphia, PA, pp 228-293.
• Burnfield JM, Cesar GM, Buster TW, Irons SL, Pfeifer CM (2018). Walking and fitness improvements in child with diplegic cerebral palsy following motor-assisted elliptical intervention. Pediatric Physical Therapy, 30(4):E1-E7. DOI: 10.1097/PEP.0000000000000541 . PMID: 30277973.
• Burnfield JM, Cesar G, Buster TW, Irons SL, Nelson CA (2017). Kinematic and muscle demand similarities between motor-assisted elliptical training and walking: Implications for pediatric gait rehabilitation. Gait & Posture, 51:194-200. DOI: 10.1016/j.gaitpost.2016.10.018 . PMID: 27810692.
• Burnfield JM, Powers CM (2017). Normal and Pathological Gait, Chapter 15. In Placzek JD, Boyce DA (Eds). Orthopaedic Physical Therapy Secrets, Third Edition. Hanley & Belfus. [Bookshelf Online].
• Burnfield JM, Buster TW, Goldman AJ, Corbridge LM, Harper-Hanigan K (2016). Partial body weight support treadmill training speed influences paretic and non-paretic leg muscle activation, stride characteristics, and ratings of perceived exertion during acute stroke rehabilitation. Human Movement Science , 47:16-28. DOI: 10.1016/j.humov.2016.01.012 . PMID: 26845732.
• Irons SL, Brusola GA, Buster TW, Burnfield JM (2015). Novel motor-assisted elliptical training intervention improves Six-Minute Walk Test and oxygen cost for an Individual with Progressive Supranuclear Palsy. Cardiopulmonary Physical Therapy Journal , 26(2): 36-41. DOI: 10.1097/CPT.0000000000000007 .
• Nelson CA, Stolle CJ, Burnfield JM, Buster TW (2015). Modification of the Intelligently Controlled Assistive Rehabilitation Elliptical (ICARE) system for pediatric therapy. Published online, ASME Journal of Medical Devices, 9(4): 6 pages. DOI: 10.1115/1.4030276 .
• Burnfield JM, Irons SL, Buster TW, Taylor AP, Hildner GA, Shu Y (2014). Comparative analysis of speed’s impact on muscle demands during partial body weight support motor-assisted elliptical training. Gait and Posture, 39(1):314-320. DOI: 10.1016/j.gaitpost.2013.07.120 . PMID: 23973354.
• Fager SK, Burnfield JM (2014). Patients’ experiences with technology during inpatient rehabilitation: opportunities to support independence and therapeutic engagement. Disability and Rehabilitation: Assistive Technology, 9(2):121-127. DOI: 10.3109/17483107.2013.787124 .
• McCrory B, Harlow AH, Burnfield JM (2014). Musculoskeletal risk to physical therapists during overground gait training: A case report. Proceedings of the Human Factors and Ergonomics Society Annual Meeting 10/2014; 58(1):1219-1223. DOI:  10.1177/1541931214581254 .
• McCrory B, Burnfield JM, Darragh A, Meza JL, Irons SI, Brusola G, Link AM. (2014). Work injuries among therapists in physical rehabilitation. Proceedings of the Human Factors and Ergonomics Society Annual Meeting 10/2014; 58(1):1072-1076. DOI:  10.1177/1541931214581224 .
• Buster TW, Burnfield JM, Taylor AP, Stergiou, N (2013). Lower extremity kinematics during walking and elliptical training in individuals with and without traumatic brain injury. Journal of Neurologic Physical Therapy, 37(4):176-86. DOI: 10.1097/NPT.0000000000000022 . PMID: 24189335.
• Burnfield JM, Shu Y, Buster TW, Taylor A, Nelson CA (2011). Impact of elliptical trainer ergonomic modifications on perceptions of safety, comfort, workout and usability for people with physical disabilities and chronic conditions. Physical Therapy, 91(11): 1604-1617. DOI: 10.2522/ptj.20100332 . PMCID: PMC3367158.
• Nelson CA, Burnfield JM, Shu Y, Buster TW, Taylor A, Graham A (2011). Modified elliptical machine motor-drive design for assistive gait rehabilitation. ASME Journal of Medical Devices, 5(2) 021001 (May 02, 2011): DOI: 10.1115/1.4003693 .
• Burnfield JM, Shu Y, Buster TW, Taylor AP (2010). Similarity of joint kinematics and muscle demands between elliptical training and walking: Implications for practice. Physical Therapy, 90(2):289-305 . DOI: 10.2522/ptj.20090033 . PMID: 20022994.
• Perry J, Burnfield JM (2010). Gait Analysis, Normal and Pathological Function, 2 ^nd Slack: Thorofare, NJ.
• Kulig K, Burnfield JM (2008). The role of biomechanics in orthopedic and neurological rehabilitation. Acta of Bioengineering and Biomechanics, 10(2):3-14. PMID: 19031992.
• Burnfield JM, Jorde AG, Augustin TR, Augustin TA, Bashford GR (2007). Variations in plantar pressure variables across five cardiovascular exercises. Medicine and Science in Sports and Exercise, 39(11):2012-2020. PMID:

SELECTED ABSTRACTS

• Cesar GM, Buster TW, Patten A, Perlaki BA, Burnfield JM. Reliability and accuracy of commercially-available wrist step-count device for children and adolescents with neurologic-induced gait impairment. 2020 ACRM VIRTUAL Annual Conference .
• Nimmo SM, Catcher BJ, White HJ, Buster TW, Cesar GM, Burnfield JM. Impact of backward motor-assisted elliptical training on upper extremity muscle activation patterns when using reciprocally moving handles. 2020 ACRM VIRTUAL Annual Conference .
• Jacobsen A, Buster TW, Cesar GM, Burnfield JM (2020). Comparison of electromyographic demands on trunk musculature during forward and reverse motor-assisted elliptical training. 2020 ACRM VIRTUAL Annual Conference . October 23, 2020.
• Nalamasu R, Schwery NA, Rasmussen, CM Buster TW, Cesar GM, Burnfield JM (2020). Motor-assistance and resistance during elliptical training alter upper extremity muscle activation patterns when using reciprocally moving handles. American Academy of Physical Medicine and Rehabilitation 2020 Annual Assembly . San Diego, CA. November 12-15, 2020.
• Baker BC, Burnfield JM, Buster TW, Cesar GM, Mestelle Z, Olbrantz CR (2020). Comparison of lower extremity joint kinematics and electromyographic demands during backward walking and reverse motor-assisted elliptical training. American Academy of Physical Medicine and Rehabilitation 2020 Annual Assembly . San Diego, CA. November 12-15, 2020.
• Burnfield JM. ICARE: An integrated approach for addressing gait, fitness, balance and upper extremity rehabilitation goals. Ability KC. Kansas City, MO. November 20, 2019.
• Burnfield JM. ICARE: An integrated approach for addressing gait, cardiorespiratory, balance and upper extremity rehabilitation goals. Rancho Los Amigos National Rehabilitation Center. Downey, CA. November 26, 2018.
• Burnfield JM, Buster TW, Cesar GM, Irons SL, Pfeifer CM. ICARE to improve walking and fitness in adults and children with physical disabilities and chronic conditions (2018). NIDILRR 40 ^th Anniversary Celebration Poster Session. Great Hall of the Hubert H. Humphrey Building, Washington, DC. October 18, 2018.
• Pfeifer CM, Whorley BA, Buster TW, Cesar GM, Burnfield JM (2018). Investigation of center of pressure during gait and motor-assisted elliptical training in adults. Archives of Physical Medicine and Rehabilitation, 99(12):e206. DOI:  10.1016/j.apmr.2018.09.052 .
• Huang C-K, Buster TW, Siu K-C, Burnfield JM (2018). Combining virtual reality gaming with motor-assisted elliptical impacts children’s engagement in exercise. Archives of Physical Medicine and Rehabilitation, 99(12):e195. DOI:  10.1016/j.apmr.2018.09.020 .
• Burnfield JM. Invited Keynote: Foot and Ankle Rockers: Contributions to Progression, Shock Absorption and Stability during Gait. 2018 Nederlandse Vereniging van Podotherapeuten Conference. Congrescentrum NBC in Nieuwegein, Netherlands. September 21, 2018.
• Burnfield JM. SportsArt ICARE Motor-Assisted Elliptical Training to improve walking, fitness, and wellbeing. International Council on Active Aging (ICAA) Product Webinar. November 6, 2018.
• Burnfield JM. ICARE Clinical Use for Walking, Fitness, Balance and Arm Rehabilitation: An Integrated and Affordable Approach. ExercisABILITIES Physical Therapy and Medical Fitness. Rochester, MN. August 16, 2018.
• Burnfield JM. ICARE: Customizing Use for First Rehabilitation Hospital of Shanghai, China. The First Rehabilitation Hospital of Shanghai, China. April 21, 2018.
• Burnfield JM. Robotic ICARE Technology for Walking, Fitness, Balance and Arm Rehabilitation: An Integrated and Affordable Approach. The 4 ^th China Rehabilitation Forum (CRF2018). Shanghai, China. April 20, 2018.
• Burnfield JM. ICARE: A Practical Rehabilitation Solution to Address Complex Patient Challenges. Osceola Regional Medical Center – HCA. Kissimmee, FL. January 24, 2018.
• Burnfield JM. Improving Walking and Fitness Following Neurologic Injury: Practical Solutions to Complex Challenges. 2018年中美康复医学与研究论坛/ 2018 Sino-US Rehabilitation Medicine and Research Symposium. Shanghai, China. January 15, 2018.
• Cesar GM, Irons SL, Garbin A, Eckels E, Buster TW, Burnfield JM (2017). Child with traumatic brain injury improved gait abilities following intervention with pediatric motor-assisted elliptical training: A case report. Journal of Neurologic Physical Therapy , 41(1):84. DOI: 10.1097/NPT.0000000000000156 .
• Irons SL, Buster TW, Karkowski-Schelar E, Johns E, Burnfield JM (2016). Individuals with multiple sclerosis improved walking endurance and decreased fatigue following motor-assisted elliptical training intervention. Archives of Physical Medicine and Rehabilitation, 97(10):e34.
• Burnfield JM, Buster TW, Irons SL, Cesar GM, Nelson CA, Rech NR, Nichols EM (2016). Pediatric walking vs. training on prototype motor-assisted elliptical: Kinematic comparison at self-selected comfortable speed. Archives of Physical Medicine and Rehabilitation, 97(10):e99.
• Burnfield JM, Irons SL, Cesar GM, Buster TW, Khot R, Nelson CA (2016). Pedi-ICARE training improves walking and endurance of child with cerebral palsy. Archives of Physical Medicine and Rehabilitation, 97(12):e19-e20.
• Burnfield JM, Buster TW, Irons SL, Rech N, Cesar GM, Pfeifer CM, Nelson CA (2016). Pediatric Intelligently Controlled Assistive Rehabilitation Elliptical for walking and fitness: Prototype development and biomechanical analysis. RESNA/NCART (Rehabilitation Engineering Society of North America/National Coalition for Assistive and Rehab Technology) 2016 annual convention. Arlington, VA, July 13, 2016.
• Buster TW, Burnfield JM, Irons SL, Nelson CA, Trejo LH, Leutzinger TJ (2016). Pediatric walking vs. training on a prototype motor-assisted elliptical: Kinematic and EMG comparisons at self-selected fast speeds. 2016 Annual Meeting Gait and Clinical Movement Analysis Society. Memphis, TN, May 17-20, 2016.
• Burnfield JM, Irons SL, Buster TW (2016). Individual with progressive supranuclear palsy demonstrates improvements in walking distance and efficiency following a motor-assisted elliptical training intervention. Presented, 9 ^th World Congress for Neurorehabilitation. Philadelphia, PA, May 12, 2016.
• Burnfield JM, Buster TW, Irons SL (2016). Individuals post stroke improved walking endurance and efficiency following motor-assisted elliptical training intervention. Presented, 9 ^th World Congress for Neurorehabilitation. Philadelphia, PA, May 12, 2016.
• Buster TW, Burnfield JM (2016). Movement variability during walking and elliptical exercise for individuals with chronic severe traumatic brain injuries. 9 ^th World Congress for Neurorehabilitation. Philadelphia, PA, May 12, 2016.
• Trejo LH, Buster TW, Stolle CJ, Nelson CA, Burnfield JM. Influence of Rocker and Crank Arm Lengths on I ntelligently C ontrolled A ssistive R ehabilitation E lliptical (ICARE) Coupler Trajectories. Biomedical Engineering Career Conference (MBECC) 2014, Detroit, MI. November 7, 2014.
• Burnfield JM. Development and Implementation of the ICARE for Use in Rehabilitation and Fitness. Hospital Corporation of America. Nashville, TN. Presented October 14, 2013.
• Burnfield JM. Desarrollo e implementación del ICARE para uso en rehabilitación y entrenamiento físico. Instituto Nacional De Rehabilitación. Lima, Perú. September 12, 2013.
• Burnfield JM. Desarrollo e implementación del ICARE para uso en rehabilitación y entrenamiento físico. Lima, Peru. September 11, 2013.
• Burnfield JM. ICARE Training to Improve Walking and Cardiovascular Fitness for Individuals Living with Physical Disabilities and Chronic Conditions. Quality Living Incorporated. Omaha, NE. Presented April 10, 2013.
• Burnfield JM. ICARE Training to Improve Walking and Cardiovascular Fitness for Individuals Living with Physical Disabilities and Chronic Conditions. Marionjoy Rehabilitation Hospital. Wheaton, IL. Presented April 24-25, 2012.
• Burnfield JM. ICARE Training to Improve Walking and Cardiovascular Fitness for Individuals Living with Physical Disabilities and Chronic Conditions. Hospital for Special Care. New Britain, CT. Presented April 2-3, 2012.
• Yeseta MC, Taylor AP, Buster TW, Shu Y, Burnfield JM (2012). Exercise endurance and functional mobility improve for individuals with physical disabilities after training on a motorized elliptical. Online proceedings, Rehabilitation Engineering and Assistive Technology Society of North America’s 2012 Annual Conference .
• Nelson, CA. Burnfield JM (2012). Improved elliptical trainer biomechanics using a modified Cardan gear. Proceedings of the ASME 2012 International Design Engineering Technical Conference & Computers and Information in Engineering Conference [Conference Paper #: DETC2012-70439]. Chicago, IL.
• Burnfield JM, Yeseta M, Buster TW, Taylor AP, Shu Y (2012). Individuals with physical limitations can benefit from training on a motorized elliptical for community-based exercise. Medicine and Science in Sports and Exercise, 44(5 Supplement), pg. 524.
• Taylor AP, Lowndes BR, Buster TW, Shu Y, Burnfield JM (2012). Speed’s impact on pedar pressures at varying levels of body weight supported ICARE training. Proceedings, Gait and Clinical Movement Analysis Society 2012 Annual Meeting, pg 139-140.
• Shu Y, Taylor AP, Buster TW, Burnfield JM (2012). Clinicians’ motion and muscle activation patterns during body weight support treadmill training. Proceedings, Gait and Clinical Movement Analysis Society 2012 Annual Meeting, pgs . 230-231.
• Buster TW, Goulet C, Shafer D, Burnfield JM (2012). Comparison of kinematic demands of walking and elliptical training between individuals with and without mild to moderate multiple sclerosis. Proceedings, Gait and Clinical Movement Analysis Society 2012 Annual Meeting, pgs . 232-233.
• Burnfield JM. ICARE Training to Improve Walking and Cardiovascular Fitness for Individuals Living with Physical Disabilities and Chronic Conditions. JFK Johnson Rehabilitation Institute. Edison, NJ. Presented March 26-27, 2012.
• Burnfield JM, Hildner GA, Buster TW, Taylor AP, Shu Y (2011). Speed’s impact on muscle demands during partial body weight supported training on a motorized elliptical. Archives of Physical Medicine and Rehabilitation, 92(10): 1700.
• Burnfield JM, Taylor AP, Buster TW, Shu Y, Goldman AJ, Nelson CA (2011). Use of Intelligently Controlled Assistive Rehabilitation Elliptical trainer to improve walking and fitness during acute stroke rehabilitation. Stroke, 42(3), pg. e326 .

Selected Professional Presentations

• Burnfield JM, Goulet C, Buster TW, Cassel AJ, Mills J, Seow CM (2011). Comparison of velocity, muscle demands and perceived exertion during elliptical training and treadmill walking in individuals with and without multiple sclerosis. Annual Combined Sections Meeting of the American Physical Therapy Association.
• Burnfield JM, Shu Y, Buster TW, Taylor AP, Merriman L, Nelson CA (2010). Comparison of lower extremity electromyographic (EMG) demands during ICARE training and walking. Online Proceedings, American Society of Biomechanics 34 ^th Annual Meeting .
• Buster TW, Taylor AP, Frazier M, Burnfield JM (2010). Kinematic analysis of five cardiovascular exercises. Online Proceedings, American Society of Biomechanics 34 ^th Annual Meeting .
• Burnfield JM, Buster TW, Taylor A, Keenan S, Shu Y, Nelson CA (2010). Intelligently Controlled Assistive Rehabilitation Elliptical (ICARE) Training: An Analysis of Lower Extremity Electromyographic (EMG) Demands with Varying Levels of Motor Assistance. Online Proceedings, Rehabilitation Engineering and Assistive Technology Society of North America’s 2010 Annual Conference.
• Taylor AP, Buster TW, Barber BR, Burnfield JM (2009). Comparison of Forefoot and Heel Pressures across Fast Walking and Four Elliptical Trainer Conditions. Supplement to Medicine and Science in Sports and Exercise, Volume 41(5), pg. S242.
• Corbridge LM, Goldman AJ, Shu Y, Buster TW, Burnfield JM (2009). Clinician’s Muscle Effort during Partial Body Weight Support Treadmill Training: Is it Hard Work? American Physical Therapy Association’s 2009 Annual Conference and Exposition.
• Buster TW, Goldman AJ, Corbridge LM, Shu Y, Burnfield JM (2009). Partial Body Weight Support Treadmill Training: Clinician’s Upper Extremity Muscle Activation During Facilitation of Hemiparetic Limb Movement. Proceedings, Gait and Clinical Movement Analysis Society 14 ^th Annual Meeting, pgs 258-259.