In October 1999, physical therapist Darin Trees worked in the Burn ICU with a burn survivor with 95% third-degree burns. The patient underwent cultured epidermal autografting and was placed in skeletal traction for weeks to allow the skin to 'take' and prevent graft shearing.
When Dr. Trees and the rehab team attempted to stand the burn survivor, his legs were too weak to support his body weight resulting in shearing of the torso skin grafts. The Clinical Problem- How does a physical therapist help a patient with severe leg weakness learn to stand without touching the patient?
On Day 2 of therapy, the tilt table was utilized for passive standing with straps at the knees, waist, and chest. Dr. Trees was frustrated with the tilt table's inability to allow movement. The new skin grafts would shear off the back if the patient attempted a sliding squat on the tilt table surface.
Solution- What if tilt tables allowed a leg press exercise with a gliding carriage? That evening, Dr. Trees made a concept invention using PVC for rails, plywood, and roller-blade wheels to allow linear motion on the tilt table surface. The bearing wheels would reduce friction and prevent skin graft shearing.
After the first leg press on the modified tilt table, Dr. Trees knew this device was the missing link between bedrest and walking again for patients with severe leg weakness. Gravity can be controlled by changing the incline. The following week, he welded a new version while applying for IRB approval to use the novel device in the burn ICU.
Once in clinical use, Dr Trees made many modifications to the device such as the elevating head section for improved respiration and adjustable footplates for accommodating ankle plantar flexion contractures. Tilt-N-Load, as the therapists called it, quickly became a standard of care for Burn ICU patients.
In 2003, Trees and colleagues published the first case series of utilizing a modified tilt table for pre-ambulation strength training in the American Burn Association's Journal of Burn Care and Rehabilitation.
The rehab team slowly realized that patients in all ICUs may benefit from gravity-reduced, closed-chain exercise to regain leg strength and possibly improve ventilator weaning. Tilt-N-Load began traveling to all ICUs.
For unilateral leg strengthening, Dr. Trees modified the device with a leg support pad and a movable platform for patients with weight-bearing restrictions or amputations.
The leg support pad became an effective treatment strategy for patients with hemiparesis after a stroke or brain injury by supporting the unaffected leg and "forcing" the controlled use of the affected leg in a gravity-reduced environment.
In 2007, Tilt-N-Load was redesigned for mass production and the MOVEO XP was launched.
For unilateral leg strengthening, Dr. Trees modified the device with a leg support pad and a movable platform for patients with weight-bearing restrictions or amputations.
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