Terri Reed had high hopes when Via Christi Rehabilitation Hospital invested in a LokomatPro FreeD, a state-of-the-art, computerized robotic system designed to improve patients’ gait through neuromuscular re-education.
Reed, a physical therapy assistant at the hospital in Wichita, knew robotic gait therapy had the potential to help her patients get back on their feet more quickly after a stroke or other injury to the brain or spinal cord.
But several months into using the Lokomat, even she has been impressed with the results.
“Patients are becoming aware so much quicker,” Reed says. “Their level of attentiveness is better. Their ability to find midline is better. Their trunk control is better. We’re even seeing quicker improvement in speech and swallowing, which we hadn’t necessarily expected.”
The LokomatPro FreeD — the first of its kind installed in the United States — is part of an investment by Via Christi Health to provide the latest in technological advancements for its patients in inpatient and outpatient rehabilitation. The result, leaders say, should be faster recovery from a variety of neurological conditions.
Physical therapist Carrie Park helps a patient use the LokomatPro FreeD at Via Christi Rehabilitation Hospital. The robotic gait ambulator is the first of its kind in use in the United States.
The LokomatPro FreeD has been used at Via Christi Rehabilitation Hospital since November. “It’s having an effect on the patients’ entire care,” physical therapist Terri Reed says.
“These are the newest resources in evidence-based practice that therapists are using to help regain function for our patients,” says Marcia Trebilcock, PT, Manager of Inpatient Rehabilitation Therapy for Via Christi.
The Lokomat, which was installed in November, allows patients to begin walking much greater distances — and sooner — than they would have before. Reed says three therapists might have helped a patient in the early recovery stages of stroke walk 50 feet before the Lokomat. Now, the machine might help the same patient walk 800 meters with a smoother gait.
The Lokomat, through its exoskeleton design, has potentiometers that measure the amount of force or movement the patient is able to perform. A biofeedback system tracks that performance and projects progress on a screen in a graphical or game format for patients to visualize their efforts. Therapists can set up games and therapeutic activities for patients while on the Lokomat to provide motivation for improved performance.
The computer stores patient data to track progression across multiple therapy sessions. The Lokomat uses a partial body weight-supported harness system that allows therapists to gradually increase the amount of body weight and work that patients contribute to the walking process.
The Lokomat has opened up new potential for other types of therapy in its short time at Via Christi Rehabilitation Hospital.
“It’s having an effect on the patients’ entire care,” Reed says. “I’ve had patients who had no sense of sitting balance, and after using the Lokomat for two sessions they can sit at the edge of a table. It opens up more things the occupational therapists can do with upper extremities, if patients can sit unsupported, and improves patients’ abilities during self-care activities. It flows into all areas of a patient’s care.”
The LokomatPro FreeD is the centerpiece of a concerted effort by Via Christi to become a regional hub for rehabilitation by offering an arsenal of advanced options for therapists to use to help their patients.
Other recent additions include:
The ArmeoSpring exoskeleton system magnifies trace movements for patients with little muscle control to continue their motions for neuromuscular re-education.
- The ArmeoSpring, an exoskeleton system that wraps around a patient’s arm to negate the effects of body weight and gravity. It uses spring controls to magnify even trace movements for patients with little muscle control to continue their motions for neuromuscular re-education.
The system includes a visual feedback system that allows patients to complete tasks such as picking an apple from a bin at the grocery store or breaking an egg into a bowl.
“Even if they don’t have much movement,” Trebilcock says, “it expands on what they have.”
- The RT300 Functional Electrical Stimulation (FES) bike creates patterned movement in arms, legs and trunk. This enables patients to use existing muscle control in their upper and lower extremities, combined with electrical stimulation to facilitate increased muscle activity for movement.
The FES bike can help improve circulation, reduce muscular atrophy and help with neuromuscular re-education.
- The Bioness H200, a FES unit, is used in performing therapy and task-specific movements to improve impaired hand function resulting from stroke, traumatic brain injury or spinal cord injury.
Therapists are able to customize the unit for a specific patient, to help him or her reach, grab and release objects. Over time, muscles relearn the processes involved, allowing for improved ability to perform activities of daily living.
The ArmeoSpring and Bioness H200 often are used in conjunction in patients’ therapy plans.
- Via Christi also has the Bioness L300 Plus, which uses FES and is the latest in Bioness products for the lower extremities. The L300 Plus helps patients control tibialis anterior, quadriceps and hamstring muscles for knee and foot control during gait. The goal is to eliminate foot slap at heel strike and drag at toe-off, as well as to control the knee, preventing hyperextension at stance phase of the gait sequence.
The L300 Plus is programmed by the therapist uniquely for each client’s everyday needs. It also can be set for a variety of surfaces, continuing to help patients after they leave therapy.
- The Sanet Vision Integrator (SVI) uses a 50-inch touchscreen monitor, designed to improve visual motor and perceptual skills.
The SVI can be used in treatment of many visual abilities, including eye-hand coordination, reaction time, speed and span of recognition, and visual and auditory sequencing and memory. It additionally is extremely effective when working with visual acuity improvement in patients with visual field loss, visual-spatial neglect and visual-vestibular integration problems.
Letters, colors or numbers can be displayed on the device in the affected area of a patient’s vision, with the objective for the patient to scan that impaired visual area to identify the object. Once the patient sees the character or number, he or she must reach and touch it. Therapists are able to record the patient’s progress for improving vision over time.
Though the technology provides therapists at Via Christi Rehabilitation Hospital new tools for furthering their patients’ care, the human touch at the core of the hospital’s mission remains key to patient outcomes.
Jana Rombeck, an occupational therapist with Via Christi Rehabilitation Hospital, helps a patient use the ArmeoSpring to regain fine motor skills.
The LokomatPro FreeD is designed to help patients relearn their gait after a stroke or other injury to the brain or spinal cord. But Via Christi therapists have been impressed with the effects the ambulator has had on patients’ speech and cognition.
“The equipment is wonderful to have,” Trebilcock says, “but it doesn’t mean much without the therapists who dedicate their time to learning how to use it to get the best, personalized results for the patients we serve.”
“They treated me with respect,” she says. “It was as if I was at home. It was so emotional when I left there — I still cry about it. I felt like I was leaving my family.”
Since word of the Lokomat and other technology acquisitions has spread, Trebilcock says she has received inquiries from physicians from a broadening geographical area. She says the staff at Via Christi Rehabilitation Hospital remains committed to keeping referring physicians up to speed with progress notes, no matter where the patients come from.
“We’re so excited about these new therapy resources,” Trebilcock says. “We hope it will mean quicker and more complete recoveries for our patients, so they can get back to the lives they’re used to living.”
For more information or to refer a patient to Via Christi Rehabilitation Hospital, call 316-634-3400. To view a video of the LokomatPro FreeD, visit viachristi.org/rehab.