Lokomat - locomotion therapy

[Lieveling]

Hello all,

There was an article in the newspaper regarding a woman who had broken her neck while playing on a trampoline. She was in the Spinal Injuries Centre at Pinderfields Hospital in Wakefield, West Yorkshire. Unfortunately the article was vague on her injury level, if the spine was affected or not...

In any case, her rehabilitation was greatly enhanced by a walking machine called the Lokomat.
I post this here in case anyone would like to try it, use it to enhance their daily workout or integrate it into their rehabilitation.
I will be discussing it with my partner and see if we can get access to it in a unit here in Belgium.

Here is the website address of the Swiss producers of the Lokomat.

www.hocoma.ch

[wheels5894]

Mmmm, looks interesting, but it is rather short on facts. For example, we are not told the injury level and extent for the SCI people so are they complete - amazing if they are - or are they incomplete and therefore might have got that far anyway. They were able to move the legs, even a little bit, before the treatment and I don;t know about others here but I can't even do that!

I think I would like to see just how good this system is by seeing if it gets adopted in the west. I am rather sceptic till then.

[Gary Anderson]

Lieveling

The article you refer to also appeared in one of my Mother's magazines.
The woman's injury was an incomplete one and from what I gathered when reading it she recovered from the feet up. So, she was going to walk anyway the machine just enhanced what she had.

She still has some bother with her hands but now walks with sticks and her only stumbling block is stairs.

Unfortunately, incomplete means you have the ability to make a partial or whole recovery whilst complete is what it says - complete with no chance whatsoever of walking.

I have not tried such a machine, however, the one thing I would not be without is my electric exercise bike which gives my legs a real going over. I also use FES therapy a lot.

Again, I was incomplete also my spinal cord is intact it is nerve damage that I have so I am a different case entirely.

[wheels5894]

Thanks, Gary, you have cleared that one up. I could not think quite how one might have any walking or standing skill with a complete injury. The technique looks clever but I suspect that it was just speeding up the time to get walking going. mind, I didn't really like the site as it didn't really say anything about the patients and certainly suggested that anyone might recover with the machine. Sadly, as you say, it isn't going to happen for many of us.

[Lieveling]

Thanks Gary and Wheels. Good to have your input on this. It is a shame that the article was so vague on her injuries and I suspected that she would have walked anyway.

However, I was wondering if using such a machine would help as part of an exercise regime....

I think you're on to something Gary with your electric exercise bike - cycling was my partner's passion before his accident and he relishes any opportunity to use the electric exercise bike at the centre. I think we'll be purchasing one for home when he comes out. As well as a 5th wheel for his wheelchair - he used one for the first time last week and it really boosted him! At one stage the therapists gave up running beside him !!!! They had expected a leisurely walk !!!! 

[Gary Anderson]

Here is a copy of the article I referred to

http://www.wesleyjsmith.com/blog/2008/05/exercise-machine-trains-brain-of.html

[Apparelyzed]

Hi,

I have a member on my forum who has used the Lokomat, so if you want further info, it may be worth contacting her. She's a T4-5.

Here's the thread she started: http://www.apparelyzed.com/forums/index.php?showtopic=5170

Regards

Simon

[Gary Anderson]

Not wanting to sond like a kiljoy but Locomat therapy works best with incomplete injuries.

Here's an article from their website:

Therapy Information
Lokomat® Training for Spinal Cord Injury
(Also known as paraparesis, tetraplegia, tetraparesis)

Spinal Cord Injury (SCI) is a paralytic condition caused by complete or partial damage to the spinal cord. It is characterized by the loss of motor, sensitive, and vegetative functions below the lesion. This condition has the following phenomena:

• Total or partial loss of the ability to perform controlled movements in the affected body areas.

• Sensitivity to touch, pain, temperature, and depth are lost or reduced.

• The vegetative paralysis causes, among other things, problems with bladder and rectal function, impaired sexual function, problems with perspiratory gland function, and problems with peripheral circulation and temperature regulation.

Paraplegia results from damage to the spinal cord at chest level or in the lumbar spine area, with resulting paralysis of the muscles of the torso and legs.
Tetraplegia results when the arms are also paralyzed. Damage to the cervical spinal cord (from C4) also impairs the functioning of the respiratory system.
Complete paraplegia is the term used to refer to a total loss of function of the spinal cord, while with incomplete paraplegia, the spinal cord is only partially damaged.

What are the expected effects of training with the Lokomat system on paraplegic patients?

Lokomat training is used mainly for patients with incomplete SCI; in other words, for patients who still have some residual function in their arms and legs. The walking ability of such patients can be improved with the support of the Lokomat system. The gait orthosis can be adjusted to the individual functional level of each patient, and supports the patient as much as necessary, but as little as possible. A large number of repeated movements that represent a physiological gait pattern give patients the best possible help as they work to improve their walking ability.(1, 2, 3) While Lokomat training does not cause any functional development in cases of complete paraplegia, but it can lead to an improvement in secondary effects, such as: stimulating the metabolism, stabilizing circulation, reducing spasticity and long-term improvement of the intestine and bladder function.

Note: At this point, we would like to expressly state that these improvements are not due exclusively to training with the Lokomat system. They must always be regarded as a result of Lokomat training in combination with other physiotherapeutic interventions.

How often should training take place?

We recommend three to five times per week for 30 - 45 minutes (depending on the patient’s stamina and the therapy plan). For more information, please see the “Recommendations for clinical practice” in the Products/Lokomat/Interest Groups section of our website.

[jmarren]

I have used it in therapy at the Rehab Institute of Chicago.  It's a cumbersome thing but quite useful in reminding the whole body of the motion required to walk.  I recommend it. 

Judith

[Lieveling]

Thanks Judith - you obviously found it a positive experience. Nice to hear.