Monday, August 10, 2009

Pediatric Lokomat® Walking Therapy

The Rehabilitation Institute of Chicago provides robot-assisted walking therapy using the Lokomat® to help pediatric and adult patients improve their ability to walk. Featured on the Today Show, RIC offers Pediatric Lokomat therapy, or robot-assisted walking therapy, for children with neurological conditions such as cerebral palsy (CP) to help improve their ability to walk. Robot-assisted walking therapy may not be appropriate for everyone, and certain medical conditions may prohibit your participation in this activity. To learn more about our program please review the information below and also see Questions & Answers About Robot-Assisted Walking Therapy About Lokomat TherapyRobot-assisted walking therapy is a form of physical therapy that uses a robotic device to help a person improve his or her ability to walk. The patient is suspended in a harness over a treadmill, and an exoskeleton robotic frame, attached by straps to the outside of the legs, moves the legs in a natural walking pattern. A computer controls the pace of walking and measures the body’s response to the movement. The pediatric model also has an interactive gaming interface which, through cartoon characters and challenges, motivates children and provides them instruction. Without the Lokomat, this type of physical therapy is conducted with the aid of two or more therapists who manually move the patient’s legs in a walking pattern. The strenuous nature and variability of the manual method can limit the frequency and duration of therapy. With the Lokomat, the robotic device does most of the heavy work, the pattern and pace are consistent throughout the session, and the exercise can be sustained over longer periods of time, making it more effective. The Science Behind the TreatmentRIC has been examining and tracking the effects of this therapy for adults for years and continues to focus on new research and clinical trials that provide more data on this treatment. In fact, RIC was the first hospital in the U.S. to obtain this technology and began clinical trials with the Lokomat® when it was first approved by the Food & Drug Administration in March 2002. In addition to its research studies, RIC now makes robot-assisted walking therapy available in the clinical setting for adult inpatients and outpatients as well. In an early study conducted in Europe [1] examining the use of Lokomat therapy for children with CP, results indicated an improvement in walking speed and in gross-motor function. The therapy was also rated “excellent” in providing motivation for carrying out therapy among a majority of children, while there was also a very high level of approval from the therapy team and parents. QuestionsWhat are the criteria for using the Pediatric Lokomat?All patients must undergo an evaluation by an RIC physician and physical therapist before being recommended for the Lokomat. The following information can be used as a guideline for patients and family members interested in RIC’s services: Age: Minimum age typically 4 years; Lokomat is available for older children and adults Diagnoses: Central gait impairment secondary to cerebral palsy or malformations, spinal cord injury, stroke, traumatic brain injury or Guillain-Barre’ Syndrome Over Ground Walking: Achieving over ground walking ability; presents some stepping pattern in supported gait Cognition: Ability to follow single step commands and to signal fear, pain or discomfort Femur Length: Femur length must be 21 centimeters Are there conditions that would prevent a patient from using the Lokomat (contraindications)The following issues may prevent a patient from being eligible for services in the Lokomat: Spasticity: Severe spasticity requires a trial test Lokomat session Cardiovascular issues: Cardiovascular instability or thromboembolic disease are contraindications Bone Issues: Fractures, osseous instabilities, osteoporosis, scoliosis greater than 20 degrees are contraindications Skin: Unhealed skin lesions in the trunk or lower extremities are contraindications Musculoskeletal issues: Weight-bearing restrictions are a contraindication Neurological comorbidities: Acute or progressive neurological disorders are a contraindication Ventilators: Ventilator dependency is a contraindication Intravenous Drip: Intravenous drip is a contraindication Behavior: Aggressive or self harming behavior is a contraindication How much does robot-assisted walking therapy cost?The cost of robot-assisted walking therapy will vary according to how often and how long it is required to achieve the maximum benefit for each individual. Many healthcare insurance providers cover robot-assisted walking therapy; you should consult your insurance provider for details. Where can I participate in robot-assisted walking therapy?RIC offers robot-assisted walking therapy only in the inpatient, outpatient and research centers of our flagship hospital, which is located at 345 E. Superior Street in Chicago. How often does a person need to participate in robot-assisted walking therapy?The effectiveness of robot-assisted walking therapy varies from person to person, so patients should be able to commit to a minimum of 60 minutes of therapy per day, three days per week, for four weeks. Periodic evaluations will be conducted to determine if more sessions would be helpful in achieving the maximum benefit. How do I schedule an appointment for a physician evaluation for robot-assisted walking therapy?Based upon the information supplied to RIC, clinical staff will make a preliminary determination of the appropriateness of robot-assisted walking therapy. You may call RIC at 1-800-354-REHAB (7342) or 1-312-238-1000 and ask for Pediatric Lokomat Patient Line to leave your information. You also may submit an request online for a physician consultation . You will be contacted to determine how best to proceed, which may include scheduling a physician evaluation. Are the results of robot-assisted walking therapy guaranteed?No, the results of robot-assisted walking therapy or any other type of therapy are not guaranteed. However, during the course of therapy, periodic evaluations will be conducted to measure improvement and determine if more sessions may help to achieve the maximum benefit. Read further questions and answers about Lokomat therapy . -------------------------------------------------------------------------------- [1] The Rehabilitation Centre for Children and Young People (Affoltern am Albis , Switzerland ); Dr. von Haunerschen Kinderspital (Munich ) and Hocoma, 2007 Source: Rehabilitation Institute of Chicago

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