How many times do you go for treatment lakomat. New equipment. Indications for use LokomatPro Pediatric

Good day, dear readers and guests of the blog dedicated to the section of rehabilitation after neurological diseases and injuries. We write here about rehabilitation and everything related to recovery after a stroke, traumatic brain and spinal injury. The topic of rehabilitation in the conditions of specialized centers is given a special place. Time and Nuka does not stand still and new ones appear simulators and modern robotic systems for rehabilitation. Gradually, slowly, we got to this topic. Let us analyze the main such systems that are used in Russia and which are slowly but surely appearing in rehabilitation institutions.

Verticalizer Erigo (Erigo)

To date, there are many verticalizers on the market for medical simulators and systems for rehabilitation.

erigo stander

You can read about what a verticalizer is and what its main purpose is. I want to tell you exactly about the Erigo verticalizer and you will now understand why.

In the first days of training on a verticalizer, there is a risk of orthostatic hypotension - when, as a result of a change in body position, blood is redistributed and it swells from the brain, leading to darkening before the eyes, a feeling of dizziness. If for a healthy person this gives only a passing feeling of dizziness, then for a person who has had a stroke, this condition is fraught with the expansion of the ischemic zone in ischemic stroke.

Why am I saying all this? To the one, that verticalizer Erigo equipped with a system that, when the patient is vertical, imitates walking, giving a load to the legs - stimulating blood flow throughout the body, thus reducing the likelihood of orthostatic hypotension. The angle of inclination and the duration of the procedures can also be distributed according to a special program, providing a gradual adaptation to the loads.

The exercise machine Lokomat (Locomat) - an exoskeleton for rehabilitation of invalids.

Lokomat- one of the most famous robotic rehabilitation systems based on the feedback principle. This system is produced in Switzerland and is quite expensive; only large rehabilitation centers in megacities can afford it. The Lokomat simulator is designed for people who have had diseases that have resulted in the loss of the ability to walk. This simulator in the truest sense of the word teaches you to walk again.

To make it clear how this simulator works in practice, watch the video where the training process is filmed on Lokomate.

During such a study, you need to perform certain tasks that are displayed on the monitor, which is in front of the student, that is, there is also an element of motivation for classes, and this is very important condition in rehabilitation. The loss of the ability to walk more often occurs as a result of a decrease in strength in the legs, the stereotype of walking is lost. Lokomat is able to assess the force applied by the patient in order to walk. The attending physician has access to information in which the simulator indicates the force in newtons (!) - that is, fairly accurate readings (usually muscle strength is evaluated in points on a five-point system and is purely subjective). In addition to these indicators, the magnitude of spasticity in the limbs is assessed and the dynamics of its changes can be traced.

Thus, such a powerful tool for rehabilitation has been created and is being used in practice, the purpose of which is to restore the mobility of a person who has suffered such diseases of the nervous system as:

• acute cerebrovascular accident (stroke)
• acute disorders of the spinal circulation (spinal stroke)
• craniocerebral injury (consequences of closed (ZTBI) and open craniocerebral injury TBI)
• sequelae of a spinal cord injury
• consequences of previous neuroinfections (infectious inflammatory diseases of the spinal cord and brain)

Complex for the restoration of GT-1.

Another complex designed to restore the ability to stay in an upright position.

As already mentioned, the GT-1 is intended for the restoration of gait and independent standing in an upright position, moreover, it is the return of the ability to walk that often goes through the return of the ability to be in a standing position. On this simulator, you can work out all the movements involved in walking.

The trainer is good, but few places have it. At least, I saw the same “Lokomat” in rehabilitation centers more often. I do not know to what extent this impression corresponds to reality, we do not have exact figures for the equipment of the centers with this simulator.

Thus, modern means for rehabilitation and simulators for recovery after a stroke, spinal and craniocereberal injury were a little covered. I would like to note that in addition to the fact that these systems themselves have a considerable price, we also need specialists who understand this technique and can effectively use it.

At one of the conferences on recovery after a traumatic brain injury, I heard from colleagues about the presence of such expensive complexes as Lokomat in one of the medical institutions and the absence of specialists who know and can work with it. I don’t know how true this information is, it is quite likely that this is the case, especially given the lack of personnel in the field of rehabilitation today. Something like this…

The author of the article is neurologist Alexander Postnikov, the topic today was modern rehabilitation methods, using the Lokomat, Erigo and GT-1 simulators as an example, this is far from all that I wanted to tell you on this topic, a description of other rehabilitation systems will be described in the next article. Thank you for being with us, good luck and stay healthy!

What is Lokomat?

Lokomat is a robotic orthopedic trainer for restoring walking skills lost due to illness or injury, used in combination with a treadmill.

It reproduces one of the most important and complex human movements - walking.

Usually, the return of walking skills is achieved through difficult and lengthy training sessions with an instructor. Having passed all levels of physical activity, a person gets to his feet and learns to walk again. This often takes months or years.

Lokomat allows the patient to stand up, "verticalize" and "go". It helps the body to "remember" the lost skills of movement, it includes muscles that have been without movement for a long time.

In addition, training on the Lokomat gives a pronounced psychological and emotional impact. After all, a patient who has been in a wheelchair for a long time sees himself “walking” in the mirror, recalls forgotten sensations.

Who is shown training at the Lokomat complex?

All patients with partially or completely lost walking skills can train at the Lokomat complex, regardless of the cause of the violation.

Currently, the Lokomat complex is most effectively used to treat patients with the following consequences:

• Cerebral and spinal stroke;
• Craniocerebral and spinal cord injuries;
• Diseases and injuries of the musculoskeletal system;
• Children's cerebral palsy;
• Prolonged immobility;
• Multiple sclerosis.

How is the training at the Lokomat complex?

• The patient is fixed with special restraint straps and placed on a treadmill. Patients in a wheelchair can be easily transferred to the treadmill using the lift system.
• The patient's legs are attached to orthoses (robot legs) with special fasteners. Orthoses are connected to a computer that reads all load indicators.
• The patient stands on his feet in front of a screen on which a virtual person is projected - an avatar. This avatar is the image of the patient. During the session, the patient controls the avatar. This is a biofeedback method.
• The doctor or instructor performs complex settings for the act of walking individually for each patient.
• The movement of orthoses and a treadmill begins. The patient begins to "walk". The patient sees himself in the mirror and on the screen and overcomes virtual obstacles.
• The instructor monitors the degree of participation of the patient in the movement, reduces or increases the speed of the treadmill, the degree of participation in the movement of the legs of the robot, thereby changing the load for the patient.

Despite the seeming simplicity of training, this is a very complex robotic system. Three interconnected computers are involved in the management. Thus, it is possible to control the degree of load, taking into account the individual characteristics of the patient - this eliminates the possibility of any injuries during training.

What are the benefits of therapy at the Lokomat complex?

• Improves blood circulation throughout the body.
• Increases overall muscle tone.
• High-quality impulses from the lower extremities allow the brain to “remember” what walking is.
• Emotional effect - the feeling of movement gives a high motivation for treatment.

What are the advantages of therapy at the Lokomat complex?

• Workouts are longer and more intense than just running on a treadmill:
• The patient's motor activity is easily controlled and coordinated.

The effectiveness of Lokomat therapy has been proven*

Lokomat is a robotic simulator that helps to achieve what seems impossible.

The optimal course of treatment is from 10 procedures. Trainings in our center are held daily or every other day.

The duration of the workout is 30-45 minutes.

The most effective training at the Lokomat complex is carried out in combination with other methods of rehabilitation: physiotherapy, exercise therapy, classes in a rehabilitation gym, massage, drug treatment.

Contraindications to therapy

• Body weight more than 130 kg and less than 30 kg;
• Height over 195 cm;
• Age up to 11 years;
• Pronounced asymmetry in the length of the legs;
• Severe form of osteoporosis;
• Severe spinal deformity;
• Severe fixed contractures (immobility) of the joints;
• Open injuries of soft tissues;
• Unstable ununited fractures;
• Malignant neoplasms;
• Conflict behavior of the patient;
• Epilepsy.

Training at the Lokomat complex is prescribed by a neurologist or an orthopedist of the Govorovo Rehabilitation Center.

Lokomat is a unique simulator designed to train walking in patients with pathology in the field of walking skills. During therapy with Lokomat, the patient puts on an exoskeleton, which makes it possible to walk along the path under load.

The main elements of the Lokomat simulator: track, loading system, orthosis and software that control and analyze, thanks to which you can individually determine walking parameters: speed, stride length, limits of movement in the hip and knee joints.

The dynamic loading created by the individual setting during the first brace session makes it possible to learn gait skills early without having to wait until muscle strength is sufficiently developed.

Lokomat-advantages of the simulator

The benefits of early training in walking skills on the simulator are the following factors:

• minimizing the negative effects of an extended period of inactivity
• acceleration of the period of return of motor functions
• decrease in the level of pathological muscle tension
• improvement of peripheral circulation and trophism
• restoration of correct movement skills and body position

With the help of exercises on the Lokomat simulator, the correct cycles of walking are restored (the time of movement of the limbs, the length of the step, the speed of walking), the skills of correct walking are fixed.

Efficiency in the retraining of walking skills in patients after a stroke, spinal cord injuries, traumatic brain injuries, with cerebral palsy (ICP) and multiple sclerosis has been confirmed numerous scientific studies.

Lokomat – simulator capabilities

With the help of exercises on the Lokomat simulator, you can:

• control the correctness of exemplary walking skills
• combine walking with exercise
• retrain walking skills using a speed-controlled track
• individually determine the range of motion in various joints of the lower extremities
• receive feedback (biofeedback) as an auxiliary element of therapy

Approximately 60 min. Lokomat class includes: preparation of the patient and equipment for classes, 25-45 minute lesson, depending on the patient's ability, removal of the skeleton from the patient.

Lokomat simulator - what can Poland offer?

You can find out how classes are held in Poland with the help of the Lokomat simulator in the Dream Rehabilitation Center specializes in the rehabilitation of children with cerebral palsy and disorders of the musculoskeletal system. In addition to Lokomat in the center, classes are conducted on such simulators as: Armeo, TheraSuit, TheraTogs. The Dream Rehabilitation Center offers intensive rehabilitation programs with elements of NDT- Bobath / NRL Bobath, SI / SI, PNF with supportive procedures such as hydro- and physiotherapy, massages, water exercises, hippotherapy.

Rehabilitation on the Lokomat simulator - how can Polandmed help?

Polandmed is a brand of the Polish Medical Tourism Association, which cooperates directly with leading and trusted clinics in Poland. Polandmed will offer you an individual selection of clinics and doctors from its own wide base, depending on individual needs and the estimated cost of treatment. Since Polandmed works directly with clinics, payment for treatment and rehabilitation is made at the clinic or medical center. Moreover, Polandmed can also provide other related services such as issuing a medical invitation, booking hotels / inns or other places of residence, booking tickets, translation services, and other types of transport. Thus, you can calmly concentrate on the treatment or rehabilitation of yourself or your loved ones.

L O K O M A T

In our Center, you can get a service for the rehabilitation of patients with the consequences of spinal cord injuries in the late rehabilitation period on the unique LOKOMAT simulator.

The LOKOMAT training complex (robotization of walking) is a technique that allows you to put patients on their feet even after a spinal injury!

Apparatus "Lokomat" is an electrically powered robotic walking orthopedic device used in combination with a treadmill.
"Lokomat", recreating the physiologically correct walking, helps the body to "remember" the lost skills of movement, makes the muscles that have been inactive for a long time get involved in the work. In addition, training on the Lokomat has a pronounced psychological effect, because a person who, perhaps for many years, was deprived of the opportunity to walk independently, returns forgotten sensations. Currently, the Locomat complex is practically uncontested for the rehabilitation of severe patients with spinal cord injury. Currently, the Locomat complex is considered as the latest achievement in the field of gait recovery, especially in patients with lower paraplegia.

The main indications for the use of the Locomat complex are the following pathologies: partial or complete interruption of the spinal cord (spinal cord injury) condition after cerebral strokes condition after severe traumatic brain injury, accidents. And also, it is used for: the consequences of severe injuries of the musculoskeletal system, after prolonged immobility of a person, peripheral paralysis, cerebral palsy from the age of 15, but not in young children.

The system is recognized as the most effective rehabilitation technology for restoring walking skills. Computer-controlled motors of the apparatus set the patient's legs to the trajectory of movement, which forms walking, as close as possible to physiological. Allows you to evaluate the degree of participation of the patient in training using the biofeedback function. Allows you to conduct training at a qualitatively higher level, expands the possibilities of treatment, taking into account the individual capabilities of the patient and with his active participation in the rehabilitation process.

Where to apply?
The service is provided for a fee (see Price List) at the Clinical Center for Restorative Medicine and Rehabilitation. For more information, please contact the paid services department or call 8 977 708 3317

A l t e r G - anti-gravity treadmill

ALTER G is an anti-gravity track for running. With regular exercises on this simulator, any patient who has damaged his muscles or ligaments will be able to actively run.

Already a few days after surgery or injury, any patient will be able to run without undue effort, since ALTER G exercises do not strain the musculoskeletal system. The device completely eliminates the occurrence of pain, as well as possible complications in the heart. Classes on this simulator resemble a journey into space and into its anti-gravity space.

Due to its unique design, the ALTER G treadmill allows the patient's lower body during exercise to be located in a dark compartment, where, using differential pressure, it is possible to adjust its weight. The limits of such adjustment are from 100 to 20 percent of the present weight. As a result, the load on the joints is reset, and the muscles will work in the usual way, as in real active running.

Eliminating pressure on painful joints, the legs will actively work, as with an ordinary jog on a familiar surface. Muscles will also work in the usual way, and respond to all movements.

You can train on the ALTER G antigravity track with almost any disease. The device is ideal for:

• Patients suffering from heart disease. The load on the heart during the active use of the simulator is excluded.
• Athletes who want to hone their running skills. It is very convenient and practical to gradually follow and increase the manufacturability of each movement.
• Those who want to adjust their own figure or reduce weight.
• People with neurological diseases. The anti-gravity property of the device eliminates pain during use.
• Patients who have suffered sports injuries, in order to speed up their recovery.

Many physiotherapy clinics in the world, including those in Moscow, already have ALTER G antigravity treadmills. This simulator is also presented in our center.

hivamat

Khivamat - This is a simple and generally accessible option for restoring the body after a variety of past diseases, injuries and surgical interventions. Massage, carried out with the help of a special Khivamat apparatus, is an excellent healing procedure that can affect the deep tissues of the human body.

Therapy with the Khivamat apparatus

The method of therapy with the help of the Khivamat apparatus is based on the principle of a therapeutic effect on the skin and tissues subject to oscillations - vibrations of a certain depth and frequency. They occur between the patient's skin and the doctor's hands, dressed in special vinyl gloves that do not conduct current. Thus, the emerging electrostatic field affects the surface of the skin and tissues adjacent to it. During the procedure, the patient and doctor are connected to the device, and the patient's tissues are attracted to the doctor's hands at the moment they touch the skin surface. As soon as the doctor moves his hands to the side, the tissues fall back.

The surface of the human body, over which such medical manipulation is performed, makes slight reciprocating movements up and down, but the patient does not experience unpleasant or painful sensations, only a pleasant vibration.

The system for locomotor therapy "SLT" is a robotic rehabilitation complex designed to provide locomotor therapy for patients with disorders of the musculoskeletal system. It can be used for neurological rehabilitation (cerebral palsy, head injury, stroke, diseases of the nervous system), trauma rehabilitation (spinal injury, condition after prolonged immobilization of extensive injuries of the lower extremities), orthopedic rehabilitation (condition after replantation or correction of deformities of the lower extremities).
SLT allows the physiological movements of the lower extremities (walking) of the patient due to the drive system of the hip and ankle joints with simultaneous unloading of weight. At the same time, the feedback of the patient is monitored in real time, the efforts of the muscles of each leg during walking are evaluated. During the training, spasticity of the leg muscles is monitored.
The design of SLT allows it to be used both in the rehabilitation of adult patients and children - the simulator is reconfigured depending on the height and dimensions of the patient. In addition, while walking, the patient's weight can be partially or completely compensated for by the winch and cables, as well as the safety harness that is put on the patient's body. The value of the compensated weight is controlled by a special sensor, the readings of which are displayed on the methodologist's computer screen.
The simulator is designed for use in clinics, rehabilitation centers, specialized gyms. To work on the simulator, one trained specialist is enough.

Indications for use

• Motor disorders of the lower extremities due to:
• spinal cord injury
• traumatic brain injury
• stroke
• cerebral palsy
• posture disorder
• diseases of the nervous system, etc.

The robotic rehabilitation complex "SLT" is designed to carry out a number of therapeutic and rehabilitation effects by providing long-term movement of the patient's legs along the moving belt of the treadmill with partial compensation of the patient's weight.
The simulator includes two subsystems:

1. a system for placing the patient above the treadmill in a vertical position with control of partial weight compensation during walking
2. system of forced movement of the legs along the moving belt of the treadmill.

The simulator allows the patient to stand on the treadmill before training and feel the support under his feet, prepare the leg muscles for stepping movements. To ensure a stable position, he can hold on to the bars with his hands, which are adjustable in height and width depending on the height of the patient. If the patient moves only in a wheelchair, then he can enter the treadmill along the ramp, and, using arm strength or an auxiliary winch, take up a vertical position.
The running speed of the treadmill without the forced leg movement system can be adjusted from 0.3 to 8 km/h.
For the forced movement of the patient's legs on the treadmill, a set of levers with knee stops and holders of the lower leg and foot of the patient, driven by two electric motors, is used. The speed of movement of the levers is synchronized with the speed of movement of the treadmill belt. When working with the forced leg movement system, the speed of the treadmill belt can be adjusted from 0.3 to 3 km/h. In this case, the patient's walking on the moving belt of the treadmill is simulated.
The simulator provides fixation of the patient in a vertical position and forced movement of his legs along the moving belt of the electric treadmill. The treadmill allows the user to weigh up to 180 kg. The body is fixed using a special vertical support belt and a pelvic support belt. In addition, while walking, the knee and ankle joints are fixed.
Each leg is fixed in three places and with the help of a system of levers driven by an electric motor, it is forcibly rearranged along the treadmill tape. The arms are adjustable in length depending on the height of the patient. In addition, the step width can be changed. It is set equal to 30 or 45 cm. To facilitate the verticalization of the patient, a winch with a carrying capacity of up to 500 kg is used. The patient's weight compensation device is made in the form of an upper compensator, which is a system of blocks and cables. During training, the patient's weight compensation value is electronically controlled from 0 to 100 kg.
The two upper blocks are located above the patient. These blocks can move in the longitudinal direction so that compensatory forces are applied either in a strictly vertical direction or at the required angle to align the patient's body. The system supports the patient at two points, shoulder-width apart. This is done in order to achieve a more natural weight distribution than with suspension at one point.
Due to the elasticity of the halyard, the system allows a vertical displacement of the patient's center of gravity sufficient for normal walking, but does not allow the patient to lose balance.
For a short rest between approaches for the patient, there is a removable seat.
The operation of the SLT is controlled by a laptop with Windows-compatible software. When working with the program, you can set the speed of the treadmill belt, the step width, the level of spasticity restriction, the movement of one or two legs, the movement of only the treadmill belt, read the distance traveled, monitor the reaction of the patient's legs to the applied efforts. In addition, a quick shutdown of the entire system is provided either using a special position on the laptop screen or using the emergency button.

Advantages

• The term of operation, frequency and duration of use are not limited.
• To work on the simulator, one trained specialist is enough.
• The weight of the simulator does not exceed 300 kg.
• The treadmill allows the user to weigh up to 180 kg.
• Ability to freely move the position of the pelvis while walking
• Possibility of leaning on the treadmill before walking
• The possibility of self-verticalization due to the strength of the hands and the emphasis of the knee joints
• For a short rest between approaches for the patient, there is a removable seat.
• Patient weight compensation function.
• Availability of the Registration Certificate of Roszdravnadzor and the Declaration of Conformity.

Specifications

• The design of the simulator is collapsible, made of metal with a protective paint and varnish coating.
• Dimensions of the simulator in a complete set with a ramp for a treadmill: length - up to 2700mm, width - up to 1300mm, height - up to 2400mm.
• Treadmill belt speed: 0.3 to 8 km/h (without forced leg movement), 0.3 to 3 km/h (with forced leg movement).
• Operating temperature: 10-30°C
• Humidity: 30-70%
• Power: 220 - 240 V AC
• Current frequency: 50-60Hz
• Operating mode: intermittent operation (15 min - work, 10 min - break) for 8 hours.