How can I Protect Patients’ Skin when they Train on the Lokomat?
Hocoma AG has exercised great diligence in the selection of the materials that are in contact with the patient, these materials that have been assessed for its biocompatibility. Nevertheless, individual patients may under some exceptional circumstances experience adverse reactions. Abrasions or skin irritation are possible side effects of Lokomat training, to minimize these effects consider the following:
- Ensure that the patient is wearing suitable clothing. Wearing appropriate pants can reduce the risk of skin irritation. We suggest long pants or track suit pants made of soft cotton. Leggings are also suitable. Thick, rough fabrics with thick seams, very loose-fitting pants or pants with lots of zippers, studs or rivets are unsuitable. Synthetic materials can cause mild irritation or chafe the skin. Shorts are not suitable either because they allow the cuffs to rub directly against the skin.
- Avoid folds under the cuffs. When the patient is set up, wrinkles and folds in the pants under the cuffs must be avoided. These wrinkles and folds can cause abrasions while the patient is walking.
- Choose the proper cuff size. The cuffs should fit snugly but should not be so tight that they re-strict the patient’s circulation or cause skin lesions. If the cuffs are too loose, they can move up and down while the patient is walking and cause abrasions or chafing.
- Use padding. Hocoma provides two types of padding with the Lokomat: the groin padding (helps prevent irritation in the groin area) and shin guard (helps prevent irritation of the patient shins). Neo-prene is also an optional padding material; consider using neoprene pads between the patient’s legs and the cuffs. Another option would be to bandage the patient’s lower legs.
- Ensure patient is correctly set up in the Lokomat. The Lokomat’s axes must be well aligned with the patient’s joints to minimize cuff travel as the patient trains. If the cuffs move from their initial setup position, they might not fit the patient’s legs properly risking abrasion or restricted circulation. Make sure the orthoses are well fixed and do not slip down. Do not allow the lowest cuff to come in contact with the external malleolus.
- Avoid shear forces: With the FreeD module on the Lokomat, the pelvis can translate left and right and also rotate during gait. Therefore, the cuff mechanism that guides the patient’s legs also needs to allow this left-right movement of the legs to avoid shear forces. If you block the cuff movement in the frontal plane, make sure you don’t allow the pelvis lateral movement- no FreeD.
- Consider the patient population and comorbidities. There are populations with sensitive skin and comorbidities that impact the skin.
- Patients with Spinal Cord Injuries experience decreased sensation because of their injury or medical condition. Impaired sensation can lead to the development of pressure sores be-cause the patient is unaware of any problem. They cannot tell the therapist if something hurts or does not feel right.
- Older adults have gone through intrinsic changes, among them: reduction of collagen type I, elastin, fibroblasts and sebum secretion.
- Pediatric patients have thinner skin that is more easily damaged.
- Bariatric patients have less vascularization of the adipose tissue and are associated with other comorbidities.
- HIV and AIDS patients are immuno-suppressed.
Comorbidities that impact the skin:
- Diabetes with microvascular and neurologic changes (prolonged wound healing)
- Altered nutritional status
- Altered hormone levels (estrogen, testosterone, GH)
- Atherosclerosis, decreased perfusion
- Venous insufficiency
- Any source of edema: lymphedema, venous stasis, hypoalbuminemia
- Colonization of skin with fungus and pathogenic, multiple resistant bacteria
- Pharmacologic compromise: corticosteroids, immunomodulators (Jeffrey et al., 2015)
Examine patients, especially new ones, on a regular basis for any possible skin irritations and signs of allergic reactions.
When bringing the patient out of the Lokomat check the patient’s shins and groin area for possible skin abrasions. Should there be signs of skin irritation or an allergic reaction, further training is not permitted. Have the situation first clarified by a dermatologist.
Skin lesions that cannot be protected appropriately constitute a Lokomat contraindication.
Jeffrey et al., Considerations in Special Populations: Patients with vulnerable skin, National Pressure Ulcer Advisory Panel, 2015; www.npuap.org
How do I Change to Pediatric Orthosis on the LokomatPro?
Do you use the LokomatPro with both adult and pediatric patients?
Would you like a clear, step-by-step procedure to quickly and effectively change from adult to pediatric orthosis?
Watch the video or download the handout below!
Handout: How do I Change to Pediatric Orthosis on the LokomatPro?