Case report: the use of the Lokomat® and conventional therapy to train a chronic patient with a complete SCI

NeuroMoves (SCIA), Perth, Western Australia

We would like to share the clinical history of Carlos Samaan, a 39 year old patient with a complete Spinal cord injury, level C4, sustained in 2011. He has always been physically active with physiotherapy, exercise physiology and various modalities of treatments since then.

He trialed the Lokomat in Adelaide (South Australia) in 2016 and then decided to travel to Czech Republic in 2018 where he  used it consistently for 5x months. From 2019 he trains on the LokomatPro in Perth.

The patient’s rehabilitation experience with the Lokomat and his continuous determination reveals to be a very inspiring patient testimony.

Image 1: NeuroMoves team and Carlos Samaan.  Hayley Paterson the author of the case report (back row, third from the right)

Pre-treatment

Carlos had a C4 spinal cord injury ASIA A – complete quadriplegia in 2011. He underwent an epidural stimulator implanted at T12 level in 2018 and received 11 units of stem cell therapy.

When he first started on the Lokomat in Perth, April 2019, Carlos had moderate cardiovascular capacity, easily fatigued, poor trunk balance (Table 1), dependent for all ADLs, wheelchair bound for most hours for the day, low functional capacity (Video 1) and low global strength.

Video 1- Carlos’s sitting balance before Lokomat training

Treatment with the Lokomat

Carlos trains on the Lokomat (Image 2 and 3) four times per week. Each session last about 30-50 minutes, depending on his goals and focus for that day.

Each session has a different focus and stimulus.

We began to see improvements in Carlos’ trunk strength and confidence due to combination of training on the Lokomat and conventional physiotherapy. Over time, we could reduce BWS and GF as a result of Carlos’ improvement.

Image 2: Carlos setup for Lokomat training 2019.

Image 3: Lokomat training with Carlos and his therapists 2022.

Treatment with conventional therapy

On top of Lokomat therapy, Carlos also received other forms of conventional therapy such as activity-based therapy (Video 3), upper limb strength training (Video 2), functional electrical stimulation.

Video 2: Carlos doing strength training for his upper limbs.

Video 3: Carlos practicing sitting balance with his therapist.

Post-treatment

Latest assessment in March 2022 allowed to concluded that there were improvements on:

-the seated reach distances, increasement  by over 15cm (all directions, bilateral) (table 3).

-the passive and active ROM at shoulders (table 3).

– the Modified Rivermead Index and Neuro Recovery Scale ( table 3).

-the bone mineral density (Table 2).

Video 4: Carlos’s sitting balance training on the BOSU.

Table 2: Dexa scan results

Table 3: Modified Rivermead score, seated reach and neuro recovery scale – comparison between April 2019 and March 2022.

Conclusion

Carlos’ continuous rehabilitation during the last 3 years, combining conventional training and robotic gait training, lead to functional improvements (Table 2 and 3).

Carlos also witnesses psychological and overall benefits due to his therapy:

“My whole body feels more normal when using the Lokomat. I feel more active and energized while walking and for 24hrs post walking too. I feel a huge mental boost with focus, motivation, clarity to think and feeling positive about self-moving. I have also noticed an increase in my appetite.”

About us…

NeuroMoves is an innovative, holistic, evidence-based exercise and therapy service for people living with a spinal cord injury or other neurological conditions. The specialized staff provide patients with a safe and supportive environment to enable them to work towards their goals and reach their full potential.