Evelyne Wiskerke, PT MSc,

Kathrin Truempy, PT BSc

Kliniken Valens, Switzerland

We are excited to share our clinical experience with a patient who had a Polyradiculoneuropathy Guillain-Barré.

He was admitted to Valens 9th of April 2018 where he was provided with a comprehensive patient-centered rehabilitation program. Different technological therapy adjuncts were used to maximize the intensity of the patient’s treatment, among them was gait training with the Andago.

The patient’s experience with the intensive episode of care and improved outcomes motivated us to share how the Andago  can be incorporated into a program with this type of patient.


 

 

Pre-Treatment

Mr. H. is a 55-year-old man, married and father of 4 children. He worked as a production worker.

He arrived to our institution with a diagnosis of Polyradiculoneuropathy Guillain-Barré with axonal infestation. The patient had a total paralysis of all four limbs and was unable to perform any movement.

He has been involved in a therapeutic program with a multidisciplinary team (physical therapy, occupational therapy, aquatic therapy, sports therapy), from 9th of April 2018 until 30th of March 2019.

The goals of the patient for physical therapy were:

  1. To improve the transfer to bed and gain mobility
  2. To  regain sitting capabilities
  3. To improve upright standing capabilities and orthostatic tolerance
  4. To increase walking capacity
  5. To live at home with assistance

The occupational therapists’ goals for this patient were:

  1. To execute a single task:
    – can take over partial steps during morning routine
    – can carry out simple everyday tasks (that are of importance to him) with little help
  2. To improve hand and arm use on both sides:
    – can eat with thickened cutlery
    – can greet with one hand and press lightly
  3. Screen for the need of products and technologies that may be of help in the home environment

Video 1: Transfer from the wheelchair to the bed in the early phase of rehabilitation.

 

Video 2: Standing up and verticalization of the patient with assistance in the early phase of rehabilitation.

Treatment

First weeks of rehabilitation:

  • Early neurological rehabilitation program
  • Two blocks of intensive interdisciplinary therapy (PT and OT)
  • Bed mobility, sitting balance, early muscle activation of the limbs, Erigo®Pro, Armeo®Power

Middle part of rehabilitation:

  • Normal neurological rehabilitation program
  • On average 4 hours of multidisciplinary therapy
  • Training of standing activity, muscle force training, Lokomat®, Armeo®Spring

End part of rehabilitation:

  • Still on average 4 hours of mulidisciplinary therapy with an increase of self-regulated exercise
  • Training of gait, balance and muscle force training, Andago and C-Mill training

 

Table 1: Patient’s timetable during the rehabilitation.

Andago® Treatment

 

Video 3: Patient walking in the Andago using free mode.

 

Video 4: Balance training combined with the upper extremity exercises in the Andago.

Post-Treatment

 

Video 5: Transfer from the wheelchair to the bed in the late phase of rehabilitation.

 

Video 6: Patient walking alone with crutches in the late phase of rehabilitation.

 

Pre-Post Assessment Comparisons

 

Table 1: Muscle strenght of lower extremites, static hand force, functional ambulation categories, and gait tests pre and post treatment.

 

Table 2: Chedoke-McMaster Stroke Assessment pre and post treatment.

Conclusion

Goals in function and activity:

  • The walking speed and the walking distance greatly improved as seen in 6 MWT and 10 meter walk test (Table 1).
  • Decrease of the physical impairment and increase of activity as seen in the Chedoke-McMaster Stroke Assessment (Table 2, compare video 1 & 5, comapre video 2 & 6).
  • Improve on the muscle strength for the knee flexion and knee extension (Table 1).

Goal in participation:

  • The patient was able to return home and live with the help of his family.

 

About Us

The five centers of the Kliniken Valens – group are specialized in the treatment of disorders of the musculosceletal system, disorders of the neurological system, rheumatologic illnesses, orthopedic problems, pneumologic diseases, oncologic diseases, geriatric disorders.
The Kliniken Valens offers an interdisciplinary, patient centered rehabilitation program to about 2600 patients each year. It is important to us to assist the patient through the different phases of recovery, in order for the patient to reintegrate back into society, family life and work life. One of our treatment offer is our extensive robotics program in which patient train with the whole range of the Hocoma devices, such as the Erigo, Lokomat, Andago, ArmeoPower, ArmeoSpring and Armeo®Senso, Valedo® and C-Mill.


 

Note:

This clinical experience report is meant to serve as an example of how the Andago is integrated into the rehabilitation program of a guillain-barré patient. It is not necessarily a standard recommendation from Hocoma.