September 8, 2017
Clinical Integration of the Lokomat®: Journey Forward
Journey Forward, Canton, Massachusetts, USA
Journey Forward is an exercise-based program designed to assist those with Spinal Cord Injuries so they too can achieve some of these most basic lifelong functions and benefits. We work with Spinal Cord Injured clients of all levels and abilities in a very active and full body approach. This is what separates Journey Forward from many other adaptive gyms. Many gyms that center on working with individuals with disabilities tend to focus only on the client’s abilities and don’t work on the affected areas.
We have been working with the Lokomat since April 2012. In 2016 we purchased our second Lokomat and often we have both devices treating clients at the same time. On any given day we have 5-8 hours of running time on the devices.
A majority of our Lokomat sessions are done with patients with spinal cord injuries, however we have used the Lokomat with patients with other neurological diseases, such as acquired brain injury (through stroke or trauma). We strive to provide treatment options to every patient and family that approaches Journey Forward.
We offer those with spinal cord injuries an intensive and effective exercise-based program. Our mission is to make this program as accessible as possible to those who need it. We are accomplishing this by working to open centers throughout the country and making it affordable to those who so desperately need this program.
Prescription: Inclusion Criteria
The first step is getting our patients medical clearance from their doctors to participate in active therapies.
Then they need to demonstrate that they can withstand the physiological effects of standing (assisted or not).
Finally, we double check that there are no other contraindications (contractures, pressure sores, obesity, etc.) that would prevent them from receiving Lokomat therapy.
Regardless of an individual’s physical function level, we try to provide Lokomat treatment to all of our participants.
There is great potential for physiological and psychological benefits for everyone who participates, especially those who are not currently ambulatory.
Duration and Frequency of Lokomat® Sessions
Our participants are scheduled for a one-hour block of Lokomat therapy, with typically 45-50 minutes of active therapy. Our skilled staff is very proficient in setting up the patient in the Lokomat. Set-up time is kept as low as possible, but depends on factors such as additional equipment the patient may have when coming into the clinic that needs to be handled before the session.
Since we just added a second Lokomat, due to high demand from our client base, we are now able to provide clients with more Lokomat therapy sessions per week. Clients can receive up to 2-3 sessions a week depending on the client goals, schedule and availability.
Journey Forward is not a traditional therapy center. Our clients stay as long as what fits into their lives. We have clients who have been part of our program since we first opened our doors in 2008.
We have several different evaluation techniques and tests that look at overall neurological improvement. We start with an initial evaluation, then agree on a timeframe for the goals to be achieved; this timeframe depends also on the patient’s ability to pay. We do intermediate evaluations to see how they are progressing or if we need to be adjust the goals. Lastly, we carry out a final evaluation at the end of their treatment to see if they need more therapy.
Specifically with the Lokomat we look at duration, speed, Biofeedback, Guidance Force and body weight support to determine how they are progressing with the Lokomat therapy.
We approach each client individually and find outcome measures that are coherent with the goals the patient wants to accomplish. While some patients may want to focus on gait, others may be looking for improvement in their balance. A close discussion with the patient and their families determines what our outcome measures will be.
Reasons to Include the Lokomat® as Part of the Therapy Program
The Lokomat allows us to provide a dynamic, full-body activity for our clients with limited function in a safe and effective way.
The Lokomat also offers the ability to have intensive training in one hour-long session, with no breaks.
Also, the ability to have only one person running the machine allows other staff members to be assisting clients elsewhere at our facility.
We have seen many positive outcomes using the Lokomat outside of the gait pattern re-training such as balance. Clients report that they feel better after a Lokomat session; they say being upright and walking for an hour is mentally freeing.
Other Therapies Provided in Addition to Lokomat® Training
Our center is equipped to provide all kinds of different therapies.
We focus on many dynamic full-body activities including but not limited to:
- resistance training
- active gait training/supported ambulation
- upper and lower body cycle ergometry
- functional electrical stimulation
- cross training
- speech therapy
Almost all Lokomat therapy sessions are preceded or followed up by an hour of overground training. The overground trainings focus on activities of daily living and other specific goals of the individual.
Organization: Responsible Therapy Team
Journey Forward has a lead technician to oversee all Lokomat sessions.
The technician is responsible for client safety and initial set-up on the Lokomat device. Other responsibilities of the lead technician include making sure the machines are running properly and that all equipment (i.e. harnesses and cuffs) are clean and in working order.
Besides the lead technician we also have 8 other exercise specialists who have been trained as “Lokomat Users” and are able to operate both Lokomat devices.
Billing and Financial Compensation of Lokomat® Therapy
All Lokomat sessions are paid out of pocket by our clients.
We charge a flat hourly rate for our program and the Lokomat treatment is included in the price; typical sessions last two hours.
We try to work with each client to find financial services that are accessible to them.
Journey Forward is a 501(c)3 non-profit organization located in Canton, Massachusetts and we are dedicated to bettering the lives of those living with paralysis through an intense exercise based program, so they too can achieve some of the most basic lifelong functions and benefits.
At Journey Forward we focus on our client’s weaknesses and work on coordinating the entire body in a very functional and complete style. Journey Forward is also part of the Christopher and Dana Reeve’s foundation which works with the Neuro-Recovery Network to provide data and feedback to assist in finding a cure for spinal cord injury.
This clinical experience report is meant to serve as an example of how the robotic equipment is integrated into the rehabilitation setting in one individual hospital. It is not necessarily a standard recommendation from Hocoma.