Charlotte Britton,

Sarah Ali, 

Tamsin Reed

Wellington Hospital, London, UK

We would like to share our clinical experience with a patient with incomplete T5 paraplegia. He was admitted to the Wellington Rehabilitation Unit, the largest Private Rehab Unit in the UK 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 on the Lokomat. The improvement we observed over the therapy progression encouraged us to share our experience to support other clinicians working with the same patient group.

 

Pre-Treatment

19-year-old patient with a flaccid paraplegia due to transverse myelitis:

  • T5 ASIA C
  • Extensor and adductor spasms and spasticity in both lower limbs 1+ on Modified Ashworth Scale (MAS)
  • Left quadriceps weakness 1/5 MRC
  • Left foot drop 1/5 MRC
  • Requires assistance of 2 to transfer on and off the floor
  • Spinal Cord Independence Measure (SCIM): 28/40
  • Modified Barthel  Index (MBI): 76/100
  • Northwick Park dependency score (NPDS): 13/100
  • 10-m walk test (10MWT) with pulpit frame and assistance from 3 therapists: 1 min 54 seconds
  • Unable to perform 6-min walk test (6MWT)
  • Functional ambulation Category (FAC): 0/5.

Transfer of the patient and the manual taining session.

 

Treatment with the Lokomat®

This table represents the patient’s training schedule. (*) Gait training includes training on the Lokomat and Indego.

Patient exercising on the Lokomat.

 

 

This table indicates the progress of the patient’s training on the Lokomat.

Post-Treatment

Successful outcome, tolerated high intensity of walking.

  • T6 Asia D with improved pin pick sensation to L4
  • Extensor and adductor spasms and spasticity in both lower limbs 1 on MAS
  • Left quadriceps weakness 2/5 MRC
  • Left foot drop 2/5 MRC
  • Independently able to transfer on and off the floor
  • SCIM: 35/40
  • MBI 90/100
  • NPDS: 4/100
  • 10MWT with supervision from 1 therapist and elbow crutches: 47 seconds
  • 6MWT: 55 m with elbow crutches and supervision
  • FAC: 3/5

 

 

Summary of the patient’s therapy outcome.

About us

The Hospital Neurological Rehabilitation Unit is the largest private rehab unit in the UK. The unit provides rehabilitation services for patients with neurological conditions including head injuries, spinal cord injuries and strokes, providing comprehensive patient-centered rehabilitation. There is an interdisciplinary team of experienced consultants, physiotherapists, occupational therapists, speech and language therapists, neuropsychologists and dieticians. Facilities include three gyms, a hydrotherapy pool and occupational health areas and specific robotic and assistive technology equipment such as the Lokomat, Erigo and the Armeo.

 

Note:

This clinical experience report is meant to serve as an example of how the Lokomat are integrated into the rehabilitation programm of a transverse myelitis patient. It is not necessarily a standard recommendation from Hocoma.