Therapy Session

Q&A

What is the purpose of the Biofeedback Graph and how can I use it?

The Biofeedback Graph is an interactive tool to confirm that your patient remains active during the Lokomat session. In combination with the high number of repetitions achieved during a training session, this effort results in high training intensity.

The purpose of Biofeedback is to enable both the clinician and the patient to visualize objectively the amount of effort the patient is contributing during a gait cycle. Thus, to provide feedback on the performance of the patient.

 

How is it displayed?

Biofeedback Graph can be displayed at any moment of the Lokomat session on the therapist screen if you click on the button Biofeedback Graph on the bottom tab of the Lokomat training screen (Figure 1).

Figure 1: Biofeedback Graph icon on therapist screen.

To display the Biofeedback Graph on the patient screen and therewith enhance the patient’s attention and motivation, choose the Biofeedback Graph on the Library and add it to the therapy plan of your patient (Figure 2).

Figure 2: Biofeedback Graph on patient’s Therapy Plan

In both situations, the Biofeedback Graph is represented as a group of four graphs corresponding to the hip and knee activity for the left and right legs. Every graph has two lines: an orange line that indicates the level of activity during swing phase and a blue line indicating the level of activity during stance phase. On the vertical axis of the graphs (y axis), we can observe the amount of biofeedback units (the Lokocontrol software converts the force measured at the hip and knee joints), while on the horizontal axis (x axis), we can see time in seconds (Figure 3). On a functional level, this allows both the clinician and patient to know whether the patient is active at the appropriate time in the gait cycle.

Figure 3: Biofeedback Graph display with 4 graphs.

Some recommendations for its application:

Based on the experience of Lokomat Users, here are some recommendations on how to benefit from the Biofeedback when treating a patient.

  • Observing the baseline: When starting the training and while the patient is still relatively passive, visualize the Biofeedback Graph to see what a “passive” graph looks like.

It is important to remember that the absolute values of the Biofeedback Graph on the y axis may be different from session to session, that is why we recommend observing the session’s baseline during this passive phase.

  • Assess the patient’s ability to increase effort: Once you have set a baseline, you can assess your patient’s ability to generate more gait-phase-appropriate force i.e., the patient helps with the movement (graph line goes up), or more gait-phase inappropriate activity, i.e., the patient resists the movement (graph line goes down).
  • Use during training: Use the biofeedback screens during training to maximize your patient’s effort. Some examples:
  • Adjust the Biofeedback Graph to show only 1 joint in 1 gait phase and get your patient to focus on that particular movement (Figure 2 and 4).

Figure 4: Biofeedback Graph showing 1 joint on patient’s screen.

  • Monitor your patient’s effort. You can use the Biofeedback Graph to make sure that your patient is training throughout the entire Lokomat session.
  • Monitor the effects of your training adjustments. You can use the Biofeedback Graph to monitor any activation changes in relation to other treatment parameters (speed, loading, guidance force).