Therapy Session

VIDEO

FreeD Pediatric Frontal Plane Settings

This video shows in detail how to set the frontal plane with the pediatric FreeD module.

VIDEO

FreeD (Adult) Frontal Plane Settings

This video shows in detail how to set the frontal plane with the adult FreeD module.

Q&A

What do I Need to Consider During Patient Setup with LokomatPro with FreeD?

FreeD is an optional module of the Lokomat that provides a more natural and physiologic gait pattern while supporting lateral transition of the body weight. In order to setup a patient on a safe and efficient way with the new FreeD module we recommend you to read this entry. Below, you will find a detailed description of a patient setup with and without FreeD.

LokomatPro

  1. Measure upper and lower legs, adjust the orthoses and enter the values in the software.
  2. Select the cuffs and attach them to the orthoses.
  3. Select the harness and leg loops. Fix the harness on the patient.
  4. Attach the patient to the support frame and lift the patient. Close the swivel door and lower the orthoses.
  5. Adjust the height of the Lokomat by placing the hip cushions directly above the greater trochanter. Set the pelvic depth and width using the dedicated hand wheels. Fix the pelvis by fastening the strap around the pelvis and by adjusting the orthosis to the rings on the harness.
  6. Close the upper cuff and check the knee axis, adjust lower leg length if necessary. Close the middle and lower cuffs.
  7. Adjust the upper cuff bracket so that the orthosis is aligned with the patient’s femur. Adjust the lower bracket so that an imaginary lines through the lower leg falls behind the lateral malleolus. Adjust the middle bracket and check the knee extension.
  8. Adjust the upper, middle and lower cuffs so as to follow the anatomical axes of the patient’s legs and so as to set the track width.
  9. Fasten the foot lifters.

 

LokomatPro with FreeD

  1.  Measure upper and lower legs, adjust the orthoses and enter the values in the software.
  2. Select the cuffs and attach them to the orthoses. The upper cuffs are delivered in sizes 9 and 7 and should fit most patients. If this is not the case, the middle cuffs can be used.
  3. Select the harness and leg loops. Fix the harness on the patient.
  4. Attach the patient to the support frame and lift the patient. Close the swivel door and lower the orthoses. Open the pelvic orthosis to its maximum width.

    Opening pelvic orthosis to maximum width

  5. Adjust the height of the Lokomat by aligning the greater trochanter with the white plastic indicators.

    Alignment of the white indicator with the greater trochanter

    Adjust the pelvic depth by turning on the hand wheel and the pelvic width by pushing inwards on the pelvic cushions (to open, push button and pull). Attach the patient harness to the orthosis by buckling the pelvic straps on the harness.

  6. Close the upper cuff and check the knee axis, adjust lower leg length if necessary. Close the middle and lower cuffs.
  7. Adjust the upper cuff bracket so that the “Lokomat femur” is aligned with the patient’s femur. Adjust the lower bracket so that an imaginary lines through the lower leg falls behind the lateral malleolus. Adjust the middle bracket and check the knee extension.
  8. Fasten the foot lifters.
  9. Adjust the lower cuff so as to set the track width (frontal plane alignment). Set the amount of lateral and medial translation of the upper and middle cuffs and close the blocking mechanism screws.
  10. Check that each leg does not collide with the foot lifter bar of the opposite leg at any time during the gait phase.

 

Handout: Setup Differences Between FreeD and non-FreeD
Q&A

What can I do if the Patient is Uncomfortable in the Harness?

A proper setup will increase comfortable for the patient in the Lokomat. Here we provide some practical tips.

Minimize “Hang” Time

When you set your patient up, be as efficient as possible to minimize the time he is fully suspended. Be systematic in your setup; this will help you be quick and thorough.

Positioning the Harness

  • Groin padding: The Lokomat offers two groin pads. Make sure they are placed in such a way as to cover the sensitive groin area. Take into consideration that the most of the pressure is anterior rather than posterior, so ensure that the padding is placed forward enough to provide good protection.

Groin Paddings

  • Selecting the leg straps: Two different options are provided, a triangular pelvic harness or two separate straps. Some patients will prefer one option over the other. When using the triangular harness, we recommend placing one groin pad horizontally. Make sure the leg straps are long enough to cover the patient’s sensitive area and that they are tightened symmetrically on both sides.

Pelvic Harness

Leg Straps

  • Attaching the leg straps: The leg straps can be attached to the harness in two different ways. If your patient feels uncomfortable with the medial position, try the lateral position. This position may affect superior translation of the harness on your patient, but it may be more comfortable.
  • Placing the harness: Check that the harness is straight and symmetric. If the weight is not evenly distributed, the harness might put more pressure on one specific area, which will cause discomfort. Make sure the harness is not too high, especially on women, to avoid pressure on the breasts.
Q&A

How Can I Improve Lokomat Setup in Patients with a Narrow Pelvis?

Patients with a narrow pelvis, in particular children, may experience difficulties when training with the Lokomat because the cuffs might collide during walking. To avoid this and ensure a safe and correct walking pattern throughout the entire training session, follow these recommendations:

  • Frontal plane settings (indicated by letters):
    Check whether the cuffs are placed correctly during setup. Leave enough space between the cuffs, especially around the thighs and knee joints, to avoid collision once the pelvis is fixed (picture 1).
    Make sure that the legs are correctly aligned. If the cuffs still collide with each other, move them laterally (towards the letter “A”).

Picture 1

 

  • Cuff size: Make sure that the selected cuff size is not too large.

 

  • Specific hip pads: Thicker hip pads are provided together with the pediatric orthosis. They increase the space between both orthoses during setup, thereby avoiding the collision of the cuffs during walking (picture 2).

Picture 2