The services provided in the Specialised Services unit at Netcare Rehabilitation Hospital include:
Gait Lab, including Lokomat and Biodex
Upper limb clinic
THE GAIT LAB
The ability to walk is fundamental to a person’s quality of life, yet a substantial portion of the population has difficulty walking. This includes people who have suffered a stroke, traumatic head injury, spinal cord injury, amputation or indeed any disabling illness or trauma that affects their lower limb function and mobility. Attaining a functionally efficient and as cosmetically “normal” a pattern of gait as possible is a high priority in the rehabilitation of patients with a physical limitation involving the lower limbs.
Rita Henn & Partners, with the support of Netcare Rehabilitation Hospital in Auckland Park, have combined the skills of trained physiotherapists with highly advanced specialised equipment to establish THE GAIT LAB. The Gait Lab is a gait retraining facility which aims at assisting patients during rehabilitation to achieve maximum independence and an optimal gait pattern in walking. Equipment utilised in the training includes the Lokomat® for robotic walking, the Biodex® Unweighing System for body-weight supported treadmill walking and Functional Electrical Stimulation to stimulate specific muscles needed during the various phases of walking.
The Lokomat® is an electromechanical-assisted device for gait training. It comprises an exoskeleton which facilitates the movement of the hips and knees during the phases of walking and can be used with or without body weight support. The patient is supported in a harness over a treadmill and the frame (exoskeleton) of the robot, attached by straps to the outside of the patient’s legs, then facilitates the legs in a natural walking pattern. A computer controls the pace of walking and is able to measure the body’s response to the movement.
The benefits of walking using the Lokomat system include:
Task specific training – allows for an optimal walking pattern to be practiced more efficiently and sustainably over a longer period of time
Strengthening of innervated muscles
Reduced risk of osteoporosis (weight bearing exercise is known to increase bone mass and density)
Increased range of movement in joints
Improved proprioception (sense and awareness of the position in space of your body)
Increased patient engagement through the emotive component of being able to stand and “walk”
Biodex Unweighing System
The Biodex Unweighing System allows partial weight-bearing walking training to be conducted with the assurance of patient confidence and safety, while still allowing the therapist hands-on access for manual assistance and correction. The patient is strapped into a harness which is then connected to an overhead platform that will take some of the patient’s weight while standing and walking. This increases the safety of the patient and also allows the therapist the freedom to concentrate on facilitating the patient’s gait without having to hold the patient up at the same time. The Biodex can also be used with a treadmill if needed.
Functional Electrical Stimulation
Functional Electrical Stimulation (FES) allows for the controlled electrical stimulation of specific muscles needed in the various phases of walking via carefully placed electrodes. Initially the therapist controls the specific placement of electrodes and the timing and strength of the impulses but once the parameters have been established for effective walking, the patients are empowered to set up and control the system themselves.
For example, the Odstock Dropped Foot Stimulator (ODFS) is a single channel neuromuscular stimulator used to correct drop foot, a condition commonly found in patients with stroke, incomplete spinal cord injury and peripheral nerve lesions.
Aqua therapy is physical therapy based in a heated pool which can be very beneficial for a range of disabilities. The advantage of hydrotherapy is that it negates a percentage of the patient’s body weight thus making active and assisted movement much easier than on land. The water can also at the same time serve as a resistance medium for strengthening exercises and is able to provide a good medium of cardiovascular strengthening. A variety of different positions can be utilised in the pool with the support of the water that are not possible on land. Often just the comfort of the heated water can be beneficial to patients with painful conditions.
A full assessment needs to be done before the patient can be taken into the aqua therapy pool to establish contra-indications and precautions.
Optimal wheelchair seating is a fundamental principle in the rehabilitation of patients who are confined to wheelchairs. The correct seating is vital in order to prevent complications such as pressure sores and scoliosis. It also allows for maximal functional abilities within the wheelchair, as the correct posture and support is vital for upper limb function and reach. At our seating clinic, we utilise a sophisticated seating mapping system in order to objectively map the patient’s position on a cushion and where the pressure areas are. The system can also be used as a strong visual tool when educating patients on effective pressure relief. Much time and effort is spent, in conjunction with the wheelchair suppliers, on assessing exactly which cushion and wheelchair is most optimal for our patients and best suits their unique needs.
UPPER LIMB CLINIC
The upper limb clinic is a new project in our special services unit. We are using specialised assessment and treatment tools/equipment to allow us to objectively measure and report on a patient’s upper limb function, target function in therapy and monitor progress.
Other aims of the upper limb clinic are to educate patients on aspects of upper limb impairments and to make available appropriate upper limb assistive devices. In the future the upper limb clinic will also be looking into utilising high technology devices such as robotics for intensive upper limb treatment.