|
Patients attend for different reasons - most patients attend from interstate and many from overseas. The combined services of Hyperbaric Oxygenation and Lokomat (Robotic Gait Assisted Walking) together with other assertive modalities are unique. Simply Google search for this combination and you will observe only one facility world wide - HyperMED NeuroRecovery Australia. All patients are required to complete the On-Line Patient Application Form and email or fax prior to attending HyperMED.
HyperMED NeuroRecovery goes ‘Beyond Therapy’ NeuroRecovery goes beyond the conservative therapy program a person would normally receive as an ‘in-patient’ or even attending an out-patients program where the focus is on coping and adapting to disability. Most traditional rehabilitation programs are typically designed to get patients as independent as possible and trained on how to take care of themselves after discharge. In contrast HyperMED NeuroRecovery focuses on the full extent and capacity to re-train and re-learn function. Most patients in the chronic phase of their condition become stagnant in their recovery and virtually all aspects of recovery and motivation fade. HyperMED NeuroRecovery is like a ‘rigorous boot-camp’; patients attend between 4-6 hours on each day and receive combination therapies designed to challenge immune and physiological responses and facilitate functional change. At HyperMED NeuroRecovery we make no apology for ‘politely pushing’ the patient – the objective is to penetrate the deeper neurovascular structures, unlock dormant pathways and promote functional changes. Patients require an initial intensive saturation or start up program, typically 2-3 weeks followed by periodic short blocks of intensive therapies designed to promote neuroplasticity salvage. Prepare yourself - You have got to WORK! HyperMED Protocols Treatment varies from individual to individual. Many patients attending HyperMED are directed for further investigations including MRI (brain and full spine) and bloods for underlying 'opportunistic infections'. Most complex neurodegenerative conditions require an initial base line period of between 80-100 hours to change the dynamics of the damaged region and commence some form of worthwhile recovery. Most patients suffering complex and advanced degenerative neurovascular disorders including stroke, closed head injury, failed back surgery etc may in fact, require several hundred hours to effect clinical change and certainly a base line of between 100-150 hours is typically required. Blocks of short intensive durations are recommended for complex disorders. All patients require an initial ‘kick-start’ saturation to penetrate the deeper neurovascular structures to commence some form of vascular change commencing the process of neuroplasticity (functional change). Typically most patients attend for an initial 2-3 week block receiving between 4-6 hours HBOT each day and for those patients requiring Lokomat; between 1-2 hours each day on Lokomat. The intensity of therapy is individual and based on the patient’s condition and specific requirements. The objective of this is initial saturation is to provide between 60-80 hours HBOT and approximately between 15-20 hours Lokomat combined with additional supportive therapies. Interstate patients are then required to return for typically short saturative blocks at appropriate intervals based on clinical changes and improvements. Individual progress varies - all patients are required to complete the Patient Evaluation form after each return to HyperMED. During the initial stages of treatment the patient will experience a range of symptomatic change. If you have high levels of bacterial and or viral load in your blood then patients will often experience a ‘Herxheimer’ reaction which is the term used that describes a ‘killing effect of the pathogens’, resulting in elevation of toxic levels in the blood. This is your immune system responding. Simply stated you may feel tired, aching, irritable, mood swings, migratory joint pains and possibly periods of changing bowel activity. It is important that if you experience this reaction, notify us immediately. Please ensure that if you are experiencing a ‘Herx’ reaction – drink plenty of water, get plenty of sleep, and watch your diet! To combat these underlying issues and reactions, we also recommend very specific immune stimulating vitamins and amino acids - refer to HyperMED Oxy-Health section. Rehab Plus has been developed by this facility and is pivotal in enabling your body to respond at its best maximizing the benefits of treatment including Hyperbaric Therapy. In addition other non-drug recommendations including immune stimulating injections are recommended.
Lokomat (Robotic Gait Assisted Walking) Gait Training Lokomat is NOT passive involvement. The Lokomat is constantly adjusted to best assist the functional responses of the patient. Patients commence with passive assistance however as the patient compliancy builds the Lokomat settings and various programs are tailored to the patient performance and capabilities. Some patients have high level spasticity and others a complete loss of tone. Each patient's presentation is different - Lokomat provides excellent opportunity to 'best-fit' the patients specific capabilities and capacity to re-train function. And this is replicable on every separate training session! In addition the support harness treadmill system are utilized independent of the Lokomat to promote functional changes. Functional changes being driven by 'man and machine' are then put to the test with the patient then able to implement strategies being focused on during each Lokomat session. This combination effect is both unique and significant towards each neurologic patient developing a sense of supportive assistance whilst focusing on improving functional independence. Walking requires a 'fluid like connection between spinal reflex generators and higher brain centers'. The combined approach is invaluable to promote functional changes - neuroplasticity (the ability to salvage back what has been damaged).
Background Information - Lokomat (Robotic Gait Assisted Walking) For the past 15-years bodyweight supported treadmill training (BWSTT) has become a prominent gait rehabilitation method in leading rehabilitation centers throughout the world. This type of locomotor training has many functional benefits but the labor costs are considerable. To reduce therapist effort, Robotically Gait Assisted BWSTT (Lokomat) has been shown to be more accurate and financially feasible, compared to the other BWSTT modalities. Currently 45+ Lokomat systems are in use in large Neurorehabilitation hospitals in the USA and approximately 150 Lokomat systems found in 31 Countries. In December 2006 HyperMED NeuroRecovery located in Melbourne installed Australia’s first Adult and Pediatric Lokomat systems (Robotic Gait Assisted Body Weight-Support Treadmill Training) providing opportunity for adults and children with gait impairment due to spinal or cerebral motor disorder to improve functional outcomes. Neural plasticity refers to the natural ability of the neurons in the nervous system to generate and develop new connections aimed at repairing the neuronal damages. In the other word, they can learn new tasks. Based on this fact, locomotor training focuses on retraining the nervous system through simulating and repetition of walking gait, in order to regain their function and/or enhance their existing potentials. By repetitively stimulating the muscles and nerves in the lower body Lokomat Gait Assisted Training works to awaken dormant neural pathways controlling standing, stepping and balance. Experiments conducted on spinalized cats demonstrate that treadmill walk was possible suggesting evidence of a central gait pattern generator which remain active; these spinal generators drive the ability to re-learn function. When these generators are not activated the spinal circuits remain dormant; this inability to realize a movement combined with the neuroplasticity of the central nervous system may induce a secondary functional incapacity called “learning non use” – the ability to sit!
Activity based rehabilitation after neurological injury relies on three principles of motor learning.
These three principles are critical to promoting activity-dependent plasticity (i.e. altering the efficacy and excitation patterns of neural pathways by activating those pathways). With regards to neurological rehabilitation, it is important to emphasize that plasticity occurs in neural pathways that are active. Over the past decades, extensive research studies have assessed and evaluated the use and benefits of body weight-supported locomotor training. These studies reveal that BWSTT can effectively improve walking parameters such as speed, limb coordination, distance, and level of independence. It has also been shown that BWSTT in incomplete SCI patients can also lead some positive neurological alterations namely stepping ability, corticospinal tract function, and increased electromyography activity. Manually assisted treadmill training has been used for more than 15-years as a regular training for patients with spinal cord injury and stroke. The most extensive study published to date found that 80% of wheelchair bound patients with chronic incomplete spinal cord injury gained functional walking ability after functional training Spinal Cord Inj Rehabil 2005. Unfortunately BWSTT has not found prominence in Australian hospitals or private rehabilitation clinics.
What are the limits of Lokomat Gait Training? Patients with spinal cord injuries who have been wheelchair bound for many years are still potentially able to ambulate. Improving a patient to the point that he/she no longer needs a wheelchair to move would definitely lead to reducing the yearly costs of his/her neurological disease as well as the financial burden of wheelchair-associated complications such as; pressure ulcers, circulatory disorders, osteoporosis and attendant care. Lokomat Gait Training also records improved cardiovascular performance and reductions in spasticity, bone loss and bladder/bowel complications.
Lokomat Gait Training kinetic settings can be varied and specifically adjusted throughout the training session intensifying functional outcomes. Patients with incomplete spinal lesions and with stroke undertaking Lokomat Gait Training have measurable functional changes; reflex stiffness and spasticity are significantly reduced; range of motion, peak velocity and acceleration of voluntary movements are increased with patients with incomplete spinal lesions and stroke. Therefore the walking ability improves as well as functional independence. Additionally, it has been revealed that Lokomat Gait Training can lead to functional improvements in patients with different neurological diseases such as; Multiple Sclerosis, Chronic Stroke, Parkinson’s Diseases, Cerebral Palsy (CP), as well as the other various types of idiopathic and secondary muscular dystrophies and neurological disorders in adult and children. In stroke hemiparetic patients BWSTT has been shown to improve balance, lower limb motor recovery, walking speed, endurance, and other important gait characteristics such as symmetry, stride length and double stance time. Moreover, a number of research studies have shown that Lokomat Gait Training can not only improve the gait in neurological patients but also positively affect cardiovascular and general health regulations. For this reason, to keep a level of maintenance treadmill training after the initial period of intense training is highly recommended.
|
