Rehabilitation Matters

The ELLIOTT™ orthosis - Early Lower Limb Intervention Orthosis for Therapeutic Treatment

Early intervention with an orthosis to assist standing and then start early walking training is a good thing for many patients recovering from a stroke.  The primary goals of early orthotic intervention are to prevent or minimize impairments and maximize functional recovery.

For a number of years we have advocated the use of an "evaluation orthosis" with such neurologically involved patients.  This is valuable when it is too soon for a therapist to know whether a custom-fit orthosis is required.   However to be valuable as an evaluation tool, such an orthosis needs to have many of the merits of a custom fit device but with the ability to be adjusted easily even when coming "off the shelf".

It is important to avoid poor, ill fitting, solutions that give the therapist no control.

In contrast, proper timing and use of an orthosis can facilitate gait training, increase overall safety, offset contractures, improve sensory feedback.

Our USA based partners at Anatomical Concepts Inc have designed a new product that we will shortly bring to the UK market.  We will post details on anatomicalconcepts.com shortly

ELLIOTT™ (Early Lower Limb Intervention Orthosis for Therapeutic Treatment) is a prefabricated lower limb orthotic system that has been designed specifically for application in the acute, sub-acute and home health rehabilitation environments for management of the neurologically involved patient. 

This unique lower limb system consists of bilateral Knee Ankle Foot Orthoses (KAFO’s) referred to as ELLIOTT™ and ELLIOTT II™.

ELLIOTT™ consists of a KAFO (Knee Ankle Foot Orthosis) with three separate AFO (Ankle Foot Orthosis) variations that can be used either as part of a KAFO system or individually as AFO’s.

ELLIOTT II™ consists of a KAFO with three AFO’s that are part of the KAFO. The AFO segment can be quickly separated from the Knee Orthosis (KO) segment enabling the rehabilitation team member to use the KO independent of the AFO.

Utilizing either ELLIOTT™ product in the rehabilitation setting rectifies these concerns through the unique multipurpose design and multifunctional capabilities.

Having eight variations within the ELLIOTT™ system that are fully adjustable enables the rehabilitation team to intervene effectively and at the earliest point of the rehabilitation process.

ELLIOTT’s built in fully adjustable capabilities allows for accurate and effective joint positioning for gait and positioning augmentation to facilitate optimal outcomes. Single posterior upright minimizes bulk and impingement over bony prominences.   Secondary benefits consistent with early mobilization include; prevents DVT, skin breakdown, contracture formation, constipation and pneumonia.

Guidance on leg spasm reduction following spinal cord injury

Leg spasms are problematic for many persons who have experienced a spinal cord injury.  Medication is not always easy to optimise and many clients like to avoid this if possible.  The guidance note below relates to what experience shows us about the impact of FES Cycling for leg spasm reduction.

Inspirational Client

New client Jonathan always dreamed of standing on the Olympic podium.  But when the promising slalom skier was struck down by meningitis that dream was put on hold.  The 23-year-old has been left paralysed from the neck down and is only able to breathe with the help of a ventilator. 

Jonathan is now using our RehaMove FES Cycling system to allow him to exercise and yesterday we delivered and set this up for him.  Back in July last year we were able to meet Jonathan and demo the system for the first time.  Since then, the hope was that the health service in some form would fund this purchase.  However, despite great efforts the sytem was eventually purchased with private funds.

It is a pleasure to work with Jonathan.  Despite his injury he has goals and ambitions and inspires eveyone with his determination and spirit. 

If you want to know a little of how Jonathan sees his life you can take a look at his Youtube video

 

Back in July, Jonathan's father surprised me by asking to video the demo whilst I gave a voice over. 

It's a bit like looking in the mirror these days - Im surprised to see how "grey" I've become.  Nevertheless, despite the informality I think the video shows something of Jonathan and how he respondes to the FES Cycling.

 

Client Sarah on her Support for Spinal Injuries Association

Despite her spinal injury our FES Cycling client Sarah has a formidable list of accomplishments so far in her life: a Master’s Degree  in human rights, work with an NGO in Africa, a modelling contract, deep-sea diving and backpacking across Australia and New Zealand. She recently featured in a Times article in support of her work voluntereering for the Spinal Injuries Association.

Now "a bit older" -  Sarah had broken C7, the seventh vertebrae in her neck in car accident when she was 16.  This crushed her spinal cord and, initially, left her completely paralysed and as the break was close to her voice box, she could not speak above a whisper.

She had just been selected for the under-18s Scotland hockey team, and the thought that she would never play again was one of the most painful aspects of her injury.  Sarah is keen to keep fit and adopted our RehaMove FES bike as a means of achieving this.  She had some prior expience with FES Rowing but had to stop due to hip problems.

Case Study - How RehaCom is used in practice.

This a case study focusing on RehaCom.  You probably haven't heard about RehaCom which is Europe's leading software for the professional therapist or neuropsychologist involved in dealing with cognitive impairments following an acquired brain injury (whether due to trauma, stroke or other condition).   Brain injury can have a devasting effect on the person - so essential is it to all aspects of life.  Even moderate injury can result in cognitive impairments such as lack of ability to concentrate, pay attention, remember and other aspect of daily life.

The software is very strong in Germany - the home of the manufacturer - Hasomed GmbH who have developed this software since the early 1990's.  This software has never been fashionable in the UK, but is finding favour now as it supports cost-effective therapy and lends itself to care in the community.

This article is more likely to be of interest to therapists who work in the area of cognitive rehabilitation and based on an interview made by Karen J Hewitt on our behalf.  As Anatomical Concepts now represents RehaCom in the UK we are interested in how we can learn from best practice elsewhere in the world.

Introduction
Frau Wartenberg is a (PTA) PT Assistentin, which is the German equivalent of a Doctor’s sister. She is an exception in terms of her training, in that she works as an Occupational Therapist (OT), but is qualified as a Psychologist.  Frau Wartenberg has been a PTA for 20 years at the NRZ Magdeburg (www.mediankliniken.de), Neurological Rehabilitation Centre. This rehabilitation centre is based at one of 22 Median state clinics (hospitals) all over Germany, and was founded by the late Professor Hans Regel. Frau Wartenberg, therefore, has known RehaCom for a very long time.

Clinic challenges
The main constraints and challenges within the NRZ Magdeburg Neurological Rehabilitation Centre are currently as follows:
1. Financial – The government budget available for cognitive rehabilitation insurance payouts is shrinking
2. Patient demand – the number of incidents of stroke and head injury are increasing all the time in Germany, indeed worldwide, and the clinic is required, therefore, to treat more patients than ever before.
3. Human resources – The therapist will always be essential to cognitive rehabilitation.  Currently there is a limit to the number of therapists allocated by the Government to the clinic.
4. Complexity – At the NRZ Magdeburg Neurological Rehabilitation Centre, the whole spectrum of brain injuries – from stroke to aneurism to head injuries and MS – is treated. Patients are also treated across the whole spectrum of cognitive disorder severity – from acute patients to levels B and C and also day patients. The therapist’s role is therefore varied, complex and demanding, including not just cognitive rehabilitation work, but also diagnostics and group work.

The implications
The implications of the above challenges at the NRZ Centre are as follows:-
1. Repeat visits - The financial constraints described above mean that patients often have to go back to work before they are ready.   Sometimes this leads to them becoming overstretched in their jobs and having to return to the clinic for a second phase of rehabilitation.

2. Time – The financial constraints described above mean that patients cannot stay as long at the clinic as the therapists would like to be able to do their job effectively, and the latter are under pressure to deliver the same results in a shorter space of time.

3. Stress – The combined challenges of increased patient demand, reduced time to carry out therapy, the growing complexity of the therapist’s role and a limit to the number of extra therapists that can be taken on at the clinic inevitably mean that the therapist’s role is increasingly stressful.

The solution
Therapists are greatly in need of tools in general which make their jobs easier and less
stressful.

Now, more than ever, Cognitive Rehabilitation Centres and their therapists need an effective cognitive rehabilitation tool in particular which saves them time, allowing them to treat a growing volume and complexity of patients in an ever decreasing time period. Importantly, though, effective cognitive rehabilitation (effective = improved cognitive functions that are translated into everyday life) can only happen through a trained and experienced therapist. This means that any solution to the challenges described above can only ever be an “Enabler” used alongside an experienced therapist i.e. a tool which enables the therapist to carry out effective cognitive rehabilitation as quickly and easily as possible.

RehaCom the Enabler
RehaCom is not the ANSWER to cognitive rehabilitation it is THE ENABLER.

A good therapist already has the knowledge of how to work alongside the patient to improve their cognitive functions and develop strategies to translate these improvements into everyday life. What RehaCom does is provide the materials and tools for these improvements and strategies, and this makes the therapist’s life much easier.  Frau Wartenberg has known this for some time, and has found RehaCom to be a great enabler since it was first adopted back in the early 1990s. Now, more than ever, and in the face of the current challenges, a good therapist is required to use RehaCom to its full potential and realise all the benefits it is capable of.  A word of caution RehaCom has a vast capability covering more than 20 different cognitive procedures and many different difficulty levels for each. As such, it requires an experienced therapist to fully understand and exploit its capabilities.  But RehaCom is so intuitive as to be deceptively simple.

Daniel's Story - FES Cycling client

Need a bit of inspiration? Our client Dan Eley, 33, was working with disadvantaged children and teenagers living on the streets in Colombia when he broke his neck on New Year's Day 2010.  It was the internet that came to Mr Eley's aid in the wake of his accident, as more than 8,000 people from around the world joined a Facebook appeal group to help him.

Undaunted by his accident, Dan now has an ambition to forge ahead with a new charity to continue his humanitarian efforts.

We are proud that Dan uses our RehaMove system to help him maintain his long term health.

The site - www.danieleley.org - describes Dan's experiences and future plans.

Today's article by Surrey and Berks Media is worth a read

http://www.getsurrey.co.uk/news/s/2086774_video__support_spurs_on_paralysed_dan_eley

Dan speaks of his plans

 

 

Using Sequence Mode Software - Clients Only

Sequence Mode software is a powerful optional add-on to our RehaStim unit.  Whilst RehaStim is normally used by our clients primarily with FES Cycling software, this 8 channel FES stimulator is a very flexible system. Adding the Sequence Mode software allows free standing use of the stimulator in a variety of applications only limitedby your imagination.

In this video we show how to programme a muscle stimulation sequence. So it's interesting if you are a client - 10 boring minutes if you're not :)

 

Upgrading a MOTOmed to an FES Bike

It's nice to provide FES Cycling systems.  We work with the German manufactured RehaMove system.  This combines a custom, 8 channel FES stimulator (manufactured by Hasomed GmbH) with a Reck MOTOmed motion trainer.  The computerised stimulator can be loaded with software to create a powerful FES bike that harmonises muscle stimulation based on a control system that links the two units.

We work hard to provide a first class service to our clients who are most often spinal cord injured.  Unfortunately many individuals who could benefit from these systems find them hard to finance.  Because the medical evidence and long term health benefits are clear, it would be great if everyone who could benefit could get to grips with these systems. 

Sometimes following a spinal cord injury, insurance and compensation processes can help with finance. That is rarely the case with persons who have MS or are recovering from a stroke, but nevertheless these individuals could benefit from an FES Cycle too.

One saving grace of our FES Bike is that anyone who already has a Reck MOTOmed Viva2 model can upgrade to a full FES Cycle.

This ability to upgrade has proved to be a great benefit - for example, when a client has not initially been responsive to stimulation, or now wants to increase the effectiveness of their exisitng motion trainer.

For individuals who already have a MOTOmed Viva2, the upgrade is very quick and easy to accomplish.  It may be necessary to replace the bike's controller - held with two screws - if the existing controller doesn't already have the interface to connect with the stimulator.

MOTOmed Viva2 is a trademark of Reck MOTOmed, Movement Therapy Systems

RehaMove is a trademark of Hasomed GmbH