Lower Limb and Walking

GEO

8-axis computerised gait robot with passive, semi-active and active modes made by Reha Technology.

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It is based on an end-effector technology (2 movable metal plates) to simulate walking and compared to ‘exoskeleton’ technologies allows partial limb movements to be modified.

The patient wears a safety sling to support him in the standing position during therapy and has a monitor in front of him with load bearing indicators on both feet as visual feedback.

The rehabilitator stands in front of the patient and can freely intervene to support and encourage the patient to work actively.

There are 5 possible variants of therapeutic use:

      Gait therapy in which the parameters that can be varied with regard to the stride are the speed (or cadence) and the length while with regard to the ankle the parameters that can be varied are both the initial contact of the heel of the foot, which during the gait phase is placed anteriorly, and the detachment of the heel of the foot, which is placed posteriorly. Finally, thanks to the presence of lateral carabiners to be attached to the sling, it is possible to vary parameters relating to the centre of gravity.
      Partial gait movements whereby parameters can be set on individual limbs to correct certain gait characteristics during walking. In particular, you can improve the three basic gait cycle movements of the individual limb: pre-flight, flight and stance.
      Visual Scenario consists of displaying 5 types of landscape scenarios on the monitor placed in front of the patient.
      Standard protocols are predefined by the device for patients with Alzheimer’s or Parkinson’s in both the possible less severe and more severe situation of the disease manifestation.
      WizardTherapy is a gait simulation mode that allows the rehabilitator to select and programme a customised combination of exercises and treatment protocols according to the patient’s needs.

COPERNICUS

It is a rehabilitation system for the early initiation of locomotion of hemiplegic patients.

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The patient wears a pair of insoles in his shoes equipped with piezo-resistive sensors that detect the stance of the foot and transfer the information via Wi-Fi to a controller with a monitor (tablet) that provides visual feedback for the patient when performing the various rehabilitation exercises.

Under the constant assistance of the therapist, the patient is positioned in an upright position laterally to a mechanical support that is height-adjustable to position the arm in abduction at 90° with respect to the trunk and that also acts as a lateral support to fix the hip of the healthy limb. In this way, the patient not only has the presence of the therapist but also feels a solid support for the healthy hemi-side. In a first rehabilitation phase, the patient wears a sling that supports him/her from above to relieve weight and to ensure standing.

The use of the sling also avoids the risk of falls and ensures that the exercises can be performed safely for the patient.

In a second rehabilitation phase, the patient can start to locomote as the arm-halve support can slide along a mechanical guide so that the patient can make a circular path and the sling can support the patient if he/she still needs it as it is also attached to the sliding support.

Rehabilitation exercises consist of a first modality in which the activity required of the patient is to distribute weight by progressively alternating the load from one foot to the other. Sensorised insoles measure the stance times for each foot and the number of stance changes. Furthermore, for each foot it is possible to extrapolate whether the foot strike is uniform as each insole has three sensors in three characteristic foot strike positions. Specifically, one sensor is positioned in the inner sole of the foot, one is for the outer sole of the foot and one is for the heel. This can also be displayed on the tablet monitor so that the patient can instantly correct the stance.

A second rehabilitation exercise modality consists of a walking activity in which the patient can progressively reach a predetermined number of steps by displaying a virtual landscape path on the tablet monitor.

PEGASO

Motorised cycle ergometer made by Biotech that enables assisted exercise with both passive and active training modes.

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Pegaso is equipped with an electronic control system capable of recognising the subject’s level of muscular effort in order to deliver the level of exercise most suited to the patient’s physical state.

In addition to enabling the pedalling movement and adjusting its resistance for cardio-pulmonary exercise, Pegaso is able to monitor and accurately measure the kinematic and dynamic parameters of the movement, such as pedalling speed, the power exerted by the muscles, and the distance virtually covered.

The system is equipped with an electrostimulator with 6 independent channels, each capable of delivering up to 140 mA.

Finally, Pegaso’s controller automatically adjusts the intensity of the electrical stimulation and thus the work done by the muscles, and the help or resistance offered by the motor to the pedalling to optimise the exercise in every pathology and training condition.

BALANCE

Easy-to-use stabilometric platform with an intuitive touch-screen display that offers training modes to improve balance, increase agility and develop muscle tone.

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The methods of use of the device consist of both evaluation and rehabilitation exercises..

La valutazione è permessa grazie a 5 metodi che sono:

  • the fall risk;
  • the single-leg stability test;
  • the static and dynamic stability limit;
  • the postural stability;
  • the CTSIB (Clinical Test of Sensory Integration of Balance) which identifies and tracks disturbances in balance and the three sensory systems associated with postural stability for compensation in cases of one or more compromised sensory systems.

The rehabilitation exercises consist of 6 modes in static and dynamic function:

  • postural stability;
  • stability limits;
  • weight displacement;
  • the control of trunk movement in a maze;
  • the loading percentage and random control of trunk movement;
  • finally, it is possible for the patient to perform an exercise in interactive mode.

OAK

Innovative and unique integrated system for fall risk assessment and prevention developed by Khymeia.

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OAK incorporates and digitises in virtual reality assessment tests based on clinically and scientifically validated international scales.

OAK is capable of performing complete objective fall risk assessment tests in a matter of minutes. Based on the test results, the system provides for the assignment of specific exercise modules to prevent falls.

The OAK instrumentation, together with a complete virtual reality visualisation and interaction system presented to the patient and instructor via the monitor, enables the implementation of an extremely advanced learning and rehabilitation framework based on operant conditioning. It should be noted that the environment within which the patient’s movement is implemented is virtual reality, so it not only allows an infinite number of scenarios to be developed for the patient, but also represents a completely safe working environment where there is no risk to patients in terms of safety.

GAIT ANALYSIS

Complete laboratory for functional assessment by means of integrated kinematic, electromyographic and dynamic analysis, developed by BTS Bioengineering

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The Movement Analysis Laboratory makes it possible to perform, with the use of advanced, non-invasive biomedical technologies, an accurate analysis of the kinematics and dynamics of the body segments, the relative joints involved and the muscular districts involved in the motor task being assessed, in pathological and healthy subjects, including sportsmen.

One of the main aims of the Movement Analysis Laboratory is to gain a thorough and precise understanding of the subject’s situation after an adverse event or surgical treatment, directing an appropriate rehabilitation therapy and evaluating the subsequent outcome.

ERIGO

Robotised elevation, stepper and integrated functional electrical stimulation bed made by Hocoma.

Erigo is an instrument that makes it possible to bring the patient upright at an early stage, even when the clinical situation is such that cooperation is not possible (presence of disorders of consciousness, such as vegetative state or coma).

The important added value of Erigo is that, at the moment the patient is verticalised, there is mobilisation of the lower limbs, which can take place either passively (the machine moves the limbs at a programmed speed according to a pattern of alternating flexion and extension) or by stimulating the active participation of the patient, when able to cooperate. The upper body is restrained by a sling attached to the tilt table at the chest and shoulders. The patient’s thighs are attached to the movement mechanisms and the feet are secured to special plates with springs, while the upper body is held in place by a sling integrated into the tilt table. Consequently, the flexion and extension movements of the hips triggered by the mechanisms are followed by the loading/unloading of the feet.

In this way, the therapy affects the movements of the hip, knee and ankle joints. The mobilisation of the lower limbs is controlled by a computer, which allows adjustment of leg movement, load, speed, hip extension and other parameters.

Erigo allows controlled verticalisation with movement of the lower limbs at a very early stage for patients who arrive from intensive rehabilitation in a non-mobile condition and who therefore first need to be readjusted to a vertical position.

On the two lower sides of the Erigo’s chassis are the delivery stations (4 ch. sn + 4 ch. dx) of Functional Electrical Stimulation that will be natively triggered depending on the constrained movement of the limb. Complete with system for easy patient transfer from the bed to the Erigo with treated antibacterial cover.

PROKIN

The Prokin system developed by Tecnobody, responds to the need to be able to visualise and quantify, by means of electronic processing, the proprioceptive sensitivity of the limb under examination both in the evaluation and rehabilitation phases.

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Prokin is an assessment and rehabilitation system that allows the quality of rehabilitation programmes in the orthopaedic and neurological fields to be improved with applications such as:

  • precise dynamic/static orthostatic balance assessments that allow rehabilitation intervention to be targeted;
  • assessment and training of cognitive and sensorimotor skills in the lower limbs;
  • muscle and movement biofeedback.

The system essentially consists of a network of sensors capable of detecting the smallest angular displacements and loads applied to a sophisticated treadmill.

When the patient interacts with the treadmill, the data acquisition card converts each movement into electrical impulses and sends them directly to the personal computer.
The electrical impulses, processed by the software, make it possible to display on the computer monitor a tracing closely related to the angular movement of the treadmill or to the loads applied to it; the patient, thus, can have a continuous visual feedback that allows him to establish a comparison between what he feels at a proprioceptive and kinesthetic level and what he actually produces motorically.

In essence, the patient is able to gradually reconstruct the correct map of proprioceptive and motor sensations.

EKSO

Automatic wearable rehabilitation exoskeleton for walking, aimed at people with motor disabilities of the lower limb made by Bionics.

It enables people with different motor skills, paraplegia, partial or total quadriplegia, hemiplegia, multiple sclerosis, and all conditions requiring rehabilitation for walking to stand and walk.

Ekso offers the patient total support and assistance for walking. Thanks to a complex system of sensors, specific to the pathology being treated, it enables the patient to walk passively, actively or with assistance.

WalkerView

Sensorised assessment and rehabilitation treadmill for improving the quality of movement by means of a comprehensive gait and running analysis in orthopaedic and neurological patients made by Tecnobody.

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Its use can be extended both to a user of normo-types for injury and trauma prevention, and to a user of sportsmen and women who want to assess their biomechanical set-up with specific tests and seek performance enhancement.

The WalkerView, allows the user to walk or run while analysing the correctness and quality of gait (walking/running) in real time.

With the Gait/Run Analysis function, it is possible to identify a series of parameters that are essential for understanding the quality of movement.

The WalkerView system has been clinically validated in comparison with traditional stereophotogrammetry motion analysis systems.

The Walker view sensorised treadmill enables the following functions:

  • Assessment and training in different aerobic training modes;
  • Assessment and training in postural posture during walking and running;
  • Assessment and training of segmental and global coordinative and sensorimotor skills;
  • Assessment and training of heterometry effects;
  • Assessment and training of joint asymmetries (presence of dysmorphisms and/or paramorphisms), focus on trunk, hips and knees;
  • Assessment and training regarding contact time, support and stride length;
  • Evaluation and training regarding load asymmetries between the two hemisomes, during stance phases;
  • Biofeedback inherent to the vertical oscillation of the subject’s centre of gravity;
  • Biofeedback inherent to joint angles during the kinematics of movement.

OMEGO

A highly innovative medical device made by Tyromotion for patients with gait disorders and impaired lower limb function that combines movement with neurocognitive rehabilitation; indispensable for recovering the correct gait pattern.

Omego is a robotic lower-limb therapy device that revolutionises the variability of movement therapy in cases of limited lower-limb function, supporting the patient from early rehabilitation to the possibility of verticalisation.

Two separate drives allow mobilisation of the patient, turning it into the missing link in gait therapy. The Omego supports the patient during rehabilitation to improve motor, sensory and cognitive deficits.

The Omego enables unilateral and bilateral lower limb rehabilitation with a variety of functions such as symmetry detection, leg press, stepper, cycling, rhythmic stimulation, proprioceptive and dorso-plantar flexion training.

Pre-gait therapy is specific rehabilitation for a single or multiple lower limb problems.

VRRS (Virtual Reality Rehabilitation System)

Medical device made by Khymeia from internationally patented Class I certificate and based on a virtual reality system for rehabilitation and telerehabilitation.

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Extreme user-friendliness, high customisation capacity, complete automatic reporting, and a telerialisation function are some of the guiding principles of the system’s continuous development.

VRRS, in fact, is conceived as a ‘central HUB’ to which a series of specialised peripheral devices can be connected via USB, fully synchronised and integrated with the system.

VRRS, with its exclusive magnetic kinematic acquisition system, is used as a clinical routine for the rehabilitation of a broad spectrum of pathologies through its numerous rehabilitation modules containing a vast library of clinically validated exercises for neurological (motor, cognitive, speech, posturographic, hand, finger and wrist, cervical head, immersive virtual reality, occupational therapy, muscle synergies) and orthopaedic (ankle, knee, pelvis, hip, hand, finger, wrist, elbow, shoulder, back, cervical head) recovery.

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