Whether a child receives care for their complex condition or injury in an inpatient or outpatient setting, comprehensive rehabilitation is key to making progress. Rehabilitation therapy helps patients learn how to maximize their abilities and become familiar with new ways of moving. At Gillette Children's Specialty Healthcare, the use of locomotor training, a form of walking therapy that involves body weight support, can help eligible patients increase function in their lower extremities and improve their mobility.
A device called the Lokomat® is one tool that can help some patients participate in locomotor training. The Lokomat uses a robotic exoskeleton to help the user move their legs during therapy. At Gillette, we call this robotic-assisted locomotor training. Gillette has been using a pediatric Lokomat with patients since 2011, and is home to one of few available in Minnesota today.
As a destination for world-class pediatric rehabilitation therapies, Gillette has one of the nation’s top rehabilitation programs accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). Gillette is one of only eight U.S. pediatric inpatient rehabilitation facilities to have CARF accreditation for both its pediatric specialty and pediatric brain injury programs.
The Role Lokomat Plays in Pediatric Rehabilitation
At Gillette, the Lokomat is used during inpatient and outpatient rehabilitation therapy to help children who have walking goals and can tolerate supported standing for a long duration of time. Kids who have complex conditions like cerebral palsy, traumatic brain injuries, spinal cord injuries, or other non-progressive neurological disorders can use the device. “It allows them to safely experience walking earlier than they would without locomotor training,” says Amy Schulz, a physical therapist and clinical educator at Gillette, who works closely with patients on the Lokomat.
One common use of the Lokomat at Gillette is for patients who have cerebral palsy and who are recovering from a selective dorsal rhizotomy (SDR) or single event multi-level surgery (SEMLS) procedure. For 6-year-old Caleb Magana, getting on the Lokomat after his SDR surgery was an exciting learning opportunity and a chance to push himself towards his goals in a fun way.
“The Lokomat helped Caleb discover muscles he wasn't used to using,” says Kenia, Caleb’s mom. “His gait has improved tremendously and he is now able to do what he calls ‘heel-to-toe’ walking. In just the short months since the surgery, we've seen a great improvement and can't wait for his continued progress!”
For children who have incomplete spinal cord injuries—meaning they still have some sensation and/or movement in their lower extremities—walking may not be the immediate goal. Similarly, with patients who have acquired a brain injury, therapy goals are typically focused on helping them become independent and functional first. Therapists will recommend an eligible patient try the Lokomat after starting with skills that will help them function at home sooner, like learning to transfer from their wheelchair to their bed.
Therapists might use the Lokomat 2-5 times a week over the span of 6-9 weeks, depending on a patient’s therapy goals and schedule. “As a patient makes progress, they might stop using the Lokomat and advance on to other therapies that will help them continue to improve,” explains Amy. “They might also continue to use the Lokomat with less support or guidance provided by the robotic exoskeleton.”
Therapists are present during sessions to assess a patient and make any necessary adjustments to the hardware, speed and support of the device, or incorporate the augmented features—like videos or games—to provide motivation and engagement. Other tactics to help patients progress during a session might include reaching activities, music activities to help them incorporate rhythm, or having them pretend to step over something.
The Difference Locomotor Training Makes
The Lokomat is different than other rehabilitation equipment because it combines a robotic exoskeleton with dynamic body weight support, meaning the machine moves up and down with the patient to mimic a natural walking pattern. In addition, where other forms of therapy might require several therapists to get a child up and moving, the use of the Lokomat allows a child to participate with the assistance of only one therapist.
“We got our Lokomat in 2011, and we assess patients before and after treatment with measurable outcomes based on family goals to see how satisfied they are with progress,” says Amy. “We get constant feedback from families that they are noticing differences by the end of therapy, especially with patients who have undergone selective dorsal rhizotomy surgery.”
Watching families react to their child walking for the first time with the Lokomat can be an emotional moment. “Being able to walk is likely something a patient has been working toward for a while, so seeing it visually is quite special,” says Amy.
Kenia agrees. “Being on the Lokomat was the first time Caleb mimicked walking after his surgery and I wasn't sure how he'd do,” she explains. “But he is very strong-willed and not only LOVED being on the "robot" (Lokomat) but actually looked forward to it. We were in awe of how he excelled, and learning how the device worked and taught him movement was even more astounding.”