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1. If the foot drops down at initial contact, does this affect therapy outcome? Answer
2. With which treadmills can the LokoHelp be used? Answer
3. Can the LokoHelp be retrofitted? Answer
4. Is the stride length of the LokoHelp adjustable? Answer
5. Are there published studies referencing the LokoHelp? Answer
6. Which diseases with which therapy goals can be treated with the LokoHelp? Answer
7. Is there an age limitation for patients or minimum age for this kind of therapy? Answer
8. Is there a therapist able to tell us about his / her practical experience with LokoHelp therapy? Answer
9. What happens when a spasticity is elicited? Answer
10. Is the gait pattern physiological as there is no heel strike? Answer
11. Is the "drop-down" in the beginning of the stance phase disadvantageous? Answer
12. The transition from stance phase to swing phase seems somehow unsmooth. Is there any effect regarding the quality of movement of the "relearned" gait pattern? Answer
13. How active is the patient during the LokoHelp training? Answer
14. Does the orthosis allow movements of the ankle joint? Answer
15. Under which patient conditions can training with the LokoHelp begin? Answer
16. Does a fixed stride length make sense as it differs from patient to patient? Answer
17. Is it necessary to have an adjustable stride length on a gait trainer? Answer
18. Are there existing studies comparing the LokoHelp to other gait trainers? Answer
19. Is there a risk of overexerting the knee? Answer
20. Is LokoHelp training suitable for geriatric patients also? Answer
21. Is the LokoHelp training superior to the manual assisted treadmill training? Answer
22. Is it important to unload the patient from his body weight during LokoHelp training? Answer
23. Can the patient do the LokoHelp-training on his own? Answer
24. Is it important to fix the patient's pelvis during LokoHelp training? Answer
25. Is it possible to practice the posture control during LokoHelp training? Answer
26. Is it important to instruct the patient during LokoHelp training? Answer
27. Which factors are essential for the therapy outcome with the LokoHelp? Answer
28. Is the position of the body weight support system relevant? Answer
29. Can LokoHelp training be conducted with one-point body weight support suspension or is it necessary to have two-point-suspension? Answer
30. Does the treadmill need to have inclination? Answer
31. Is it important to fix the patient forward? Answer
32. What is the difference between the LokoHelp and other gait trainers? Answer
33. Is a dynamic weight-unloading system advantageous? Answer
34. How long does it take to prepare the patient for LokoHelp training? Answer
35. Is a time-intensive instruction course necessary for application of the LokoHelp? Answer
36. Can the harness be applied to the patient while he is sitting in a wheelchair? Answer
37. What type of "progress" can be achieved with the LokoHelp? Answer
38. May the patient wear his own shows and also his own orthoses during the LokoHelp-training? Answer
39. May the patient train with the LokoHelp barefoot? Answer
40. What is the maximum weight load of the LokoHelp? Answer
41. Is the LokoHelp suitable for home use and does it require assisting professionals? Answer
42. Is there a feedback system that provides active feedback regarding patient performance? Answer
43. Up to which location of spinal cord injury can patients be treated with the LokoHelp? Answer
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| 1. If the foot drops down at initial contact, does this affect therapy outcome? |
No, because other facts are relevant for the therapy outcome. Relevant are hip-extension and load on the foot sole during the stance phase and the number of repetitions of the gait cycle. back to list of questions
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| 2. With which treadmills can the LokoHelp be used? |
Generally the LokoHelp works with every treadmill. For adapting the LokoHelp to a treadmill we require the following information: from WOODWAY-treadmills, the serial-number, from non-WOODWAY-treadmills we need to check the adaptation possibilites. For this we need to know the exact product name with technical measures, ideally photos. It's important to have a stable, preferably height-adjustable handrail and a body-weight-support system. back to list of questions
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| 3. Can the LokoHelp be retrofitted? |
Yes, the LokoHelp can be retrofitted at any time. back to list of questions
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| 4. Is the stride length of the LokoHelp adjustable? |
The stride length is not adjustable. There are two sizes of the LokoHelp: the LH 400 M with a stride length of 40cm for adults (body height approx. 1.50 to 1.98m) and the LH 300 M with a stride length of 30cm for children (body height approx. 1.1 to 1.5m). With these both sizes most of the patients can be treated adequately. back to list of questions
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| 5. Are there published studies referencing the LokoHelp? |
Yes, there are two studies verifying the improvement of gait ability:
1) Freivogel S, Schmalohr D, Mehrholz J
IMPROVED WALKING ABILITY AND REDUCED THERAPEUTIC STRESS WITH AN ELECTROMECHANICAL GAIT DEVICE.
J Rehabil Med 2009; 41: 734–739 read more
2) Freivogel S, Mehrholz J, Schmalohr D
GAIT TRAINING WITH THE NEWLY DEVELOPED „LOKOHELP-SYSTEM IS FEASIBLE FOR NON-AMBULATORY PATIENTS AFTER STROKE, SPINAL CORD AND BRAIN INJURY.
Brain Injury, July 2008; 22(7-8): 625-632 read more
back to list of questions
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| 6. Which diseases with which therapy goals can be treated with the LokoHelp? |
The LokoHelp improves gait ability in many patients with spinal cord injury, stroke, traumatic brain injury, cerebral palsy and with diseases of the spinal cord or peripheral nerves affections. The LokoHelp-training can also be conducted for improving the range of motion of joints, for strengthening the muscles as well as for cardiovascular training in orthopedic and geriatric patients in addition to severely affected neurologic patients. back to list of questions
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| 7. Is there an age limitation for patients or minimum age for this kind of therapy? |
No, there is no age limitation. However, patients should be at least approx. 1.1 m in height with a maximum approx. height of 1.98 m. back to list of questions
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| 8. Is there a therapist able to tell us about his / her practical experience with LokoHelp therapy. |
Yes, please see the interview with the physiotherapist Ms. Tanya Husak-Sotomayor. back to list of questions
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| 9. What happens when a spasticity is elicited? |
The LokoHelp and the treadmill will be stopped automatically. back to list of questions
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| 10. Is the gait pattern physiological as there is no heel strike? |
Generally heel strike is possible with the LokoHelp if the patient is positioned properly over the LokoHelp and if he is instructed. Though the evidence based treadmill-training supports other mechanisms; of key significance are the spinal locomotor generators, that are activated by load on the foot sole and on the forefoot (and not by the heel strike). back to list of questions
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| 11. Is the "drop-down" in the beginning of the stance phase disadvantageous? |
The "drop-down" can be reduced by moving the suspension point ventrally. If the patient shows a knee flexion in the mid stance, the unloading should be increased. back to list of questions
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| 12. The transition from stance phase to swing phase seems somehow unsmooth. Is there any effect regarding the quality of movement of the "relearned" gait pattern? |
The goal of the LokoHelp-training is to practice stance and swing phase. Itis not intended to trigger a perfect physiological gait cycle. It's worthy of mention that studies with other devices for automated locomotion therapy
have shown that the optimized gait pattern during the training does not lead to an improvement of the patient's gait pattern while walking on the floor. back to list of questions
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| 13. How active is the patient during the LokoHelp training? |
We do not know exactly, however, EMG recordings have shown that the patient shows muscle activity in the relevant muscles. It is important to ask him to actively stretch the leg during the stance phase. back to list of questions
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| 14. Does the orthosis allow movements of the ankle joint? |
No, and this is desired in order to avoid a pronation / supination of the ankle joint. However, the movement between the orthosis on the orthosis runner enables a flexion and an extension movement which is necessary for the push-down in terminal stance. back to list of questions
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| 15. Under which patient conditions can training with the LokoHelp begin? |
Ability to sit; i.e. the patient must show balance reactions in the sitting position. Moreover, it has to be possible to trigger load and unload of the lower extremities while using the body-weight support system (with the help of a harness). Standing ability is not required. back to list of questions
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| 16. Does a fixed stride length make sense as it differs from patient to patient? |
In the initial phase of relearning to walk a fixed stride length is sufficient. In later stages, if the patient walks independently and the LokoHelp training is no longer required, he will choose his own stride length. However, it is often noticed that the stride length then is less than the stride length of 40 cm given by the LokoHelp. back to list of questions
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| 17. Is it necessary to have an adjustable stride length on a gait trainer? |
Adjustability of the stride length is not required in the initial phase of relearning to walk when the LokoHelp is used. back to list of questions
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| 18. Are there existing studies comparing the LokoHelp to other gait trainers? |
To date, there is no clinical study comparing efficiency in regard to the improvement of gait ability. A recent investigation has shown that the muscle activity and the load are comparable between the devices. back to list of questions
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| 19. Is there a risk of overexerting the knee? |
No, if the required unload and a correct suspension point is correctly regulated and maintained. With pronounced muscle weakness it may be advisable to give additional support to the knee with braces or manual support. back to list of questions
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| 20. Is LokoHelp training suitable for geriatric patients also? |
Yes, the LokoHelp training is suitable for all ages if with sufficient cardio-pulmonary capacity. back to list of questions
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| 21. Is the LokoHelp training superior to the manual assisted treadmill training? |
Yes, as stride frequency is higher. Since the physical strain of the therapists is eliminated training sessions are longer, the number of repetitions is higher - an essential fact for relearning to walk. back to list of questions
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| 22. Is it important to unload the patient from his body weight during LokoHelp training? |
Generally the less the patient is unloaded the better. Patients showing a knee flexion in mid-stance have to be unloaded. back to list of questions
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| 23. Can the patient do the LokoHelp-training on his own? |
For safety reasons the patient should be supervised at all times during LokoHelp training. In order to achieve a successful therapy outcome gait pattern must be supervised and corrected when needed. back to list of questions
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| 24. Is it important to fix the patient's pelvis during LokoHelp training? |
Yes, in order to stabilize the patient's center of mass. Usually elastic rubber bands are used which do not limit the mobility of the hip joints. back to list of questions
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| 25. Is it possible to practice the posture control during LokoHelp training? |
Yes, it is possible because the patient cannot lean on anything toward the rear. In order to train posture control the patient should not grip the handrails. E.g. by extending one arm forward or turn the patient's head one can increase the demand to the posture control. back to list of questions
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| 26. Is it important to instruct the patient during LokoHelp training? |
Yes, definitely. The patient should be requested to perform an active hip- and knee extension during the stance phase if possible. In addition to instruction one must give manual and / or verbal feedback about the patients performance to achieve optimal gait pattern results. back to list of questions
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| 27. Which factors are essential for the therapy outcome with the LokoHelp? |
Frequent therapy sessions (3 times per week), a high number of step cycles (800 - 1000 per therapy session) as well as an active extension in hip- and knee-joints during the stance phase and the correct position of the center of mass are all essential for positive therapy results. back to list of questions
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| 28. Is the position of the body weight support system relevant? |
Yes, the suspension point should be vertically centered over the middle of the orthoses runners. Therefore, it is advantageous if the suspension point can be adjusted in the horizontal direction. back to list of questions
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| 29. Can LokoHelp training be conducted with one-point body weight support suspension or is it necessary to have two-point-suspension? |
LokoHelp training can be conducted with one-point-suspension, however, one-point-suspension leads to more trunk instability and moreover asymmetric unloading is not possible. A two-point suspension system is therefore more favorable. back to list of questions
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| 30. Does the treadmill need to have inclination? |
No, LokoHelp training can also be conducted without inclination. However, by inclining the treadmill up to 10% it is possible to provoke necessary hip-extension even further. back to list of questions
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| 31. Is it important to fix the patient forward? |
It is not absolutely essential to fix the patient forward but it helps to bring the patient further into proper hip extension. LokoHelp patient harnesses are equipped with two lateral metal rings where a specially designed elastic band can be fixed and wrapped around the front cross bar to assist with this. back to list of questions
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| 32. What is the difference between the LokoHelp and other gait trainers? |
The LokoHelp is an end-effector-system, i.e. only the last joint of the kinematic chain (here the foot) is supported passively by the device. On the contrary, other gait trainers exist which are referred to as exoskeleton-devices as they support hip- and knee joints similar to movement splints. According to current studies the end-effector-principle seems to be superior in regard to relearning to walk as the patient is required to do more "work".
Please see here studies regarding the efficacy of gait trainers. back to list of questions
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| 33. Is a dynamic weight-unloading system advantageous? |
LokoHelp training can be performed with a static body weight support. Dynamic body weight support is preferred when performing LokoHelp training without bearing weight on the hands via treadmill handrails. back to list of questions
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| 34. How long does it take to prepare the patient for LokoHelp training? |
Therapy preparation depends on the severity of the patient's impairment and also on the experience of the therapist - usually 10 - 15 minutes are sufficient. Harness application is more time-consuming than orthoses application, though harness application is necessary with all gait training systems. back to list of questions
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| 35. Is a time-intensive instruction course necessary for application of the LokoHelp? |
No, instruction for a trained therapist takes only approx. 4 hours. back to list of questions
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| 36. Can the harness be applied to the patient while he is sitting in a wheelchair? |
Yes, the harness is designed for application while sitting. However, the harness usually fits even better if it is applied while the patient is standing e.g. with support of a wall bar or while lying. back to list of questions
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| 37. What type of "progress" can be achieved with the LokoHelp? |
The LokoHelp can achieve independent walking ability with or without walking aids, improvement of joint mobility and muscle power as well as the reduction of spasticity of the lower extremities. It can also improve trunk- and head control, the facilitation of transfers as well as an improvement of subjective well-being. back to list of questions
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| 38. May the patient wear his own shows and also his own orthoses during the LokoHelp-training? |
Yes, the special design of the LokoHelp orthoses allows the patient to wear his own shoes and also his own orthoses during the LokoHelp-training. back to list of questions
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| 39. May the patient train with the LokoHelp barefoot? |
Yes, though for hygienic reasons shoes should be worn. back to list of questions
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| 40. What is the maximum weight load of the LokoHelp? |
The LokoHelp LH 400 M can bear 120kg (the LH 300 M can bear 60kg). Patients with more body weight must be unloaded by the body weight support system. back to list of questions
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| 41. Is the LokoHelp suitable for home use and does it require assisting professionals? |
Yes, the LokoHelp is suitable for home use as well. Therapists and other attending persons must be instructed and a treadmill with body weight support must be available. back to list of questions
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| 42. Is there a feedback system that provides active feedback regarding patient performance? |
The LokoHelp does not currently yet offer a feedback system. However, through our close cooperation with the Freiburg university hospital in Breisgau, Germany, we are currently developing a feedback-system which will be tailored to LokoHelp training and we expect to be able to offer this in the near future. back to list of questions
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| 43. Up to which location of spinal cord injury can patients be treated with the LokoHelp? |
Basically LokoHelp-training is possible in patients even with cervical spinal cord injury. An independent walking ability however will be achievable only in patients with incomplete lesions. back to list of questions |
