Our last week has come to a close, and it didn’t disappoint! I was able to increase my caseload and try new things with patients!
For two afternoons, I learned how to operate and use the Lokomat (a body weight support system combined with a machine that moves the lower legs on a treadmill). It is so complicated! There are so many things that you have to do before you even get the patient! During the examination, you have to get measurements of the legs and enter it into the computer. Then every time that patient comes, you have to manually set the machine to those measurements so it fits the patient perfectly. Each patient does it for 20-30 minutes depending on how much they can tolerate. The type of patients that can use the Lokomat varies. Some patients have some movement in their legs, so the level of assistance that the Lokomat provides is less and vice versa. Even though most patients will probably never walk again, it can be good for maintaining passive range of motion and reducing spasticity. Also, if the patient has some weight-bearing on the treadmill, that is good for maintaining bone strength.
There was a big screen set up in front of the patient that they could play games. Many of the games had an avatar who performed the same movements as them. The object of the game was to catch different items on the screen. In order to turn, the patient could use what little movement they had to change directions on the screen. There were graphs on the computer monitor that showed how much assistance the patient needed, and if their movement was corresponding with the machine or not. If the patient were cognitively aware, they would be able to adjust.
One of the coolest things I saw was the “Indego”. It was invented in Germany, but Italy is the first nation in the WORLD to get it approved and use it in their clinics. It is like the Exo-skeleton (which is also a body movement walking system) but much smaller and lighter weight. All you need to be able to use it is passive movement of your legs. The level of assistance the machine gives can vary from patient to patient. There is a computer in the hip and the knee and the total weight is 12lbs.
Our hospital/clinic was on the news because there was a patient who was getting married, and he was to use the Indego to walk down the aisle!!!! It’s amazing what technology can do. The ultimate goal is that because it’s so compact, lightweight, and easy to use, that patients will be able to use it at home. It costs about $80,000 so those who can afford it can purchase it; otherwise, the hope is that as the price goes down, they will become more affordable.
One of the Indego patients was a 47-year-old woman who also had surgery on her spine and no longer has use of her legs. She uses the Indego almost every day. I also saw an Indego examination of an anesthesiologist who fell from a small ladder and injured C3-C5. He regained use of his arms and trunk, but not his legs.
On Wednesday, Kristin and I presented our inservice, “Mobilization with movement” (Mulligan Concept). We spoke in English incorporating some Italian, but our Powerpoint was ENTIRELY in Italian. It went awesome, and all the therapists were really impressed. We even included two demonstrations of the techniques. Normally in the US we bring in food for the inservices we present, but here they had a spread of pizza, paninis, and dessert!
MY FAVORITE PATIENT:
My favorite patient was always treated in her room because she had a trach and an NG tube. In the last two weeks, we progressed to standing and walking! Her hair was always crazy when we started getting her out of bed, so I would comb it for her (one of my favorite things). The last week my therapist and I would tell her I was leaving and traveling Europe and then heading back to America. On Friday, I told her “ e stato un piacere” (It was nice to meet you), buona fortuna (good luck), and even asked her to come back to my house! After all this, she looked up at my CI and says “ill see her Monday??” We had to explain I was leaving…forever. ;(
Before leaving, one of the CI’s told us, “Buona Vita”, meaning have a “good life”. Contrary to belief, it’s a term used instead of goodbye, in the possibility of reuniting in the future even though we are a world apart. I love it, and I will be back. I promise.
PS: Next post from Vienna, Austria!