MOTIONrehab believes in using technology that can help and promote rehabilitation. It is essential that any technology implemented by MOTIONrehab is there to help promote outcomes and functional recovery.
This means the technology has to facilitate high repetition and practice of movement patterns to provide intensive neuro-rehab.
In 2018, MOTIONrehab opened the UK’s first highly intensive neuro-rehab centre based in Leeds.
The selection of devices for the centre was crucial and Director, Sarah Daniel, ensured the devices chosen were backed by clinical evidence and could really promote outcomes by allowing patients to practice high repetitions with natural movement patterns.
When ReWalk approached MOTIONrehab to see if the ReStore could be integrated into MOTIONrehab’s clinical practice and trial it with their clients, the team felt the device fitted MOTIONrehab’s portfolio perfectly.
The ReStore uses a sensor-based system to detect a patient’s walking pattern and at the appropriate times the ReStore robotics will lift and lower the foot to naturalise the walking pattern to improve gait biomechanics.
Uniquely, The ReStore robotics not only provides a lift of the foot during the swing phase of walking, it also assists the user into planta- flexion to recreate the ‘toe-off’ phase of gait and facilitate propulsion.
It was very clear early on while working with ReWalk that the ReStore would have huge benefits to patients in the acute phase of their rehabilitation, for example, the early days post stroke or even early after a MS relapse.
MOTIONrehab is now working with the ReStore to explore its role in more chronic patients and individuals who are further down the line in their rehabilitation.
Tom McGregor, clinical lead for Hull and East Yorkshire at MOTIONrehab, says: “We already utilise other technologies, including robotic gait training and functional electronic stimulation, and we’re always on the lookout for anything new that might assist our clients in rehab.
“Our initial impression is that the ReStore has the potential to influence neuro-plasticity, “re-wiring” of the nervous system, for a range of patients and presentations.
“By using the ReStore patients have better gait biomechanics which in turn is resulting in increased walking distances, faster walking speeds and greater confidence to walk.
“The facilitation of the push off and lift of the foot during walking in a naturalised gait pattern is permitting high repetition of stepping needed to influence the nervous system to enhance outcomes.
“We’re using ReStore as a therapy tool in clinic to optimise our treatment sessions.
“The clients that have tried it so far have reacted really well, so the plan is to utilise it on successive sessions over the coming weeks and months.”
The device can be used in three separate modes. Firstly, in a ‘slack’ mode that provides no assistance. Secondly, in a ‘brace mode’ that replicates the rigid support usually provided by an ankle-foot orthosis (AFO) and lastly, in the ‘active’ mode where it provides dorsiflexion and planta-flexion synchronised with the user.
Standardised assessments of walking can also be measured, such as the 10m, two minute and six minute walking tests.
Tom says: “Following stroke or neurological illness patients commonly experience weakness or loss of control around the foot and ankle. This can frequently impact on their walking abilities and it can take a lot of effort to move.
“If we’re assisting in that movement, we often need two therapists and it can be quite effortful for the both therapist and client.
“With the device on, it takes some of that away and gets the client moving more naturally at the ankle through the use of the targeted robotics. It gives the patient a natural pattern of push-off (planta-flexion) and lift up at the ankle (dorsiflexion) – which makes the leg lighter so they can then take a step forward.
“I have found that the outcome reporting from the device has been helpful in treatment sessions to monitor and measure progress. Using the internal sensors in the device, the ReStore collects walking parameters such as gait speed and number of steps. By switching between the modes on the device you can accurately track progress and measure outcomes accurately.”
MOTIONrehab has found that patients have responded positively to the ReStore.
“A good example of the benefits is the outcomes from one of our client’s using it for the first time. It’s worked really well, he was able to put less effort into his walking and achieved a better step with less effort. That allowed us to walk significantly greater distances with more steps than we would usually be able to do in a session.”
Sessions with the ReStore at MOTIONrehab generally last 50 to 55 minutes. Setting up of the device is currently taking around eight to 10 minutes, although it is anticipated this will reduce with experience.
The amount of walking distance enabled in sessions with the device, is “easily” double that of sessions without the device, says Tom.
Another benefit of ReStore, aside from efficiency, is that it frees up the therapist to spend more time either analysing the client’s overall movement as they don’t require the same level of assistance, or the therapist can facilitate other areas of the body as necessary.
“It’s meant that we don’t have to assist clients as much with their walking because the device is supporting them. From a therapist’s point of view, that means we are better positioned to observe what the rest of their body is doing – like their trunk position and weight transference.”
Restore has also brought a new level of reliability into the sessions, which breeds confidence in the client, says Tom.
“The steps have a consistency that is hard to match for therapists manually supporting them. With the device on, the patients know every time they step, they’re going to get a consistent and reproducible ankle movement, which is especially important if we’re working on gait.”
Another client advantage seen by Tom is motivation.
“One stroke survivor who would normally manage four or five walks using the 10-metre wall bar without the device, achieved 10 in our last session with Restore, double his usual walking distance with ease.
“When he has the device on, it really engages him and he actively wants to do more walking because he likes the feel of a normal walking pattern. Technology can sometimes be quite scary for clients but equally, if they know it’s going to help them, patients embrace it. It also adds variety into what we’re doing.”
MOTIONrehab will continue to work with ReWalk and the ReStore device over the next six months, collating data on its impact with clients and integrating it into its clinical practice. For more information on MOTIONrehab visit www.motionrehab.co.uk.
To register your interest in ReStore contact Stephen Ruffle (firstname.lastname@example.org / +44(0)7469254453). Read more: www.rewalk.com.