ReoAmbulator ™ Advance Gait Training Platform

January 2015

The ReoAmbulator ™ A Leading Advanced Gait Training Platform

Introduction

Presentation Intention

• ReoAmbulator ™ - The winning solution

• ReoAmbulator ™ – Features & Benefits

• ReoAmbulator ™ – PT’s and Patient’s experience

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Gait Rehabilitation Market

• REHABILITATION POST-SURGERY

– hip: partial/total hip replacements

– knee: total knee replacements

• NEURO-REHABILITATION

• Strokes; Multiple Sclerosis ;Parkinson; Cerebral Palsy.

• PROSTETICS REHABILITATION – Amputees (VA, IP, OP )

• REHABILITATION POST SPORTS / RECREATIONAL INJURIES

Background ReoAmbulator was introduced in 2002

150 sites, >100,000 patients up to date

Bridging the Technology Gap • HW- System design-√

• SW- user interface (Software screens, intuitive flow, Reports)- √

• Clinical applications:

Gait analysis and Biofeedback- √

Multi-tasking interactive program- √

Real-time measurable outcomes (distance, speed, Body weight)- √

• Patient engagement (motivation, level of interest ) -√

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The ReoAmbulator ™

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The ReoAmbulator ™

The ReoAmbulator ™ is composed of:

• Ergonomically Designed Advanced Robotics Platform

• Body Weight Supported Treadmill

• Gait Analysis Module combined with audio/visual Feedback

• Virtual Reality -Multitask interactive training program

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Ergonomically Design - Hardware

Folding robotic legs and detachable hand rail

Extra-wide treadmill

Integral 40” patient monitor

Separate 22” therapist monitor

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Intuitive Software Flow

A dedicated, 22” therapist monitor

An intuitive user interface,

Customized training parameters

to each patient

Data collection and PDF report: • Detailed gait analysis and biofeedback

• Monitoring and tracking patient’s session parameters & performance

• Ability to print reports and graphs

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Integral VR system

40” screen

Virtual Reality

• Real images

• Coordinated with treadmill speed

Real time feedback about speed and distance travelled

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Harnessing Design Short set-up time

• Easy harnessing

• Quick Connection

• Computerized control of robotic legs

Easy to use

Natural Gait Pattern

Natural Hip , Knee and Ankle Movements

Natural Center of Gravity movement

3 Physiological Gait Profiles

Optimal weight bearing

Natural Pelvic Rotation

Natural Pelvic lateral shift

Natural Gait Profile

Anterior View Lateral View

What Makes ReoAmbulator the winning Solution

Different Ambulatory / Activity Level

Full Continuum of Care

IP, OP, SNF, LTC

Adults and Children

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Acute Stages Chronic Stages

ReoAmbulator fits wide spectrum of patients populations, different stages in rehab and variety of ages

Wide Spectrum of Patients

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• Neurological and Orthopedics • Adult and Pediatrics

• Low and High level of Gait Training • Various Ambulatory Levels

What Makes ReoAmbulator the winning Solution

Clinical Rehabilitation and Research are moving toward Activity participation, Motor learning.

Motor learning – “a permanent change in motor behavior as a consequence of experience”.

• Practice

• Feedback during and after the activity

Active participation influence the plasticity of the brain and enhance or speed up recovery of motor function

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ReoAmbulator enhance Active Therapy- Motor Learning

Active Participation

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• “More learning will occur with more practice and repetitive trials” (Schmidt and Lee 1999)

– Butefisch et al. 1995

– Parry et al. 1999

– Taub et al. 1997

• The patient should learn maximally. The learning takes place through repeated experience with the

environment. (Affolter and Stricker, 1980)

• Increasing amount/intensity => Decreased degree of impairment and functional limitations

Neuroplasticity- change structure and function

“The idea that the brain can change its own structure and function through thought and activity is, I believe, the most important alteration in our view of the brain since we first sketched out its basic anatomy and the workings of its basic component, the neuron” (Doidge, 2009).

Image from www.socialphy.com

Doidge, N. (2009). The brain that changes itself. New York, NY: Penguin.

ReoAmbulator - Innovative Active Therapy

Training modes: includes the Active Ambulatory Therapy mode for an advanced active participation.

Active participation and enhancement of motor learning during various gait critical events.

Enhance Active movement at Loading Response, Midstance, Terminal Stance.

Facilitate learning process through repetitive practice and feedback.

Point 3- Terminal stance

Point 2- Mid stance Point 1- Loading response

Active Gait Training

• Active/Passive Therapy

• 2 Assisted Modes

• Real time Feedback

Point 1- Loading response Point 2- Mid stance

Patient Active Participation

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Innovative Modes of Operations

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ReoAmbulator ™ - Enhance motor recovery

Enhance symmetrical pattern

• Functional training

• Active participation

• Self-initiated movements

• Intensive and repetitive

Exercises Improves recovery

Stroke- Left Hemiparesis

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Intensive and controlled gait training

• Uneven stride length • Decreased stance time • Decreased eccentric control

during stance. • Compensatory gait pattern

CVA- Rt. hemiparesis

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Gait Coordination Training

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• Accuracy in step length

• Frequency

• Compliance score

• Real time Visual/Auditory Feedback

Audio-Visual Feedback

Audio Visual Feedback

Enhance gait symmetry • Gait coordination training with visual

and auditory biofeedback

• Step and stride length

• Weight Bearing, Speed and Distance

Progress to:

Less BWS + Higher speed

Higher steps length

Dynamic Balance Training- Multitasking

Comparison Rt Vs Lt -Accuracy

Stroke- Lt. Hemiparesis

Gait Coordination

Multi-Tasking Training

Multi-Tasking Training

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Gait training combined with Upper limb Motor & Cognitive challenges

Arch Phys Med Rehabil. 2009 March ; 90(3): 381–387

Multi Task- Motor and Cognitive training

Moving the upper extremity in a motor- cognitive interactions contribute to the challenge of gait regulation and postural control:

Changing the center of gravity location – challenge the control of gait function

Adding additional protuberance as a result of the external movement

Require a cognitive decision in real-time

Allow development of task-coordination skills

Allow improvement in walking speed during multi task activities.

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Pediatric- VR

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Motor and cognitive rehabilitation:

Enhances motivation

Improves gait & balance

Motion detection sensors follow patient movement in real time

Multi-tasking training:

Upper extremity exercises

Cognitive tasks

ReoAmbulator ™ - Benefits Intensive and controlled gait training therapy,

Online dynamic monitoring of the rehabilitation process,

Passive and Active mode of training,

Increased patient awareness , understanding, engagement,

Increased motivation by integrating multitask motor and cognitive training,

Improved therapy management by monitoring session's information and patient's progress.

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Clinically observed effects

Current patients experience:

• Improved confidence

• Improved stance stability

• Improved sensation in affected leg

• Decreased muscle spasticity with activity

• Improved endurance

• Decreased compensatory strategies

Testimonial

“Fast set up”. (M.S.)

“Gait pattern felt efficient movement” (S.S.)

“The active participation allows re-enforcement of hip extension” (M.S.)

“Gait feedback enhance my step length control” (Y.E.)

“At the end of my session I wonder -When can I come again..” (S.S.)

“I have got again the experience of a normal walking after 1.5 years…”(S.S.)

“It gives me hope!” (S.S.)

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ReoAmbulator ™ -The Winning Solution

Ergonomic design, Integrated Therapy Platform

Maximal Flexibility for patients at different stages of Rehab

Efficient ambulatory Therapy

• Natural Gait Pattern

• Short Set Up time

• Active training mode

• Integral VR -Multi-tasking

• High level of gait coordination

training.

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Thank you!

www.motorika.com