The use of assistive technology within neurorehabilitation is embedded well within the Acute Neurorehabilitation Unit at the Wellington Hospital. More recently we have been able to successfully integrate the Indego exoskeleton as another treatment tool alongside our existing technologies. Whilst in the early stages, the Indego exoskeleton was primarily utilised within our facility within spinal cord injury. The subsequent advent of Therapy Plus software has enabled a wider cohort of patients to benefit from the device. This has included early pre-gait training within our stroke population and spinal motor incomplete patients. Moreover, we are continuing to utilise it to complement patients’ therapeutic programme addressing other impairments following neurological injury including trunk control and midline awareness.
Starting out with the Indego
To a certain extent we envisaged at the start of this process that the Indego exoskeleton would be a natural progression from one of our other robotic gait training devices. It would also enable our patients who had a spinal cord injury the experience of trialling an exoskeleton. We have however learned and found over recent years that the Indego can be used across both in- and out-patient settings and at different time points following neurological injury.
Recent research has highlighted the use of technologies to improve outcomes following both stroke and spinal cord injury and that this is most effective when combined with Physiotherapy. As such it is key that there are clear aims and goals of any technological adjunct used within Neurorehabilitation. It’s vital that this complements the individual patient’s rehabilitation programme. Often this can be challenging to ensure a balanced and cohesive rehabilitation programme. Moreover, there remain many unanswered questions and tools to assist new staff in selecting the most appropriate technological adjunct. As such it is key that within each team there are staff members driving further learning and training forward and have a specialist interest in technology within neurorehabilitation.
Within our in-patient population we have been able focus on a range of areas rather than just gait re-education over recent years. Within our unit the Indego is, more often than not, used as a therapy tool. Recently we have started to explore its use within our spinal injured population as an alternative tool to a routine passive standing frame. Whilst we know the benefits of a regular standing programme within this population there are clear advantages from taking them through a physiological gait pattern compared to a static stand.
A recent patient on our unit who suffered a cervical motor incomplete injury progressed to using the Indego with the therapy team three times a week as part of his programme. He was able to use the device and walk with a pulpit frame and assistance of one therapist for up to 30 minutes. Improvements were also noted in his 6-minute walk test from 100m with a pulpit frame and assistance of two, to 155m with a pulpit frame and assistance of one, alongside a reduction in perceived exertion. Within our Neuro-Outpatient service we have continued to offer Indego exoskeleton trials for patients both within the UK and overseas. Currently we perform weekly sessions with a patient who suffered from Guillan-Barre syndrome. The primary goals for the patient using the device early on was to explore its potential to challenge both trunk control and cardiovascular fitness. More recently the sessions have been driven by the patient himself a part of his on-going therapy programme and to explore the use long term in the community.
“The experience of practicing assisted walking had a positive physical and psychological impact on the rehab program. The Indego sessions were frequently the most challenging but also some of the most enjoyable sessions I had due to the nature of the activity as well as the overall set up of the session.”
-Wellington cervical motor incomplete patient
We continue to learn daily about how best to integrate technology within Neurorehabilitation. Patients themselves are driving this forward too and are vital in their feedback as technology continues to evolve and develop within this field.
Rob Bateman, PT, MSCP is a Clinical Specialist Physiotherapist at the Wellington Hospital, London. Rob received a MSc (Pre-registration) Physiotherapy degree from King’s College London at the end of 2009. He started his career working at Guy’s and St Thomas’ Hospital within the National Health Service through a 5-year period. During this time Rob began to specialise within Neurological Rehabilitation and subsequently took up a position at the Wellington Hospital in London on the Neurological Rehabilitation Unit in 2015. During this time Rob gained further experience and expertise utilising a range of technologies at The Wellington Hospital including; Indego Exoskeleton, Hocoma Lokomat and Erigo alongside a range of functional electrical stimulation devices. Since 2018 Rob has been working as the Clinical Specialist Physiotherapist on the Rehabilitation Unit and continues to drive the use of technology within Neurorehabilitation. Rob is a certified Indego trainer and has lectured on the use of assistive technology within Neurorehabilitation.
The Wellington Hospital
The Wellington Hospital's Rehabilitation Centre is the largest private centre in the UK. Designed specifically for rehabilitation patients, we provide intensive and bespoke programmes of care for patients particularly those with complex neurological injuries and conditions such as a stroke, head injury or spinal cord injury. We have a Neurological Rehabilitation Unit, Prolonged Disorders of Consciousness Unit (PDOC), Medical Rehabilitation Programme, Functional Restoration Programme (FRP) and Polytrauma and Amputee Rehabilitation Programme. Having access to a wide range of medical specialties and acute care here on-site – including critical care – enables us to admit patients soon after injury or diagnosis.