The Neurological Interdisciplinary Treatment Centre NiB (Neurologisches Interdisziplinäres Behandlungszentrum) is an innovative rehabilitation centre in Cologne. The Made for Movement partner centre has recently started to use the new model of the robotic movement trainer Innowalk Pro. Julian Breuer, senior physiotherapist at NiB, shares the clinics experience with us.
The NiB rehabilitation centre
The clinic NiB in Cologne is an outpatient rehabilitation centre, specialised in holistic, individual treatment options such as gait therapy. The clinic was established in 1998 and is run by Dr. med. Anuschka Rodenberg, medical director, and Jens Rodenberg. Their broad expertise makes it possible to treat about 50 different rehabilitation patients every day.
The team of occupational therapists, physiotherapists and doctors at NiB offers a wide range of services for patients with neurological/neurosurgical conditions. The Innowalk Pro has since 2019 been an integrated part of therapy, and the new device is now in daily use alongside its predecessor.
New version of the Innowalk Pro
The NiB clinic was the first rehabilitation centre in Germany who purchased the newest version of the Innowalk Pro. They have long experience with using the device in rehabilitation and was excited about getting the new version with new features up and running.
"We were particularly impressed by the new device's lower entry point, which allowed us to significantly reduce the set-up time for each patient. A majority of our patients can now independently transfer themselves into the device with help of the strength in their arms. The patient "slides over sideways from the wheelchair". We found this very important and valuable for therapy," says Julian Breuer enthusiastically.
Julian Breuer continues: “Furthermore, the development from the first to the second model was very clear: the whole design, the smoother raising and upright positioning - it simply made us want to train with this device straight away. And that's why we quickly decided to purchase this new model."
Read more: New Innowalk Pro 2.0 is available for your rehabilitation facility
Innowalk Pro full-body robotic therapy
A therapy session with the Innowalk Pro at the NiB usually lasts 60 minutes, giving patients around 45 minutes of active training time. For Julian Breuer and his team, the optimal use of therapy time is an important factor.
Julian explains: "We have learned that when the patient is safely secured in the device, the therapist has hands free while the patient is training. The therapist only needs to help the patient get out of the device again. To be efficient we came up with the idea of doing a kind of a group therapy session with two devices at the same time. We typically plan to have two patients for one hour. First one patient is secured in one device, then the other, this means that both still have a net training time of 30-40 minutes. We have been during this for 2 months and it works very, very well. We can combine patients that have just started to learn to walk again, who are wheelchair users, but can stand up and handle transfer independently, with patients severely affected where the set-up time takes a little longer. This works very well, but it can also be done well in one hour with two severely affected patients"
Following the motto "If you want to learn to walk, you have to walk”, NiB offers intensive gait-specific training (GA.IT). The GA.I.T. concept is based on a precise analysis of function and capability and with a clear definition of individual goals. A tailored training and therapy plan is developed from this, for which state-of-the-art therapy equipment is available.
"We have a suitable device for every category of patient, regardless of how severely they are affected, in order to meet the patient's needs at their level. The most severely affected patients can always train in the Innowalk Pro. This is basically 1st step for people with poor circulation, immobility, low level of strength and endurance. We don’t experience any complications in the sense of therapy being discontinued due to circulatory instability or too rapid fatigue or that the movement sequences do not work due to spasticity. In this 1st step of the development ladder, the Innowalk Pro always suitable, regardless of how severely a patient is affected” Julian Breuer explains
As the training progress and the patient’s function increase, the therapy is adapted accordantly. For example, when the patient’s positioning and tolerance for standing with movement have improved. The patient moves into the 2ndstep of the development ladder. At this point the clinic introduces other robotic devices they have available, such as the Lokomat. Innowalk Pro will continue to be used parallel with other robotics, especially focusing on improving range of motion in lower extremities and increase endurance by introducing arm handle movements.
Who is the Innowalk Pro suitable for?
When Julian Breuer, who has several years of experience using the Innowalk Pro in a clinical setting, is asked who he find the Innowalk Pro most suitable for, he replays:
“I do find that patients with a wide range of diagnoses can benefit from training in the Innowalk Pro, of course adapted to the severity of their disability. It can be patients with traumatic brain injury to people with complete spinal cord injuries and coma patients. It can also be patients severely affected by a stroke, Parkinson disease or MS patients who are wheelchair depending. Basically, it can be patients with a neurological disease”.
The new features at a glance
The new Innowalk Pro model offers many other valuable innovations compared to the previous model in addition to the lower entry mentioned above.
The swivel seat is used for easier in and out and independent transfer to the device. NiB has also realised that for patients who are performing over-ground gait training after an Innowalk Pro session, the swivel seat, turned outwards and slightly elevated is an excellent starting point for gait training.
Julian Breuer also emphasis the significant advantages of the swing away leg supports, which make transfers easier for both therapist and patient.
Furthermore, most functions can now be controlled by the remote control, including the seat depth, which can be adjusted with a touch of a button. Handling and set-up time are simplified and shortened, enabling more training and less time spent on set up.
According to Julian Breuer, it can be challenging to involve arm and hands in combination with leg movements due to restriction like spasticity, high tone or pain. Now with the new and more flexible arm handles available for the Innowalk Pro, almost 80% of patients are able to adjust the handles to their needs and use them. Combining arm and leg movements intensified the training of patients greatly.
Julian Breuer summarizes the advantages:
"The speed and also the sound of the Innowalk Pro are very pleasant for both patient and therapist, so you feel like exercising. It's fun to work with the device. The operation is very easy and intuitive. Movements of the legs per minute have increased which is an advantage that patients in particular enjoy. Exercise training is now even more fun thanks to the higher frequency of movement."
The team at NiB has tried out the test version of the new VR glasses in combination with the Innowalk Pro. This allow patients to be in a virtual environment, and conduct games that can be controlled with arm-hand controllers. Physiotherapist Julian Breuer find that the combination of movement in the Innowalk Pro and VR makes training even more motivating and attractive for the patients and it enables specific training of eye-hand coordination.
"A lot of what I think is great about the Innowalk Pro was already offered by the previous model. Basically, people like this training because it conveys a natural movement. Patients feel safe but can still be individually encouraged and challenged. And that's what sets the Innowalk Pro apart from other devices!" Julian Breuer concludes.
Made for Movement is delighted to see that the two Innowalk Pro movement trainers are working so well at the NiB clinic and serving their patients as intended. We thank Julian Breuer for sharing his experience using the device in every day clinical work.
