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”If you want to learn to walk, you have to walk”

Lokomat is the world’s first active orthosis that assists walking movements of gait impaired patients on a treadmill. It allows a proper training of physiological gait pattern assisted by body weight support system. The Lokomat allows the patient to precisely perform the maximum number of gait cycles repetitions in correct gait pattern. It is an essential element in the rehabilitation of lost or impaired gait function. It also prevents the formation of compensation and pathological patterns in neurological diseases in the early stages of rehabilitation. The Lokomat offers an effective and motivating locomotion therapy for gait impaired patients following stroke, spinal cord injury, cerebral palsy, multiple sclerosis and other neurological diseases and injuries.

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http://www.hocoma.com/products/lokomat/lokomatpro/

During the therapy this unique device based on the latest technology ensures the safety of patients with the most serious movement limitations.

Armeo is an innovative solution for upper limb rehabilitation used to improve hand function and to increase the involvement of children in healing the process. This child friendly therapy allows to perform a series of functional exercises such as target squeezing, grasping and turning the forearm.
In comparison to traditional methods biofeedback technology used in the Armeo triggers greater child involvement in the therapy. It assists movements what motivates to continue the therapy. Adjustable level of difficulty allows to customize the therapy to individual abilities of the patient.

More details  http://www.hocoma.com/products/armeo/armeospring-pediatric/

Research shows that intensive manual training is very effective in improving the functioning of the upper limb. Currently used therapies have limited abilities to carry out functional training on a very weakened upper extremity. The Armeo leads hand therapy to the new level by combining exercises in the load with effective biofeedback. The Armeo is specifically designed for and adapted to the needs of children with movement impairments in their arms and hands resulting from neurological conditions.t

We combine kinesitherapy (therapy by movement and exercises) with elements of NDT-Bobath method. It is an approach to the treatment of sensory-motor disorders resulting from the deficit of the central nervous system. The NDT-Bobath method consists of concepts based on correct child development, correct movements and postural control.Learning movement is based on correct or close to correct muscle tension. The ultimate goal of the NDT-Bobath therapy is assimilation of physiological, functional motor patterns which are necessary to learn skills of everyday life. The components of the NDT-Bobath therapy apart from normalization of muscle tension are inhibition of pathological, uncontrolled reflexes and initiation and facilitation of appropriate movements. In order to change or replace the abnormal movements to more functional the therapy must be frequent and intensive.

The integral parts of this therapy are positions (lying down, seating, standing) dependent on the needs and abilities of the child. These positions allow to normalize muscle tension, maintain proper joint mobility, stabilize the body parts while facilitating performance of the correct movements, thereby increasing the activity of the child.

TheraSuit Method uses TheraSuit costume. It is as an alternative and complement to other therapy methods. It is an individual and intensive program aimed to:

• normalize the nervous tension
• increase the strength and power
• improve the control of strengthened muscles what allows the child to enhance the function and to achieve movement independence
• restrain negative effects of lack of movements, reduced muscle power and physical fitness

The method is based on the theory of development, power training and post-workout physiological  and morpho-functional changes. When participating it the TheraSuit therapy, the organism of a disabled child is treated as a fully efficient one. The TheraSuit Method is a modern approach in kinesitherapy based on physiology and sporting effort knowledge. Customized and individual program enables to hasten the motor development of small patient. The costume is designed to facilitate control and proper body movement in the space.

Sensory integration is a complex process of central nervous system to ensure accurate assessment of the situation and to allow an adequate response. To be able to create a correct picture of the situation the brain needs to receive an information from all senses, identify them, classify and interpret and eventually integrate into a coherent whole.
Jean Ayres, creator of this method, emphasized that adequate integration is the basis of normal learning.

There are various types of disorders involving one or more senses and they can occur at any stage of the process: registration of a stimulus, diversification, leadership or interpretation.

If there are any problems at any stage of the process it is difficult to produce an adequate response or either it is associated with excessive energy expenditure which results in increasing fatigue and makes difficult to function in everyday life.
Symptoms of sensory processing disorders may apply to such functions:

• motor (muscular tension, physical activity, motor and visual-motor coordination, ability to maintain balance, manipulation skills, fine motor skills, motor planning, oral functions – including the speech)
• cognitive (difficulties in learning, writing and spelling, reading, counting, identifying colors, shapes, concentration difficulties, etc.)
• visual
• auditory
• superficial sensation
• deep sensation (proprioception)
• senses of smell and taste
• emotional (fear of heights, taking your feet off the ground, fast motion, difficulties with self-regulation of behavior, emotional lability, lack of security, aggressive self-injurious behaviors)
• social (withdrawal from the peer group, reluctance to play in the group, physical contact and hugging avoidance)

This method consists of multidirectional and multi-sensory stimulation of a child through fun. It is used to improve the functioning of all the senses and the whole process of integration of stimulus in the central nervous system. Early identification of sensory processing deficits allows effective therapy to help child’s wellbeing, joy of play and learning.

Exercises in aquatic environment play an important role in small patients rehabilitation process and they are undoubtedly a specific type of rehabilitation therapy for children with CP. Magic lies in fact that the therapy is conducted in water environment. For children this environment is different and challenging but at the same time tremendously exciting and very attractive. Water environment stimulates imagination, encourages and motivates to undertake the activity, induce to play, causes movements which are often difficult to implement in the terrestrial environment easier and more attractive for a child.

Water physiotherapy for children with CP manifest signs of comprehensive rehabilitation. Individual water exercises have various character,  from simple in the load to complex with usage of specialized equipment designed to shape the overall and special fitness. Water therapy primarily consist of active, but also passive exercises. Because of the specific aquatic environment they often provide surprising results. Therefore, learning how to walk in water environment and chain of exercises conducted according to special techniques are of special importance.

In addition to other benefits aquatic environment creates favorable conditions to improve sensory integration. Children with CP have deficits in sensory integration so it seems very reasonable to use water environment also in this aspect. Aggravating nature of water increases the ability to perform movements and to feel the body. These advantages are used in rehabilitation of children with cerebral palsy in any age because changes which occur in this syndrome are persistent and require an ongoing rehabilitation.

Children with motor limitations are eager as their healthy peers to play, be active, accepted and to be appreciated. They need variety of games for their best possible development. Physiotherapy in water is both great fun as well as “scientific” play which immensely affects motivation and commitment of exercising children. Due to exploration of unknown environment water exercises trigger the most positive emotions in children like laughter and enjoyment. Exercises in aquatic environment may therefore be a perfect complement to the basic therapy, although in some cases it might be the only possible form of physical activity. Typically aquatic exercises prepare little patients for further training in dry environment  without ease offered by the water.

UGUL (Uniwersalny Gabinet Usprawniania Leczniczego) Universal Exercise Unit
This allows the therapist to perform complex exercises with the patient. The use of partial and complete suspensions, helps even very weak patient, self-active exercises with suspention, exercises with resistance, costume TheraSuit costume, Thera Togs costume and “SPIDER” etc.

A variety of equipment which can be used in a UGUL gives the therapist the possibility use their own skills and creativity.

P – (proprioception). Deep sensibility, (receptors) are located in the muscles and tendons. They provide information about the brain muscle tone, movement and positioning of the body in space

N – (neuromuscular). Activation of nerves and muscles

F – (facilitation). Facilitating the movement, leads to an increased effectiveness of the treatment.

The primary goal of therapy is to work on a feature. The essence PNF method is the maximum stimulation of receptors found in the body, and various areas of the cerebral cortex in order to facilitate motion in the damaged area. PNF sees the patient as a whole, so this is a holistic method, uses a stronger undamaged areas to assist, disadvantaged areas. During therapy, the movement is three-dimensional in a plane which results in engagement of the maximum amount of muscle fibers.