Neuro Rehab - Gait, Balance, and Communication Technology

What is Zero G?

A 3D overhead robotic body-weight support system used for gait and balance training

What directions can the Zero G overhead frame move?

Medial/lateral and anterior/posterior

Where can Zero G be used?

Overground, on stairs, and over a treadmill

What are the primary safety features of Zero G?

Adjustable body-weight unloading and vertical fall protection

Which patients benefit from Zero G?

Patients at high risk for falls due to weakness, poor coordination, balance deficits, size, or impulsivity

What is Zero G's maximum static unloading capacity?

450 lbs

What is Zero G's maximum dynamic unloading capacity?

200 lbs

Contraindications for Zero G

Pregnancy

Uncontrolled hypertension

Seizures

Severe osteoporosis

Chest tubes

Unstable rib fractures

Weight over 450 lbs

Certain acute spinal precautions

Halo

Wound-vac harness interference

MD-prohibited loading of the harness contact regions

Zero G advanced features that applies brief perturbations to challenge postural reactions

Training Responses in Postural Rehabilitation (TRiP)

A visual feedback activity requiring patients to align a red movement circle with a yellow target

Zero G Target Matching

Patients use medial/lateral and up/down movements to move and rotate falling game pieces

Zero G Tetris

A robotic gait-training device that assists reciprocal stepping, weight shifting, and gait patterning

Eksoskeleton

What movements can the Eksoskeleton assist?

Swing phase and stance control, bilaterally or unilaterally

What UE strength is required for a patient post-CVA?

At least 4/5 in one upper extremity

What UE strength is required for a patient with SCI?

At least 4/5 bilaterally

Which SCI levels are appropriate for Eksoskeleton use?

C4 and below, typically AIS C; some research includes AIS B

What is the Eksoskeleton weight limit?

220 lbs

What is the height requirement?

5'0"-6'4"

What is the maximum standing hip width?

18 inches or less

What standing tolerance is required before using the Eksoskeleton?

15 minutes in a standing frame

What should be monitored during Eksoskeleton use?

Blood pressure

Orthostatic hypotension symptoms

Pain

Spasticity

What ROM limitations apply to Eksoskeleton use?

- Neutral ankle (may flex knee up to 12°)

- Knee flexion contracture no greater than 12°

- Hip flexion contracture no greater than 10°

- Leg-length discrepancy less than ½ inch

- Lower-leg discrepancy less than ¾ inch

What are contraindications for Eksoskeleton use?

- Severe spasticity (Modified Ashworth 4)

- Unstable spine

- Unhealed LE or pelvic fractures

- Pressure sores at contact areas

- Severe cardiac or infectious conditions

Does the Eksoskeleton prevent falls?

No. Hands-on assistance is required at all times.

What is the L300 Go?

A functional electrical stimulation (FES) system used during gait

Which patients benefit from L300 Go?

Patients with dorsiflexion and/or knee flexion-extension weakness due to CNS or UMN disorders

What diagnoses may benefit from L300 Go?

CVA, SCI, brain injury, and MS

What are the benefits of FES?

- Muscle re-education

- Prevents disuse atrophy

- Maintains joint ROM

- Increases local blood flow

Which nerve does L300 Go stimulate for ankle dorsiflexion?

Common peroneal nerve

Which muscle is stimulated to produce ankle dorsiflexion?

Tibialis anterior

During which gait phase does L300 Go assist dorsiflexion?

Swing phase

Which muscles can be stimulated for knee movement?

Quadriceps for knee extension and hamstrings for knee flexion

What feature eliminates the need for a foot sensor?

Built-in movement sensor

What are the components of L300 Go?

- Lower-leg cuff

- Thigh cuff

- External pulse generators

- Control tablet

- Optional foot sensor

- Optional control unit

Can the lower-leg and thigh cuffs be used independently?

Yes, independently or together.

What are contraindications for L300 Go?

- Demand-type pacemaker, defibrillator, or electrical implant

- Metallic implant directly beneath electrodes

- Cancerous lesion in leg

- Fracture or dislocation affected by use

- Severe plantarflexion contracture

What are precautions for L300 Go?

Epilepsy, impaired sensation, pregnancy, fragile skin, heart monitor, heavy bleeding disorder after acute trauma/fracture, and inability to follow commands

What adverse reactions may occur with L300 Go?

Redness, indentation, increased spasticity, allergic reactions, heart-related stress sensations, and edema

How long should normal redness or indentation under electrodes last?

It should disappear within one hour

Computerized Dynamic Posturography using a force plate and virtual reality

Bertec Balance Advantage

What does the Bertec force plate measure?

Center of gravity, sway, and force movement data

What sensory systems does Bertec challenge?

Visual, vestibular, and somatosensory systems

What are common uses for Bertec?

Balance disorders, falls, imbalance, dizziness, visual motion sensitivity, ankle impairments, and post-TKA/THA rehabilitation

How can Bertec benefit patients after TKA or THA?

Provides visual feedback for symmetrical weight-bearing and squatting.

What are contraindications for Bertec?

- Mobility impairments requiring a wheelchair or walker

- Weight over 500 lbs

- Improper harness fit

What are precautions for Bertec?

Severe visual motion sensitivity

Claustrophobia

Acute/unstable orthopedic injuries

Severe cognitive or communication deficits

What is the Sensory Organization Test (SOT)?

Assesses how effectively the visual, vestibular, and somatosensory systems maintain balance

What are the six SOT conditions?

1. Eyes open, fixed visual environment, fixed support surface

2. Eyes closed, fixed support surface

3. Eyes open, moving visual environment, fixed support surface

4. Eyes open, fixed visual environment, moving support surface

5. Eyes closed, moving support surface

6. Eyes open, moving visual environment and moving support surface

What is the Motor Control Test (MCT)?

Assesses the ability to react and recover from unexpected perturbations

What does an abnormal MCT indicate?

Increased fall risk

How many MCT conditions are performed?

Six: small, medium, and large forward and backward translations, each performed three times

Assesses the ability to adapt to repeated surface irregularities

Adaptation Test (ADT)

What movements occur during the ADT?

Platform tilts toes up for five trials and toes down for five trials

What ankle ROM is required for the ADT?

8° of ankle dorsiflexion

What does decreasing sway energy slope indicate?

Rapid adaptation

What does a flat or rising sway energy slope indicate?

Poor habituation, often associated with vestibular disorders and increased falls

Assesses how well a patient controls their center of gravity and available ROM

Limits of Stability (LOS) test

How should a patient perform the LOS test?

Lean from the ankles without bending the waist or knees

What are normal LOS ranges?

8° forward

8° left/right

4.5° backward

What can abnormal LOS results indicate?

Motor planning, timing, or movement-control problems and increased fall risk

A 4D perturbation treadmill mounted on a moving force plate platform

Balance Tutor

Which directions can Balance Tutor move?

Medial/lateral and forward/backward

Who are the indications for Balance Tutor?

Neuromuscular:

CVA, TBI, SCI, PD, MS, CP, Peripheral nerve injury

Musculosketal:

Joint surgery, fracture, amputation/prosthetic training, muscle/tendon strain, ligament strain

Vestibular:

Dizziness, vertigo, equilibrium

Sports injuries return to play training

Aging:

Fall prevention, ADL activities improvement

What are contraindications for Balance Tutor?

- Weight over 295 lbs

- Severe fixed contractures

- Bone instability

- Open skin lesions

- Severe cognitive deficits

- Mechanical ventilation

- Severe cardiac conditions or LE vascular disorders

What are precautions for Balance Tutor?

Poor joint stability

Soft tissue damage (ligament tear)

Severely low bone density

Post ACL/PCL injuries/surgery

Foot drop, use orthotics

Lower limb prosthesis

Epilepsy

Craniotomy/ectomy

Not to be used with walking devices

Can Balance Tutor be used with walking devices?

No

What is the main difference between Bertec and Balance Tutor?

Bertec emphasizes sensory diagnostics and balance training; Balance Tutor emphasizes reactive perturbation training

Compared with Zero G, what type of balance challenge does Balance Tutor provide?

Higher-level balance challenges

A non-invasive transcutaneous cervical spinal cord stimulator

ARC-EX

Where are ARC-EX electrodes placed?

One level above and one level below the injury

How does ARC-EX work?

Modulates neuronal subpopulations within targeted spinal segments by recruiting afferent fibers

What is the primary goal of ARC-EX?

Improve upper-extremity sensation, strength, and function in chronic tetraplegia

Should ARC-EX be used alone?

No. It is paired with functional, task-specific training.

What are indications for ARC-EX?

Medically stable individuals with chronic incomplete cervical SCI

What are contraindications for ARC-EX?

Active implantable devices (Pacemakers, defibrillators, deep brain stimulators, and baclofen pumps)

Pregnancy

Open wounds

Infection

When should ARC-EX treatment stop immediately?

Autonomic dysreflexia, sustained BP/HR changes, skin breakdown, muscle spasms, or pain

Technology that allows individuals with speech impairments to communicate through alternative methods.

Augmentative and Alternative Communication (AAC)

Which diagnoses commonly benefit from AAC?

ALS, autism, and CP

How can patients operate AAC devices?

Eye gaze, blinking, head pointers, hands, or joysticks

How frequently does insurance cover an AAC device according to the lecture?

One every five years

Name common AAC device companies.

Tobii Dynavox, Smartbox/Talk To Me Technologies, PRC Saltillo, Forbes AAC, and EyeGaze Inc

What are the benefits of Tobii Dynavox?

Personalized communication, adjustable settings, and wheelchair mounting

What additional functions can Tobii Dynavox provide?

Internet browsing, social media, gaming, and home-environment control

Which technology is best for a high fall-risk patient needing body-weight support during gait?

Zero G

Which technology assists reciprocal stepping through robotic lower-extremity movement?

Eksoskeleton

Which technology helps a patient with foot drop during swing phase?

L300 Go

Which technology identifies whether visual, vestibular, or somatosensory input is impaired?

Bertec SOT

Which technology evaluates responses to unexpected platform translations?

Bertec MCT

Which technology evaluates adaptation to repeated surface tilting?

Bertec ADT

Which technology measures limits of stability and controlled COG movement?

Bertec LOS

Which technology simulates slips and trips to train reactive balance?

Balance Tutor

Which technology may improve hand function and sensation after chronic cervical SCI?

ARC-EX

Which technology helps a patient with ALS communicate without speaking?

AAC, such as Tobii Dynavox

Why should PTs use technology alongside traditional therapy?

It provides objective measurements, feedback, progression, and patient engagement while clinical judgment remains essential