General Information for patients (Self-payers too)
The Rehabilitation Institute Kladruby (hereafter mentioned as Institute or RIK) (Rehabilitační ústav Kladruby) near Vlašim, Czech Republic, has a long tradition in providing inpatient medical rehabilitation. The RIK provides medical rehabilitation/ treatment mainly to adult patients after surgeries and after injuries and affections of movement and nervous systems. Similar to trends in the whole world to provide physiotherapy as soon as possible after the injury or affection, a Spinal rehabilitation unit was created on 1 July 2002 to ensure care for serious fresh spinal injuries. The RCK also admits clients with back pain resistant to outpatient treatment. The RCK belongs to the most important facilities in the country and works nationwide with a limited admission of clients from other countries. The Rehabilitation Center Kladruby is a state allowance organization and is directly controlled organization by The Ministry of Health of The Czech Republic.
Shortened history of Rehabilitation Institute Kladruby
The Rehabilitation Institute Kladruby is situated next to the village of Kladruby at a distance of 7 km away from the town of Vlašim. in a well-preserved natural environment of Podblanicko Area on the border of the Vlašim Valley. The memorable Blaník Hill which is connected with the old Czech legend of Blaník Knights can be seen on the horizon.
The decision to build a new sanatorium for bone tuberculosis treatment was taken in the year 1932. A suitable place was selected on an elevated area at the foot of the Kostelík Hill (524 meters) near the Kladruby village. The leading personality at that time was Doctor Schiller. First, a drive way was constructed (1934) and at the same time the adaptation of the park around the planned buildings was started. In 1937, the foundations of the sanatorium were laid and in December 1938, the roof was completed.
After the German military occupation in 1939, the association aimed to sell the sanatorium but the Nazis had other plans and took the sanatorium for military purposes. All construction work was completed in 1941 and put into service as a military hospital a year later. The Nazis set up a “Forschungsinstitut der D.A.F. Kladruby” (research institute of D.A.F) a part of which was leased to Wehrmacht (German army) to treat injured soldiers brought from the war front. The sanatorium was transformed into “Reserve Lasaret Wlaschim”. In times of biggest losses, the hospital treated as much as 1,200 German soldiers. It is a tragic paradox that Dr. Schiller, the founder of the sanatorium, was executed in 1942 and all his family was tortured in Nazi concentration camps as member of the persecuted Jewish nation.
After the Second World War, the hospital served as a Soviet repatriation station where Soviet soldiers temporarily stayed before returning home.
From January to September 1946, the hospital was administered by the Central Council of the Unions and there was no clear conception as to its purpose. Starting on 1 October 1946, the hospital was taken over by the Health Ministry. Necessary modifications were quickly done including interior restoration. According to a preserved book of admissions, some 27 patients were admitted for testing service on 21 April 1947. At that time, first training of the stuff took place, it was provided by American physiotherapists and the first trainees were Czech teacher of gymnastics.
Officially, the operation was started on 1 December 1947 and the facility was named “State Institute for Follow-up Treatment”, the capacity was 160 beds. At first, the institute served for follow-up treatment of the disabled and gradually focused on treatment of movement disorders after surgeries and injuries.
The physiotherapeutical services were continually extended throughout the years and also, more requirements were laid on the services which reflected the development of basic physiotherapeutical care and the growing requirements on nursing services. Departments had to be extended. In November 1955, a new hospital building was opened and the capacity grew to 210 beds.
The Rehabilitation Center added new facilities to its premises. In 1975, the sports hall was put into service, later also a mini golf area and subsequently a large forest park. Everything was built with the needs of the disabled in mind. At that time, new modern flats for the employees were also built.
Between 1991 and 1995, new communication core was constructed with three new lifts, examination rooms and eating rooms for clients with impaired mobility. Free capacities in ward departments were utilized for improvement of accommodation quality of the clients.
In October 1995, the physiotherapeutical department was opened. The department has modern equipment and increases the quality of the provided physiotherapeutical care. All new building are interconnected with underground corridors and can be easily reached by the client even in bad weather conditions.
In 2003, the reconstruction of the old physiotherapeutical building was completed, the swimming pools were reconstructed and new facilities were constructed: a 25 meter long pool, a pool with movable bottom and a whirl pool. The reconstruction also included the gymnasium and cinema hall. Two smaller gymnasiums were built in the Fitness building and the shop with prosthetic appliances, the computer training room and psychologists were moved there.
Blanik Massive - Blanik Hill (source: wikipedia)
Blaník (Czech: [Blaɲiːk]) is a mountain emblazoned with legends, in the Czech Republic near Louňovice pod Blaníkem. The hill and surrounding area is a nature reservation. The Blaník massif consists of two forested rocky hills, the Great Blaník (638 m) and the Small Blaník (580 m).
In the 5th century BC, during the Hallstatt period was at Great Blaník a hill fort in circular shape with two rows of huge stone walls whose remains are still visible around the top, later stronghold and probably a wooden castle. The year 1404 was the beginning of the pilgrimages to the mountain. One of the traditions of local residents is New Year's Eve ascent of the mountain. In the years 1868-1871 there were held a camps requesting the Czech state law. From there has been broken off in 1868 one of the foundation stones of the National Theatre in Prague (1750 kg). At the top stands 30 m high wooden observation tower from 1941 in the shape of a Hussite watchtower.
At the top lie remains of a medieval castle. At the Small Blaník (formerly Bare Hill) are also the ruins of the pilgrimage chapel of St. Mary Magdalene, construction was completed in 1753. Then abolished in 1783 by decree of the Emperor Joseph II. Below it used to be a cave with hermit, in the middle of the ruins today grows a huge old spruce about 160 years old, which is called the "Monk".
An ancient legend says that a large army of Czech knights led by St. Wenceslas sleeps inside the mountain. The knights awaken to help the Motherland when it is in great danger. According to the legend, when this happens, Blaník's trees will dry out but an old, dead oak tree under the mountain will turn green and a small spring by the mountain will become a river. Then during an epic battle between the Czechs and their overwhelming enemy the Blaník knights will come to their aid led by St. Wenceslas on his white horse. The enemy will retreat to Prague where they will finally be defeated. Day in the mountain is long as a year on the surface.
In popular culture
Famous czech novel-writer Alois Jirásek portrayed Blaník legend in his Ancient Bohemian Legends. Mountain with its symbolism also provide theme to a number of musicians and painters in the 19th century. In the Jára Cimrman's comedy play Blaník, it was proved that this legend is not true because
The Knights of Blaník Mountain
The last of Czech old legends, that one about the knights of Blaník, was first told to king Charles by a blind man.
There is a hill Blaník, which is situated in a dark forest. It looks down gloomily on a landscape, which is far away from the world, on its plains, that are not much fruitful. On the top of the hill Blaník there are old stones and mostly ruined walls in shadows of spruces, beeches and firs. There used to be a castle, but it disappeared without any trace.
Under the walls, in the hill, there are armed knights, “Saint Wenceslas´s Army”, and they are waiting for a day, when the Czech nation needs their help.
Under the stone peak of Blaník, in eastern slope there is a rock. There is the entrance to the hill, and there is a spring. Knights in Blaník give water from this spring to their horses, when they go out from Blaník at night in the moonlight. At night like this one dark rumble resounds to the surroundings. In the morning, there is silence again, and knights, their horses, everything goes again into the hill. Only one memory will stay there – prints of hoofs.
On day a girl was standing in front of Blaník, and suddenly, one knight appeared in front of her. He told her, if she wanted to go with him to clean in the hill. She went with him. There was deep silence. By the walls there were horses, and at a table there were knights. They were sleeping. The girl went in, and she looked round, but nobody moved. She started to sweep the floor. She cleaned everything in a moment. Then she went home, and when she arrived, people asked her, where she had been for such a long time. She was surprised, so she told them that, she arrived at the same time as usually. Then they told her that she had been here one year ago. She told them, where she had been and all people knew why the time had been so long.
The third day, one knight invited a smith from Louňovice, and when he finished his work, the knight gave him a bag with rubbish. He was angry, and he spilled the bag. When he came home, he told this story and he found in the bag three ducats. He went back in front of the hill, but there was no ducat.
Blaník si locked and it looks down on the landscape. Saint Wenceslas´s army is sleeping. It isn´t still time to wake them up. The time will come, when Czech people are in the biggest danger. On the top of the hill a dry oak will become green and the spring by a rock will run down the slope. A big battle will be in the landscape near Blaník. Czech people will defend against the strongest enemies. In that specific time Blaník will open and the knights will go to help Czech people. Saint Wenceslas will ride a white horse and he will be the commander. The enemy will be surrounded of sudden fear and will go to Prague, and there will be the end of the battle. The fight will be furious, blood will run from Strahov down to Charles bridge. And Saint Wenceslas on the white horse with a standard in his hand will expel all the enemies from our country. And Saint Prokop (our another patron saint), Sázava´s abbot with his staff, will help him. Then there will be saint peace and Czech country will have a rest.
Protected Landscape Area Blaník
South of Prague is the smallest protected landscape area called Blaník. It was designated to protect and conserve the balanced landscape dominated by monument Blaník hill, which is remarkable also from a geological point of view.
The basic feature of the area is a mosaic of forests, fields, meadows and small ponds. The settlements and numerous historical monuments are well integrated into the landscape. The environment has so far been little damaged by pollution from industry or agriculture. It is the only large-size conservation area in Central Bohemia protecting typical landscape lying on metamorphic rock of crystalline complex.
The romantic Blanice River, a key feature of the regional ecological corridor, represents the centre line of the area. Blaník forests, Krasovické and Křížovské hills are an important regional biocentre. Indigenous beech forests with remainders of mixed scree forests have been conserved in Na Blanících and Křížovská Hůra (They are reserves and also beech genofund). The most valuable vegetation occurs in wet meadows and wetlands around ponds.
Typical Czech landscape of unique colour has been conserved here, on the frontier between central Bohemia and Českomoravská uplands. It also attracts considerable recreation and tourism because of the famous Blaník hill; an important Czech hill connected to ancient legends.
The legend arose probably in the 15th century among people based on an event, when miraculously at the southeast foothills of Blaník, near the village of Býkovice, was defeated more numerous enemy army.
The legend says that Good King Wenceslas and his knights will arise from their slumber when the Czechs are attacked by a number of armies equal to or greater than four (from four cardinal directions).
Since 1989 there are regularly held St. Wenceslas Celebrations, at his feast St. Wenceslas on white horse accompanied by his troops arrives from the mountain to Louňovice square where are held celebrations.
Vlašim (Czech pronunciation: [ˈvlaʃɪm]; German: Wlaschim) is a town in the Central Bohemian Region of the Czech Republic. It has 12,689 inhabitants and is situated on the Blanice river, 70 kilometers south-east from the capital, Prague. Vlašim is known for its castle and English style park with many pieces of romantic architecture such as the Chinese pavilion, Old castle and its three gates.
According to archeologists, the first inhabitants settled here as long as 30 thousand years ago. About 4,000 years ago, the place was inhabited by Celts, and later by Germanic and Slavic peoples. The town of Vlašim was founded in the 13th century. The castle history dates back to 1303. A fortress was built here in 1318 by Hynek of Vlašim. The oldest historical buildings are found around Hus square and Žižka square.
Vlašim is situated in close proximity to the D1 motorway linking Prague to Brno. Vlašim railway station, situated to the south of the town centre, is situated on the Benešov–Trhový Stěpánov line.
Winters in Vlašim area are cold and the countryside is often covered with snow from November, sometimes up until March. Summer and autumn are usually warm.
Commuting to Prague is very common in Vlašim. The most significant engineering factory in Vlašim is Sellier & Bellot, manufacturing ammunition. Packaging machinery companies are also successful world wide and employ local people.
What is admission process and Regime in RIK? Rules and Regulations of the Rehabilitation Institute Kladruby – hospital rules
1) Admission of a patient is possible after indication of stay (made by head physician/ head doctor) and reservation of stay. Indication is done by sending recommendation of patients physician, patients medical reports or direct examination of the patient in the RIK exceptionally.
2) Admission and Regime
2a) During the admission process at the department, patient should sign a consent form for his/her hospitalization and treatment in the Institute. Patient also should state the name of a person, who may be informed by the doctor about patient´s state of health and about approval or disapproval this person(s) with their inspection of patient´s medical documents (medical records), including the making of excerpts (notes), transcripts, copies.
2b) Patient may keep personal belongings (casuall dress), which can be stored in wardrobes in patient´s room after admission. Patient may also store valuables in a the safe-deposit box in cash-room (depository at the box-office) of the Institute. In case If patient lose valuables that have not been stored there, patient may not demand compensation. In the area of the Institute there is a cash-dispenser (ATM) and a post office.
2c) There is forbidden to smoke in the buildings of the Institute, balconies too. A place reserved for smoking in the Institute is in front of the entrance to a tunnel near the mini golf course.
2d) It´s forbiddent to burn and inflame candles, incense stick and other flammable objects in the rooms.
2e) Consumption of spirit (alcohol) is forbidden during treatment in the Institute. Violation this prohibition is regarded as a severe non-compliance with the rules of the Institute and is penalized. It is grounds fordismissal from the Institute (and for information to patient´s health insurance provider).
2f) It is forbidden to keep weapons, ammunition, explosives, drugs, and other psychotropic substances in the Institute.
2g) To increase the security there is installed a camera system in the area of the Institute. There is a monitored parking place on the grounds of the Institute, which is free of charge, and other places of the Institute are monitored as well. If patient vehicle is damaged patient is not obligatory entitled to the compensation from the Institute.
3) Team of Medical Professionals
3a) During patient stay in the Institute patient take care of by a team of medical professionals, led by patient´s doctor. A plan of treatment is created specifically for patient and it is necessary for patient to comply with the recommendations of the medical professionals. Patient has a right to be informed regularly about his/ her state of health and about any changes in his/ her health during stay in the RIK. All the workers (especially medical workers) of the Institute aim to be as considerate to the patient and his/ her needs as possible. Patient has a right to participate in decision-making and goal-setting in rehabilitation and treatment modalities
3b) For security of immobile patients are some rooms on Department (D) D1 (Spinal rehabilitation unit), D3, D5 monitored by a camera system within the meaning of the Act No.101/2000 Coll. These rooms are clearly marked. The records are not stored and are not published or further processed.
4) Identification of patient
In the Institute we are using identification wristbands as a patient identification device. Our aim (goal) is to eliminate the risks, prevention or reduction of adverse events. That´s a reason of using identification wristband for patients identification.
Dosage of medicines must be followed as prescribed to the patient by his/her doctor and according to doctor´s recommendations. On patient´s request, with an approval of his/ her doctor, and having been informed about the proper usage, the patient may use medicines independently. We caution that not taking prescribed medicines or using non-prescribed medicines may impair patient health.
All medical treatments must be prescribed by the doctor. For each therapeutic procedure patient has to have rehab card and a towel. Walking patients should use safe non slip shoes in the whole area of swimming pool. These shoes should be used only for this purpose. Wheelchair users should use protective covers on wheels or a shower trolley, which is in the pool locker room. All patients should wear appropriate dress and a safe sport shoes during treatments in the gym and fitness. In the rehabilitation department of the Institute there are instruments that may only be operated by medical professionals. Patient should follow the instructions of therapeutists during each therapeutic procedure.
(At the department of electrotherapy, magnetotherapy, or ultrasound treatment patient is urged to inform our medical professionals about any abnormal feelings during the procedures in order to avoid possible adverse effects. Patient may go to the swimming pool (and whirlpool) only upon the recommendation of doctor and only under the supervision of our professionals. At the gym, patient may only stay in the presence of our workers who are in charge. Training at the fitness room is a part of the rehabilitation treatment if prescribed by doctor.)
Patient has the right to a clean bed. However, patient task is to keep it as clean as possible. The bed is arranged daily, and if necessary, more often. The bed linen is changed when necessary, at least once weekly. Personal hygiene of our patients/ clients is carried out on a daily basis and according to their needs. Nurses are responsible for the personal hygiene of clients who are dependent on personal assistance. Bathrooms are open daily from 6 A.M. till 10 P.M.
Patient is not allowed to keep in patient rooms/ apartments large objects that would hamper (make difficult) their cleaning.
8) Waste sorting
Patient is obliged to keep patient´s rooms clean and tidy and dispose rubbish only into appropriate bins. Infectious rubbish is disposed in special places with labeled bins. As possible, dispose selectively paper, glass, and PET bottles. It is forbidden to throw rubbish from the balconies.
9) Department Operation
9a) Each department is directed by a head-doctor in co-operation with a head-nurse and other coworkers. Programmes of treatment are set up individually for patient and programme is binding. For patient is necessary to follow the recommendations of our staff, as they are aimed to serve the way to well-being and good health. Patient should attend prescribed procedures and medical examinations on time. Ward rounds with head-doctor take place in every department according to a schedule, patient will be informed about in advance.
9b) Patients are acquainted with the signaling system in their rooms. In patient´s rooms are not allowed to use electric devices (except for electric devices serving personal hygiene and electric devices that are already part of the equipment of the room). Patient is responsible for the technical state of personal electric devices and for damage caused to them.
9c) If patient detect a fire or a water leak, must inform nurses immediately, and if necessary, leave the building following the evacuation plan that is placed in its corridors.
The doctor prescribes patient´s diet. Patient should inform staff about any special dietary needs during admission and during stay. Patient may keep own food in a shared refrigerator for patients. Patient should mark this food with patient´s name, current diet and date of storage in the refridgerator. patient are responsible for breaking dietetic regime since food is part of the treatment. Breaking dietetic rules may impair patient´s treatment. Patients who are not mobile are served their meals in their apartments. Others take their meals in a central eating room at specific times. Patient´s and othe clients of central eating room are urged not carry out dishes and cutlery from the eating room.
11) Keeping silence
Calm and silence are very important to treatment. Therefore, patients (and workers too) are required to not disturb others with noisy behaviour. Silent hours are from 10 P.M till 7 A.M. Patient should turn off mobile phone or program it to not disturb.
12) Outings and Free Time
12a) A return of patients/ clients from their outings is at the latest at 10 P.M. Patients who need assistance with going to bed should return at the latest at 8:30 P.M. The reception is closed at 10 P.M. Late arrival is considered a violation of the rules of the Institute. Departmens are closed from 10 P.M. to preserve calm and safety.
12b) Building E is not possible to lock centrally. Patients (from department 5) who are staying here, will receive the keys to the room and entrance for this reason. The main entrance to the building must be locked at the latest at 22:00 hours, presence in the room will be checked.
12c) Permits for temporary leave (for health insured patients) may be granted according to Act No. 48/1997, and the methodology of health insurance provider, only for medical reasons. The legal entitlement to the permits for temporary leave does not exists, the permits are always based on the medical indications of the treating physician and should not disrupt the medical rehabilitation. Based on "Director´Regulation No. 26/2010" may be granted permit for temporary leave for medical reasons one day during every 21 days and not earlier than the third week of hospitalization. Permit for temporary leave is not allowed the first and last three days of hospitalization.The patient should arrange departure and arrival back alone. The patient or guardian is fully responsible for stay outside of the Institute. The Institute is not responsible for damage to health during stay outside in time of temporary leave. The Institute is not responsible for damage of unsecured objects (things) in the patient´s room during stay outside in time of temporary leave. The patient should give the request for temporary leave to the nursery until Wednesday.
12d) Patient may play minigolf or go to the cinema or library in the Institute in the free time. Time-tables are available at the reception. Patient may use television sets and radios as long as they do not disturb other clients. Gambling and games disturbing the regime of the Institute are prohibited.
12e) Cinema and other performances take place in the cinema hall. „Newsletter“ is published every month, contains the cinema and theater program, list of services of hairdresser, cosmetician and other services. Reception provides timetables of buses and trains. Television and radio receivers can be used after agreement of the staff so as not to disturb other patients
12f) At mass events (cultural, sports) could be taken photos, videos and recordings. These materials are used for interior and exterior use of the Institute - for training events, publications. If the patient do not agree with the acquisition of media records relating to him, this patient report that fact to the appropriate nurse and will not participate on that mass event.
13a) Visits to clients are allowed daily from 9 A.M till 8 P.M., they may not, however, disturb the treatment of the clients. Visits must be announced to nurses. Visitors are obliged to behave calmly and properly, it is forbidden to sit on beds, to pollute rooms, corridors and other equipment of the Institute. Medical professionals have a right to revoke guest privileges from those visitors whose behaviour breaks the rules of the Institute. Visitors may be accommodated in the Institute after an arrangement at the reception.
13b) The management of the Institute has a right to restrict or to ban visitation for any serious epidemiological reasons. Mutual visit of clients in shared rooms is only possible with the consent of their roommates.
14) Phone calls and information
Patient s are urged to tell friends and relatives to use the phone when talking to staff only in necessary situations, not to disturb the services of the Institute and the quiet regiment. Phone calls are transferred to the patient´s room to signaling equipment through automatic switchboard (PABX). If there is no phone in the room, patient could use a telephone card phone at reception.
15) Demands and Complaints
Patient may share any of demands or complaints to a Commission for the Quality of Care, to head nurses or to the head doctor of your department, in serious cases also to the Director of the Institute, or Deputy for nursing care and quality – building A, room No. 16, phone 317 881 337. There is available "Internal Directive - Handling of complaints in the Institute." to the patient, if patient is not satisfied with providing health services. This Directive is available on the treatment department or on the website (http://www.rehabilitace.cz). We monitor the quality of care in the form of a common questionnaire for most health care facilities. The results of this monitoring allow us to improve the quality of care. The results are available on our website. Collection of questionnaires is carried out once yearly. Before patient´s departure patient will receive at department a “Questionnaire on the Quality of Care” where patient may state demands and suggestions anonymously. We ask patient to put the filled in questionnaires in designated boxes in corridors of departments and in reception. These boxes are emptied by Deputy for nursing care and quality or her authorized person once weekly. All current information can be found on bulletin boards, nurse rooms or information kiosks.
16) The End of patient´s Stay
16a) At the end of stay in the Institute, patient should return all borrowed objects and keys. Patient should return Rehabilitation Card to nurses, as it is a part of medical documentation. Patient should come to the Department of cash-room (box office) to the total billing charge for TV or special accommodation. Patient will receive a final report written by doctor. Patient should be checked by general practitioner within 3 days after leave, with the discharge report.
16b) At discharge (on check out) we arrange transportation with vehicles of Medical Transportation Services. The Medical Transportation Service is provided only to those patients who are eligible for transportation according to Health Regulations by the Act No.117/1993, § 10, 11. When patients have more luggage they can send them by mail. We ask patients about checkout on departure day until 9:00 A.M..
17) Other Rules
17a) During patient stay here obey common social conventions. Patient (and workers too) should respect the privacy and rights of other patients or clients and consider respectfully their disabilities and difficulties. A head doctor may dismiss a patient / client who endangers others by his/her behaviour or breaks the rules of the Institute repetitively.
17b) Patient should behave responsibly in or around elevators and other equipment of the Institute. Patient should be economic with water and electric energy. Compensation will be demanded from the patient for any damage caused by inconsiderate manipulation of the patient.
18) The management of the Institute asks patient to follow Hospital rules of the Institute. Patient acknowledge by signature in medical documentation that has been acquainted with these rules. Disrespect for these rules may not be excused and breaking the rules may lead to an untimely dismissal of a patient / client.
19) We thanks for patient´s attention to discipline and for patient´s co-operation with the staff of the Institute. We will be grateful for all constructive comments on the operation of our Institute and for help in dealing with any problems.
Description one of Hi-Tech method - Introduction to the Ekso™ exoskeleton/
1) Ekso is a wearable, battery-operated bionic exoskeleton that enables patients with lower extremity weakness or paralysis to stand and walk on level surfaces. Motors power the hip and knee joints, and all motion is initiated through the use of an external controller. The Ekso is adjustable to fit individuals of different heights and widths. The Ekso device enables the patient to stand and walk with the assistance of either a front rolling walker or crutches. /
2) To use the device effectively, a patient must learn how to balance and weight shift when wearing the Ekso so that an efficient reciprocal gait pattern can be achieved. The Ekso is designed for use in rehabilitation settings. The Ekso must be used only on solid, dry, level (less than 2 percent slope) surfaces in areas reserved for rehabilitation therapy. Patients must use the Ekso under the direction of a physical therapist who has been trained in the correct operation by the Ekso Bionics Clinical Training Team. A physical therapist must complete Ekso certification training before using the Ekso with patients./
3) Indications for Use
Patients who may be appropriate for Ekso use have lower extremity weakness/paralysis due to spinal cord injury, Guillain-Barré syndrome, Multiple Sclerosis, or generalized weakness caused by other conditions./
4) All candidates must be screened and cleared as medically appropriate by a physician prior to evaluation by a physical therapist for Ekso use./
5) Appropriate candidates for the Ekso:
• Are between approximately 1.6 meters to 1.9 meters tall, although leg segment measurements actually determine candidate suitability
• Weigh 100 kilograms or less
• Present with a hip width in the standing position of 0.4 meters or less
• Has near normal range of motion (ROM) in all leg joints
• Must be proficient with sitting balance and transfers from wheelchair to other surfaces
• Has functional upper extremity strength to manage an assistive device
• Must be involved in a standing program or pass a standing frame trial prior to evaluation/
• Range of motion (ROM) restrictions that would prevent a patient from achieving a normal, reciprocal gait pattern, or would restrict a patient from completing normal sit-to-stand or stand-to-sit transitions
• Upper extremity strength deficits that limit the ability to balance with a front rolling walker or crutches
• Spinal instability (or spinal orthotics unless cleared by a medical doctor)
• Unresolved deep vein thrombosis (DVT)
• Decreased standing tolerance due to orthostatic hypotension
• Significant osteoporosis that prevents safe standing or may increase the risk of fracture caused by standing or walking
• Uncontrolled spasticity
• Uncontrolled Autonomic Dysreflexia (AD)
• Skin integrity issues on contact surfaces of the device or on surfaces that would prohibit sitting
• Upper leg length discrepancy greater than 1.3cm or lower leg discrepancy greater than 1.9cm
• Cognitive impairments resulting in motor planning or impulsivity concerns
• Range of motion (ROM) limitations in lower extremities or shoulders
• Healed sacral ulcers with tenuous skin integrity
• Recent history of uncontrolled orthostasis
• Active heterotopic ossification (HO), hip dysplasia, or hip axis abnormalities
• Leg length differences and/or bony abnormalities that would prevent safe operation
8) Evaluation and Screening for Ekso Use
Prior to participating in Ekso training, the patient must undergo a thorough evaluation and screening process to determine if proceeding with an Ekso trial is appropriate. The evaluation for Ekso is intended to be concise, yet thorough and includes obtaining information about the patient’s significant past medical or current medical history, functional mobility including transfer technique, ambulation, bracing and device(s) if applicable or information regarding a standing program. The objective portion of the evaluation consists of muscle testing the key muscles according to American Spinal Injury Association (ASIA), precise ROM assessment of specific lower extremity joints, spasticity assessment according to the Modified Ashworth Scale as well as skin examination of areas that come in contact with the Ekso.
In addition, the patient’s hip width, upper leg length and lower leg length will be measured to determine if the individual will fit within the Ekso. These measurements will then be converted to Ekso values in order to adjust the Ekso to the appropriate width and leg segment lengths to fit the patient. Following completion of the evaluation, the therapist will review the Patient Screening Form to help determine if it is safe to proceed with an Ekso trial. If so, a plan of action is developed to set-up the device as appropriate and safe for the patient, based on evaluation findings.
To view the Ekso in action please visit www.eksobionics.com
According to ETHICAL CODE OF PATIENT´S RIGHTS
1) A patient has the right to obtain considerate medical care performed with understanding by qualified staff. A patient has a right to considerate and professional health care provided by qualified workers with sensitivity.
2) A patient has a right to know the name of the physician and other health personnel treating him or her. They have a right to privacy and services in line with the capacities of the institution, as well as the possibility to meet daily members of their family or friends. This right for “continual visits” can be limited only for serious concerns.
3) A patient has a right to obtain from the physician information necessary to decide before the start of every new diagnostics or therapeutic procedure whether they consent to it. With the exception of acute threat the patient should be duly informed about possible risks related with the procedure. If there are several alternatives and if the patient requires information on alternative treatment, he or she has the right to know them as well as the names of persons involved in them.
4) A patient has a right to refuse treatment to an extent permitted by law as well as to be informed about health consequences of the decision made.
5) In the course of outpatient and inpatient examination and treatment a patient has a right to maximum privacy in connection with the treatment programme. Analyses of his or her case, consultations and treatment are confidential issues and must be performed discreetly. Presence of persons who are not directly involved in the treatment have to be agreed with the patient, which is valid also for university facilities, when these persons have not been selected by the patient.
6) A patient has a right to expect that all reports and records concerning their treatment are treated as confidential. Safety of this information must be also secured while processing it electronically.
7) A patient has a right to expect the hospital to comply as much as possible and reasonably with the patient’s request to a degree corresponding to the nature of the disease. If necessary, the patient may be transferred to another health care facility, nevertheless, full justification and information on the necessity of this transfer should be provided together with information on all other existing alternatives. The facility, where the patient is to be transferred, also has to approve the transfer first.
8) A patient has a right to expect that the treatment will be conducted with reasonable continuity. He or she has the right to know in advance which physicians, in which office hours and at what place they are at his or her disposal. Upon release the patient has the right to expect the hospital to set the procedure for his or her physician to provide information on the subsequent treatment.
9) A patient has a right to a detailed and understandable explanation even if a physician has decided to follow a non-standard procedure or experiment. A conscious written consent of the patient is a prerequisite for launching both therapeutic and non-therapeutic research. A patient may withdraw from an experiment at any time without giving a reason after having been informed about possible consequences of such a decision.
10) A patient with terminal illness has a right to sensitive care from all health personnel who must respect his or her wishes provided they do not violate the law.
11) A patient has a right and duty to know and follow the rules of the health care facility where he is treated (hospital rules) and the right to check his account and ask for explanation of its items regardless of who pays the account.