Herme Physiotherapy

[Ena Marklund]

Respiratoryphysiotherapy is not yet defined or structured as a sub-specialty across many European countries. Therefore this project aims to develop a post-graduate respiratory physiotherapy programme with a specific training period defined by task force members. The project will closely follow the development strategy for educational standards defined through HERMES.

This project is aimed at those who have completed postgraduate training in respiratory physiotherapy as well as allied health professionals working in this field. As the specialty is in the process of consolidation and is not recognised in many countries, those who are advocating for the recognition of the specialty will have specific use of the recommendations given in this project.

The rationale, methodology and content of the ERS respiratory physiotherapy curriculum are described in detail in an article published in Breathe, the open-access clinical educational publication from ERS.

The curriculum is designed to build upon the core syllabus for postgraduate training in respiratory physiotherapy (originally published in 2014), and outlines the knowledge, skills and attitudes that must be mastered by a respiratory physiotherapist working with adult or paediatric patients, together with guidance for minimal clinical exposures, and forms of learning and assessment.

The article states that the curriculum provides a modular framework for international training in respiratory physiotherapy, and details how it contains the elements around which an E-portfolio can be built, as well as setting a benchmark for endorsement of educational opportunities.

The HERMES Team proudly presents our pilot, 23-year-old Modestos Kapinas, for the CYBATHLON Exoskeleton Race, marking the first-ever Greek participation in the event. Modestos, an undergraduate physiotherapy student, sustained a spinal cord injury in 2017. Before his accident, he was a champion cyclist with impressive performances. His passion for sports and physical activity continues to drive him forward, and he actively participates in wheelchair basketball. The team's spirit of camaraderie fuels their dedication and competitive edge. Modestos trains rigorously with the HERMES EXO on a simulated CYBATHLON course, highlighting our commitment to excellence. With the support of the HERMES Team and our cutting-edge exoskeleton, Modestos is ready to showcase his resilience and the power of innovation at CYBATHLON 2024, demonstrating how teamwork and technology can overcome physical barriers.

The primary goal of HERMES EXO is to assist individuals with paraplegia to stand upright, walk on smooth or rough terrain, climb up and down stairs, and, in general, aid them in daily activities. It features an ergonomic and flexible design, allowing for customization according to the user's specifications (height and weight). It is easy to put on, lightweight, durable, user-friendly and offers a comfortable fit. This supportive device is specifically designed as a research prototype for participation in the Exoskeleton Race category of the CYBATHLON 2024 competition. The specifications and capabilities of the exoskeleton comply with the requirements and objectives of the competition. Our team fully oversees the implementation, construction, and operation, collaborating with certified partners for certain applications. HERMES EXO includes and integrates certified components for its intended use.

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About a year ago I was working in Edmonton and heard about the Canadian Association of Medical Teams Abroad (CAMTA). I became interested in their work and initiative to help the less fortunate in South America not only because I think it is a good cause, but also because I personally identified with their mission goal.

To put this into context, I was born in Caracas, Venezuela with clubfoot. As a child I remember using orthopedic shoes and a pair of small casts I found inside one of my Mom's vaults to help fix my feet. The idea of going to Quito to help children with similar difficulties and a shared cultural background captivated me. This deeply rooted connection brought me to this day. One year after I completed my first mission with CAMTA, I would like to share my experience.

In Ecuador and other South American countries, orthopedics is not a priority that can be easily afforded by the less fortunate. This gap in accessibility means that a procedure that is common, and even routine in first world countries, can be life-changing for these patients. It is an opportunity to have a better life and enjoy simple things, like a walk in a park or dancing to their favourite music.

We departed Canada on a Friday, and I was excited for my first experience with the Mission and to meet my team members for the first time. After a long day of travel, we landed in Quito past midnight and our first task was to take all the supplies straight to the hospital. Due to excitement I was unable to tell how tired I was and soon was comforted by the thought of having Saturday to rest and explore.

Finally, our first day at the Padre Carollo Hospital arrived. We unpacked all the medical supplies we brought from Canada and settled into our offices at the hospital. After that, the clinic day started and all potential patients were added to our database and interviewed by the CAMTA surgeons. Some of the patients had waited up to two years to qualify for the surgeries.

I had the opportunity to be inside the OR to witness a hip replacement surgery, and it was quite an experience. I watched the steps taken by surgeons, med students and nurses, and got a high-level explanation of how the surgery would proceed. The level of interaction between the team was remarkable, everyone knows their role and plays their part, like an orchestra plays music. I enjoyed the experience, and if I didn't pursue engineering as my career I would have chosen orthopedics. The surgery took about two hours, and after the patient was cleared to go to the ward, my first day was over.

The OR team had more surgeries to complete during the rest of the week, approximately 6 surgeries per day. I switched between the OR and the Ward-Clinic area during this time. Personally, the ward area was my favourite. Here we could get to know all the patients and their families, and you could feel a special bond was created.

At the ward, the main task was to monitor improvement, introduce the patients to physiotherapy, ensure that they could move by their own means, and educate them with post-surgical care before discharging them. At this stage the relationship between the patients and their families, and the CAMTA team became stronger, creating our own bond. As a translator, it was really important to transmit the instructions from nurses and the physio team in a clear way and make sure the patients understood them. However, being warm and familiar with them was also important to me in order to build trust, make them feel comfortable, and motivate them to face the challenge of walking again. A painful task that many patients were scared of.

All of the patients, children, and adults faced the task of doing exercises and physio with a great amount of courage and a positive mindset. Our own physio and nurses could not have been more impressed to see how strong these patients were, and how committed they were to the idea of walking out of the hospital on their own the day after going through surgery. Some of the patients I had the opportunity to meet and work with were Mr. Segundo, Mrs. Patricia and Mrs. Ingry.

Mr. Segundo always had a smile on his face, even after having his hip replacement. He was dedicated to recovering as soon as possible, and returning to a normal life. You could tell how strong he was by the way he walked for the first time after surgery. He told me that he used to play soccer and volleyball back in the day, and how he lived in NYC when he was a young guy. He even remembered some words in English and impressed the nurses with some sentences to express how grateful he was.

Mrs. Patricia was a special case for this year's mission. She has a rare case of dwarfism, and according to what I was told, around 70% of people with that specific genetic condition live in Ecuador. In addition to this, hip replacements with these conditions had not been broadly documented in the literature so it was a really special case for the surgeons. Patricia told me about how active she was, how she would run and play different sports before she had troubles with her hip. She was committed to going through the surgery and reclaim that part of her life that had diminished due to the pain she was experiencing. It didn't take long for her to show us how strong she was. The surgery was a success and she was recovering so fast that the day after, she was anxious to try to walk and tackle the stairs, the final test before the physios approved the discharge. Patricia walked up those stairs with no problem and went home excited and happy, because in a few months she could be active again and do things she had avoided due to her prior condition.

Mrs. Ingry's story is also special. She was very nervous the evening before her surgery, as she had been waiting a whole year for her opportunity to get a hip replacement. The morning of the surgery while I was talking to her and helping to set her up for surgery, she told me that it was her birthday! Upon hearing this wonderful news, I let the nurses know and we all sang happy birthday to her, both in English and in Spanish. Ingry was very grateful and through tears she shared that she never gets people to sing happy birthday to her. She was overjoyed and said that the surgery was her birthday present. She was then taken to the OR and when she was cleared to go to the ward, a surprise was waiting for her.

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