These results indicate that substituting Lokomat therapy for some of conventional therapy is as effective in recovering walking ability in non-ambulatory stroke patients as conventional therapy alone. Implications for Rehabilitation Recovery of walking after stroke is important. Robot-assisted therapy is currently receiving much attention in research and rehabilitation practice as devices such as the Lokomat seem to be promising assistive devices. Technical developments, sub-optimal study designs in literature and new therapy insights warrant new effectiveness studies. RESULTS of a financially and practically feasible study indicate that substituting Lokomat therapy for some of conventional therapy is as effective in recovering walking ability in non-ambulatory stroke patients as compared to conventional overground therapy alone.

Despite lower muscle activity, robot-assisted treadmill training may elicit a more symmetrical pattern of leg muscle activity, which approaches that of able-bodied individuals.

Abstract-The objectives in this study were to investigate the effect of robot-assisted gait training on cardiorespiratory fitness in subjects with motor incomplete spinal cord injury and document the exercise intensity of robotic walking in comparison with the recommended guidelines. Ten patients followed a 24-session training program with a robotic gait orthosis in addition to physiotherapy sessions completed within 10 to 16 wk. Cardiorespiratory fitness was determined in a graded arm crank exercise test before and after the training program. To assess the intensity of robot-assisted walking, oxygen consumption (VO 2 ) and heart rate (HR) were measured during a training session early in and at the end of the training program, and exercise intensity measures (percentage of VO 2 reserve [%VO 2 R], percentage of HR reserve [%HRR], and metabolic equivalents [METs]) were calculated. Whereas no changes were found in peak VO 2 , the resting and submaximal HR at a constant work load were significantly lower after training. Most subjects exercised at low intensity (<30%VO 2 R, <30%HRR, <3.0 METs), and only two subjects exercised at moderate intensity (>3.0 METs). In spite of the low exercise intensity of the training program and no changes in peak VO 2 , robot-assisted gait training induced some improvement in cardiorespiratory fitness, as suggested by lower resting and submaximal HR values.Clinical Trial Registration: ISRCTN Register, ISRCTN67827069, "Recovery of Walking Ability Using a Robotic Device"; http://www. controlled-trials.com/ISRCTN67827069

It has been suggested that aerobic training should be considered in stroke rehabilitation programs to counteract detrimental health effects and decrease cardiovascular risk caused by inactivity. Robot-assisted treadmill exercise (using a Lokomat device) has the potential to increase the duration of walking therapy relative to conventional overground therapy. We investigated whether exercise intensity during Lokomat therapy is adequate to elicit a training effect and how assistance during walking in the Lokomat affects this exercise intensity. Ten patients with stroke (age 54 +/- 9 yr) walked in both the Lokomat and in a hallway. Furthermore, 10 nondisabled subjects (age 43 +/- 14 yr) walked in the Lokomat at various settings and on a treadmill at various speeds. During walking, oxygen consumption and heart rate were monitored. Results showed that for patients with stroke, exercise intensity did not reach recommended levels (30% heart rate reserve) for aerobic training during Lokomat walking. Furthermore, exercise intensity during walking in the Lokomat (9.3 +/- 1.6 mL/min/kg) was lower than during overground walking (10.4 +/- 1.3 mL/min/kg). Also, different settings of the Lokomat only had small effects on exercise intensity in nondisabled subjects.