Prospective, Blinded, Randomized Crossover Study of Gait Rehabilitation in Stroke Patients Using the Lokomat Gait Orthosis

Abstract

Objective. Treadmill training with partial body weight support has been suggested as a useful strategy for gait rehabilitation after stroke. This prospective, blinded, randomized controlled study of gait retraining tested the feasibility and potential efficacy of using an electromechanical-driven gait orthosis (Lokomat) for treadmill training. Methods. Sixteen stroke patients, mostly within 3 months after onset, were randomized into 2 treatment groups, ABA or BAB (A = 3 weeks of Lokomat training, B = 3 weeks of conventional physical therapy) for 9 weeks of treatment. The outcome measures were the EU-Walking Scale, Rivermead Motor Assessment Scale, 10-m timed walking speed, 6-minute timed walking distance, Motricity Index, Medical Research Council Scale of strength, and Ashworth Scale of tone. Results. The EU-Walking Scale, Rivermead Motor Assessment Scale, 6-minute timed walking distance, Medical Research Council Scale, and Ashworth Scale demonstrated significantly more improvement during the Lokomat training phase than during the conventional physical therapy phase within each 3-week interval. Conclusions. Despite the small number of patients, the present data suggest that the Lokomat robotic assistive device provides innovative possibilities for gait training in stroke rehabilitation while eliminating prolonged repetitive movements in a nonergonomic position on the part of the physical therapist.

Efficacy of rehabilitation robotics for walking training in neurological disorders: A review

“…Particularly in the field of gait rehabilitation, the effectiveness of robot-assisted intervention is not yet fully realized. The Lokomat gait orthosis provides the advantage of reducing the burden on clinical staff during weight-supported gait training and has been found by some researchers to have advantages over conventional therapies [50][51]. By addressing important psychological aspects of mental engagement in technology-assisted therapies, innovations may be made that help bridge the gap found by some researchers with conventional therapies [52][53].…”

A Review of Robot-Assisted Gait Training in Stroke Patients

“…Table 2 presents the summary of 11 randomized controlled trials that compared the effects of exoskeleton robot-assisted gait training with conventional gait training on motor recovery, gait function, and balance in hemiparetic stroke. Mayr et al [10] and Husemann et al [11] reported greater augmented effects from combined exoskeleton robot-assisted gait training combined with conventional gait training compared with conventional gait training alone in 10 subacute stroke patients. Hornby et al [12] conducted a randomized controlled study that compared the effects of exoskeleton robot-assisted gait training and manual facilitation using an assistas-needed paradigm on gait function in patients with chronic stroke.…”

“…Similarly, Hornby et al [12] found that Lokomat robot-assisted therapy in 62 patients with chronic stroke was not superior to the conventional gait training. Such inconsistent results in the Lokomat robot-assisted studies may result from different experimental design and testing methods utilized [10], lack of volitional neuromuscular control [14], restricted pelvic and trunk movement control [15,16], arm swing, as well as altered acceleration and deceleration from pre-swing to initial contact [17]. …”

Efficacy of the Gait Training Using Footpad-Type Locomotion Interface in Chronic Post-Stroke Patients: A Pilot Study

“…About them, a lot of intervention effects are reported [1][2][3]. A systematic review of electromechanical assisted gait training using robotic devices was effective at improving the gait ability after stroke [4].…”