Article

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

Department of Neurology, Hospital Hochzirl, Zirl, Austria.
Neurorehabilitation and neural repair (Impact Factor: 3.98). 05/2007; 21(4):307-14. DOI: 10.1177/1545968307300697
Source: PubMed

ABSTRACT

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.
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.
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.
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.

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    • "A variety of robotic rehabilitation devices have been proposed for gait rehabilitation after stroke (eg. [5]–[8]), but have only produced moderate results compared to conventional physiotherapy [9]–[12]. Currently, there is no evidence that robotic gait training is superior to conventional physiotherapy for either chronic or subacute stroke patients [13]. "
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    ABSTRACT: Robotic devices have been used in a variety of rehabilitation protocols, including gait rehabilitation after stroke. However, robotic intervention in gait therapy has only produced moderate results compared to conventional physiotherapy. We suggest a novel approach to robotic interventions which takes advantage of inter-limb coordination mechanisms. We hypothesize the existence of a mechanism of inter-leg coordination that may remain intact after a hemiplegic stroke that may be utilized to obtain functional improvement of the impaired leg. One of the most significant advantages of this approach is the safety of the patient, since this does not require any direct manipulation of the impaired leg. In this paper, we focus on designing and applying unilateral perturbations that evoke contralateral leg motions through mechanisms of inter-leg coordination. Real-time control of floor stiffness is utilized to uniquely differentiate force and kinematic feedback, creating novel perturbations. We present results of repeatable and scalable evoked muscle activity of the contralateral tibialis anterior muscle through unilateral stiffness perturbations. We also present a mathematical model that accurately describes the relationship between the magnitude of the stiffness perturbation and the evoked muscle activity, that could result in model-based rehabilitation strategies for impaired walkers. The novel methods and results presented in this paper set the foundation for a paradigm shift of robotic interventions for gait rehabilitation.
    Full-text · Article · Jun 2015 · Proceedings - IEEE International Conference on Robotics and Automation
    • "Improvements in gait and balance have been reported in the literature for patients with spinal cord injury (Hornby et al., 2005b; Wirz et al., 2005), Parkinson's disease (Lo et al., 2010), multiple sclerosis (Beer et al., 2008; Lo and Triche, 2008) and stroke (Mayr et al., 2007). Although a recent update of a Cochrane review suggests a better outcome (independent walking) of subacute stroke patients after robotassisted gait training (RAGT) in combination with physiotherapy compared to physiotherapy alone (Mehrholz et al., 2013), it is not proven at the moment that RAGT is more effective compared to other gait rehabilitation methods (Mehrholz and Pohl, 2012; Mehrholz et al., 2008, Clinical Biomechanics xxx (2015) xxx–xxx ☆ Test location and ethical commission: All measurements were performed at the Rehabilitation Centre St-Ursula, Jessa Hospital, Herk-de-Stad, Belgium. "

    No preview · Article · May 2015 · Physiotherapy
    • "Improvements in gait and balance have been reported in the literature for patients with spinal cord injury (Hornby et al., 2005b; Wirz et al., 2005), Parkinson's disease (Lo et al., 2010), multiple sclerosis (Beer et al., 2008; Lo and Triche, 2008) and stroke (Mayr et al., 2007). Although a recent update of a Cochrane review suggests a better outcome (independent walking) of subacute stroke patients after robotassisted gait training (RAGT) in combination with physiotherapy compared to physiotherapy alone (Mehrholz et al., 2013), it is not proven at the moment that RAGT is more effective compared to other gait rehabilitation methods (Mehrholz and Pohl, 2012; Mehrholz et al., 2008, Clinical Biomechanics xxx (2015) xxx–xxx ☆ Test location and ethical commission: All measurements were performed at the Rehabilitation Centre St-Ursula, Jessa Hospital, Herk-de-Stad, Belgium. "
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    ABSTRACT: Background: Little attention has been devoted to the thorax and pelvis movements during gait. The aim of this study is to compare differences in the thorax and pelvis kinematics during unassisted walking on a treadmill and during walking with robot assistance (Lokomat-system (Hocoma, Volketswil, Switzerland)). Methods: 18 healthy persons walked on a treadmill with and without the Lokomat system at 2kmph. Three different conditions of guidance force (30%, 60% and 100%) were used during robot-assisted treadmill walking (30% body weight support). The maximal movement amplitudes of the thorax and pelvis were measured (Polhemus Liberty™ (Polhemus, Colchester, Vermont, USA) (240/16)). A repeated measurement ANOVA was conducted. Findings: Robot-assisted treadmill walking with different levels of guidance force showed significantly smaller maximal movement amplitudes for thorax and pelvis, compared to treadmill walking. Only the antero-posterior tilting of the pelvis was significantly increased during robot-assisted treadmill walking compared to treadmill walking. No significant changes of kinematic parameters were found between the different levels of guidance force. Interpretation: With regard to the thorax and pelvis movements, robot-assisted treadmill walking is significantly different compared to treadmill walking. It can be concluded that when using robot assistance, the thorax is stimulated in a different way than during walking without robot assistance, influencing the balance training during gait.
    No preview · Article · Jan 2015 · Clinical Biomechanics
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