|
Sign In to gain access to subscriptions and/or personal tools.
|
Prospective, Blinded, Randomized Crossover Study of Gait Rehabilitation in Stroke Patients Using the Lokomat Gait Orthosis
Andreas Mayr, MS
Department ofNeurology, Hospital Hochzirl, Zirl, Austria
Markus Kofler, MD
Department ofNeurology, Hospital Hochzirl, Zirl, Austria, markus.kofler{at}i-med.ac.at
Ellen Quirbach, PT
Department ofNeurology, Hospital Hochzirl, Zirl, Austria
Heinz Matzak, MD
Department ofNeurology, Hospital Hochzirl, Zirl, Austria
Katrin Fröhlich, MD
Department ofNeurology, Hospital Hochzirl, Zirl, Austria
Leopold Saltuari, MD
Department ofNeurology, Hospital Hochzirl, Zirl, Austria
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.
Key Words: Locomotion • Stroke • Assessment scores • Automated gait orthosis • Lokomat.
References
- Moseley AM, Stark A., Cameron ID, et al. Treadmill training and body weight support for walking after stroke . Cochrane Database Syst Rev. 2005;CD002840.
- Van Peppen RP , Kwakkel G., Wood-Dauphinee S., et al. The impact of physical therapy on functional outcomes after stroke: what's the evidence? Clin Rehabil. 2004;18: 833-862 .[Abstract/Free Full Text]
- Dietz V., Harkema SJ Locomotor activity in spinal cord-injured persons . J Appl Physiol. 2004;96: 1954-1960 .[Abstract/Free Full Text]
- Hesse S., Bertelt C., Schaffrin A., et al. Restoration of gait in nonambulatory hemiparetic patients by treadmill training with partial body-weight support . Arch Phys Med Rehabil. 1994;75: 1087-1093 .[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Colombo G. The "Lokomat"—a driven ambulatory orthosis . Med Orth Tech. 2000;6: 178-181 .
- Visintin M., Barbeau H. The effects of body weight support on the locomotor pattern of spastic paretic patients . Can J Neurol Sci. 1989;16: 315-325 .[Web of Science][Medline]
[Order article via Infotrieve]
- Lennon S., Baxter D., Ashburn A. Physiotherapy based on the Bobath concept in stroke rehabilitation: a survey within the UK . Disabil Rehabil. 2001; 23: 254-262 .[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Perfetti C. Der hemiplegische Patient. Kognitiv-therapeutische Übungen. München, Bad Kissingen , Berlin: Pflaum; 1997.
- Wernig A., Muller S., Nanassy A., et al. Laufband therapy based on `rules of spinal locomotion' is effective in spinal cord injured persons . Eur J Neurosci. 1995;7: 823-829 .[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Adams SA, Pickering RM, Ashburn A., et al. The scalability of the Rivermead Motor Assessment in nonacute stroke patients . Clin Rehabil. 1997;11: 52-59 .[Abstract/Free Full Text]
- Collen FM, Wade DT, Bradshaw CM Mobility after stroke: reliability of measures of impairment and disability . Int Disabil Stud. 1990;12: 6-9 .[Medline]
[Order article via Infotrieve]
- Wade DT Motor and sensory impairments. In: Wade DT , ed. Measurement in Neurological Rehabilitation. Oxford, UK: Oxford University Press; 1992:50-58.
- Cameron D., Bohannon RW Criterion validity of lower extremity Motricity Index scores . Clin Rehabil. 2000;14: 208-211 .[Abstract/Free Full Text]
- Ashworth B. Preliminary trial of carisoprodol in multiple sclerosis . Practitioner. 1964;192: 540-542 .[Web of Science][Medline]
[Order article via Infotrieve]
- Schumacher M. , Schulgen G. Cross-over Studien. In: Schumacher M, Schulgen G , eds. Methodik klinischer Studien. Methodische Grundlagen der Planung, Durchführung und Auswertung. Berlin: Springer; 2002:277-289.
- Schmidt RA, Wrisberg CA Supplementing the learning experience. In: Schmidt RA, Wrisberg CA, eds. Motor Learning and Performance: A problem-Based Learning Approach . Champaign, Ill: Human Kinetics; 2004:213-245.
- Hesse S., Sarkodie-Gyan T., Uhlenbrock D. Development of an advanced mechanised gait trainer, controlling movement of the centre of mass, for restoring gait in non-ambulant subjects . Biomed Tech (Berl). 1999;44: 194-201 .[Medline]
[Order article via Infotrieve]
- Hesse S., Uhlenbrock D. A mechanized gait trainer for restoration of gait . J Rehabil Res Dev. 2000;37: 701-708 .[Web of Science][Medline]
[Order article via Infotrieve]
- HealthSouth. AutoAmbulator clinical trials underway at HealthSouth Medical Center and HealthSouth Corporation. Health south 2002 May 20. Available at: http://www.healthsouth.com.
- Duysens J., Clarac F., Cruse H. Load-regulating mechanisms in gait and posture: comparative aspects . Physiol Rev. 2000;80: 83-133 .[Abstract/Free Full Text]
- Van de Crommert HW, Mulder T., Duysens J. Neural control of locomotion: sensory control of the central pattern generator and its relation to treadmill training . Gait Posture. 1998;7: 251-263 .[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Harkema SJ, Hurley SL, Patel UK, et al. Human lumbosacral spinal cord interprets loading during stepping . J Neurophysiol. 1997;77: 797-811 .[Abstract/Free Full Text]
- Wernig A., Muller S. Laufband locomotion with body weight support improved walking in persons with severe spinal cord injuries . Paraplegia. 1992; 30: 229-238 .[Web of Science][Medline]
[Order article via Infotrieve]
- Thelen E., Ulrich BD, Niles D. Bilateral coordination in human infants: stepping on a split-belt treadmill . J Exp Psychol Hum Percept Perform. 1987;13: 405-410 .[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Dietz V., Muller R., Colombo G. Locomotor activity in spinal man: significance of afferent input from joint and load receptors . Brain. 2002;125: 2626-2634 .[Abstract/Free Full Text]
- Thelen E., Cooke DW Relationship between newborn stepping and later walking: a new interpretation . Dev Med Child Neurol. 1987;29: 380-393 .[Web of Science][Medline]
[Order article via Infotrieve]
- Hesse S., Werner C., Bardeleben A., et al. Body weight—supported treadmill training after stroke . Curr Atheroscler Rep. 2001;3: 287-294 .[Medline]
[Order article via Infotrieve]
- Jackson D., Thornton H., Turner-Stokes L. Can young severely disabled stroke patients regain the ability to walk independently more than three months post stroke ? Clin Rehabil. 2000;14: 538-547 .[Abstract/Free Full Text]
- Perry J. Phases of gait. In: Perry J, ed. Gait Analysis. Normal and Pathological Function. Thorofare : Slack; 1992:9-16.
- Colombo G., Joerg M., Schreier R., et al. Treadmill training of paraplegic patients using a robotic orthosis . J Rehabil Res Dev. 2000;37: 693-700 .[Web of Science][Medline]
[Order article via Infotrieve]
- Uhlenbrock D., Sarkodie-Gyan T., Reiter F., et al. Development of a gait trainer with regulated servo-drive for rehabilitation of locomotor disabled patients . Biomed Tech (Berl). 1997;42: 196-202 .[Medline]
[Order article via Infotrieve]
- Colombo G., Wirz M., Dietz V. Driven gait orthosis for improvement of locomotor training in paraplegic patients . Spinal Cord. 2001;39: 252-255 .[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Werner C., von Frankenberg S., Treig T., et al. Treadmill training with partial body weight support and an electromechanical gait trainer for restoration of gait in subacute stroke patients: a randomized crossover study . Stroke. 2002;33: 2895-2901 .[Abstract/Free Full Text]
- Hesse S., Bertelt C., Jahnke MT, et al. Treadmill training with partial body weight support compared with physiotherapy in non-ambulatory hemiparetic patients . Stroke. 1995;26: 976-981 .[Abstract/Free Full Text]
- Visintin M. , Barbeau H., Korner-Bitensky N., et al. A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation . Stroke. 1998;29: 1122-1128 .[Abstract/Free Full Text]
- Husemann B. , Muller F., Krewer C., et al. Effects of locomotion training with assistance of a robot-driven gait orthosis in hemiparetic patients after stroke: a randomized controlled pilot study . Stroke . 2007;38: 349 .[Abstract/Free Full Text]
- Krewer C., Muller F., Husemann B., et al. The influence of different Lokomat walking conditions on the energy expenditure of hemiparetic patients and healthy subjects . Gait Posture. 2006 Nov 17;[Epub ahead of print]
- Macko RF, DeSouza CA, Tretter LD, et al. Treadmill aerobic exercise training reduces the energy expenditure and cardiovascular demands of hemiparetic gait in chronic stroke patients: a preliminary report . Stroke. 1997;28: 326-330 .[Abstract/Free Full Text]
- Pohl M., Mehrholz J., Ritschel C., et al. Speed-dependent treadmill training in ambulatory hemiparetic stroke patients: a randomized controlled trial . Stroke. 2002;33: 553-538 .[Abstract/Free Full Text]
- Macko RF, Katzel LI, Yataco A., et al. Low-velocity graded treadmill stress testing in hemiparetic stroke patients . Stroke. 1997;28: 988-992 .[Abstract/Free Full Text]
- Jorgensen HS , Nakayama H., Raaschou HO, et al. Recovery of walking function in stroke patients: the Copenhagen Stroke Study . Arch Phys Med Rehabil. 1995;76: 27-32 .[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Shumway-Cook A., Woollacott MH Mobility function. In: Shumway-Cook A, Woollacott MH, eds. Motor Control: Theory and Practical Applications. Philadelphia: Lippincott Williams & Wilkins; 2001:305-337.
- Holden MK, Gill KM, Magliozzi MR, et al. Clinical gait assessment in the neurologically impaired: reliability and meaningful-ness . Phys Ther. 1984;64: 35-40 .[Abstract/Free Full Text]
- Hesse S., Malezic M., Schaffrin A., et al. Restoration of gait by combined treadmill training and multichannel electrical stimulation in non-ambulatory hemiparetic patients . Scand J Rehabil Med. 1995;27: 199-204 .[Web of Science][Medline]
[Order article via Infotrieve]
- Bortz J. Wahrscheinlichkeitstheorie und Wahrscheinlichkeitsverteilungen. In: Bortz J, ed. Statistik für Human-und Sozialwissenschafter . Heidelberg: Springer; 2005:49-84.
This version was published on July
1, 2007
Neurorehabilitation and Neural Repair, Vol. 21, No. 4,
307-314 (2007)
DOI: 10.1177/1545968307300697
 CiteULike  Complore  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter What's this?
This article has been cited by other articles:
|
|
|
|
 
A Meyer-Heim, C Ammann-Reiffer, A Schmartz, J Schafer, F H Sennhauser, F Heinen, B Knecht, E Dabrowski, and I Borggraefe
Improvement of walking abilities after robotic-assisted locomotion training in children with cerebral palsy
Arch. Dis. Child.,
August 1, 2009;
94(8):
615 - 620.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. H. Dobkin
Progressive Staging of Pilot Studies to Improve Phase III Trials for Motor Interventions
Neurorehabil Neural Repair,
March 1, 2009;
23(3):
197 - 206.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. U. Blicher and J. F. Nielsen
Cortical and Spinal Excitability Changes After Robotic Gait Training in Healthy Participants
Neurorehabil Neural Repair,
February 1, 2009;
23(2):
143 - 149.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. Hidler, D. Nichols, M. Pelliccio, K. Brady, D. D. Campbell, J. H. Kahn, and T. G. Hornby
Multicenter Randomized Clinical Trial Evaluating the Effectiveness of the Lokomat in Subacute Stroke
Neurorehabil Neural Repair,
January 1, 2009;
23(1):
5 - 13.
[Abstract]
[PDF]
|
|
|
|
|
|
|
M. Kofler, E. Quirbach, R. Schauer, M. Singer, and L. Saltuari
Limitations of Intrathecal Baclofen for Spastic Hemiparesis Following Stroke
Neurorehabil Neural Repair,
January 1, 2009;
23(1):
26 - 31.
[Abstract]
[PDF]
|
|
|
|
|
|
|
R. Dickstein
Rehabilitation of Gait Speed After Stroke: A Critical Review of Intervention Approaches
Neurorehabil Neural Repair,
November 1, 2008;
22(6):
649 - 660.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. C. Lo and E. W. Triche
Improving Gait in Multiple Sclerosis Using Robot-Assisted, Body Weight Supported Treadmill Training
Neurorehabil Neural Repair,
November 1, 2008;
22(6):
661 - 671.
[Abstract]
[PDF]
|
|
|
|
|
|
|
R. Banz, M. Bolliger, G. Colombo, V. Dietz, and L. Lunenburger
Computerized Visual Feedback: An Adjunct to Robotic-Assisted Gait Training
Physical Therapy,
October 1, 2008;
88(10):
1135 - 1145.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Lam, M. Wirz, L. Lunenburger, and V. Dietz
Swing Phase Resistance Enhances Flexor Muscle Activity During Treadmill Locomotion in Incomplete Spinal Cord Injury
Neurorehabil Neural Repair,
September 1, 2008;
22(5):
438 - 446.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J.-P. Regnaux, K. Saremi, J. Marehbian, B. Bussel, and B. H. Dobkin
An Accelerometry-Based Comparison of 2 Robotic Assistive Devices for Treadmill Training of Gait
Neurorehabil Neural Repair,
July 1, 2008;
22(4):
348 - 354.
[Abstract]
[PDF]
|
|
|
|
|
|
|
T. G. Hornby, D. D. Campbell, J. H. Kahn, T. Demott, J. L. Moore, and H. R. Roth
Enhanced Gait-Related Improvements After Therapist- Versus Robotic-Assisted Locomotor Training in Subjects With Chronic Stroke: A Randomized Controlled Study
Stroke,
June 1, 2008;
39(6):
1786 - 1792.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
