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Multicenter Randomized Clinical Trial Evaluating the Effectiveness of the Lokomat in Subacute Stroke
Joseph Hidler, PhD
Department of Biomedical Engineering, Catholic University, Washington, DC; Center for Applied Biomechanics and Rehabilitation Research, National Rehabilitation Hospital, Washington, DC, joehidler{at}gmail.com
Diane Nichols, PT
Center for Applied Biomechanics and Rehabilitation Research, National Rehabilitation Hospital, Washington, DC; Physical Therapy Service, National Rehabilitation Hospital, Washington, DC
Marlena Pelliccio, PT
Center for Applied Biomechanics and Rehabilitation Research, National Rehabilitation Hospital, Washington, DC; Physical Therapy Service, National Rehabilitation Hospital, Washington, DC
Kathy Brady, MSPT
Center for Applied Biomechanics and Rehabilitation Research, National Rehabilitation Hospital, Washington, DC; Physical Therapy Service, National Rehabilitation Hospital, Washington, DC
Donielle D. Campbell, PT
Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Illinois
Jennifer H. Kahn, PT
Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Illinois
T. George Hornby, PhD, PT
Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Illinois; Department of Physical Therapy, University of Illinois, Chicago
Objective. To compare the efficacy of robotic-assisted gait training with the Lokomat to conventional gait training in individuals with subacute stroke. Methods. A total of 63 participants <6 months poststroke with an initial walking speed between 0.1 to 0.6 m/s completed the multicenter, randomized clinical trial. All participants received twenty-four 1-hour sessions of either Lokomat or conventional gait training. Outcome measures were evaluated prior to training, after 12 and 24 sessions, and at a 3-month follow-up exam. Self-selected overground walking speed and distance walked in 6 minutes were the primary outcome measures, whereas secondary outcome measures included balance, mobility and function, cadence and symmetry, level of disability, and quality of life measures. Results. Participants who received conventional gait training experienced significantly greater gains in walking speed (P = .002) and distance (P = .03) than those trained on the Lokomat. These differences were maintained at the 3-month follow-up evaluation. Secondary measures were not different between the 2 groups, although a 2-fold greater improvement in cadence was observed in the conventional versus Lokomat group. Conclusions. For subacute stroke participants with moderate to severe gait impairments, the diversity of conventional gait training interventions appears to be more effective than robotic-assisted gait training for facilitating returns in walking ability.
Key Words: Hemiplegia • Rehabilitation • Gait • Recovery of function • Robotics • Walking
References
- Barbeau H., Wainberg M., Finch L. Description and application of a system for locomotor rehabilitation. Med Biol Eng Comput. 1987;25(3):341-344.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Barbeau H., Nadeau S., Garneau C. Physical determinants, emerging concepts, and training approaches in gait of individuals with spinal cord injury. J Neurotrauma. 2006;23(3-4):571-585.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Hesse S., Bertelt C., Jahnke T., et al. Treadmill training with partial body weight support compared with physiotherapy in nonambulatory hemiparetic patients. Stroke. 1995;26(6):976-981.[Abstract/Free Full Text]
- Visintin M., Barbeau H., Korner-Bitensky N., Mayo NE A new approach to retrain gait in stroke patients through body weight support and treadmill ambulation. Stroke. 1998;29(6):1122-1128.[Abstract/Free Full Text]
- Barbeau H., Visintin M. Optimal outcomes obtained with body-weight support combined with treadmill training in stroke subjects. Arch Phys Med Rehabil. 2003;84(10):1458-1465.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Sullivan KJ, Knowlton BJ, Dobkin BH Step training with body weight support: effect of treadmill speed and practice paradigms on poststroke locomotor recovery. Arch Phys Med Rehabil. 2002;83(5):683-691.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Pohl M., Mehrholz J., Ritschel C., Rückriem S. Speed-dependent treadmill training in ambulatory hemiparetic stroke patients: a randomized controlled trial. Stroke. 2002;33(3):553-558.[Abstract/Free Full Text]
- Macko RF, Ivey FM, Forrester LW, et al. Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: a randomized, controlled trial. Stroke. 2005;36(10): 2206-2211.[Abstract/Free Full Text]
- Hidler J., Nichols D., Pelliccio M., Brady K. Advances in the understanding and treatment of stroke impairment using robotic devices. Topic Stroke Rehabil. 2005;12(2):21-33.
- DeJong G., Horn SD, Conroy B., Nichols D., Healton EB Opening the black box of post-stroke rehabilitation: stroke rehabilitation patients, processes, and outcomes. Arch Phys Med Rehabil. 2005;86(suppl 2):S1-S7.[Medline]
[Order article via Infotrieve]
- Horn SD, DeJong G., Smout RJ, Gassaway J., James R., Conroy B. Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better? Arch Phys Med Rehabil. 2005;86(suppl 2): S101-S114.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Hesse S., Uhlenbrock D. A mechanized gait trainer for restoration of gait. J Rehab Res Dev. 2000;37(6):701-708.[Web of Science][Medline]
[Order article via Infotrieve]
- Werner C., von Frankenberg S., Treig T., Konrad M., Hesse S. 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(12):2895-2901.[Abstract/Free Full Text]
- Colombo G., Joerg M., Schreier R., Dietz V. Treadmill training of paraplegic patients using a robotic orthosis. J Rehabil Res Dev. 2000;37(6):693-700.[Web of Science][Medline]
[Order article via Infotrieve]
- Husemann B., Müller F., Krewer C., Heller S., Koenig E. Effects of locomotion training with assistance of robot-driven gait orthosis in hemiparetic patients after stroke: a randomized controlled pilot study. Stroke. 2007; 38(2):349-354.[Abstract/Free Full Text]
- Folstein MF, Folstein SE, McHugh PR "Mini-mental state." A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-198.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Radloff LS The CES-D scale: a self report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385-401.[CrossRef]
- American College of Sports Medicine Web site. http://www.acsm.org. Accessed 2008.
- Salbach NM, Mayo NE, Higgins J., Ahmed S., Finch LE, Richards CL Responsiveness and predictability of gait speed and other disability measures in acute stroke. Arch Phys Med Rehabil. 2001;82(9):1204-1212.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: preliminary development of an instrument. Can J Public Health. 1992;83(suppl 2)S7-S11.[Web of Science][Medline]
[Order article via Infotrieve]
- Carr JH, Shepherd RB, Nordholm L., Lynne D. Investigation of a new motor assessment scale for stroke patients. Phys Ther. 1985;65(2):175-180.[Abstract/Free Full Text]
- Collen FM, Wade DT, Robb GF, Bradshaw CM The Rivermead Mobility Index: a further development of the Rivermead Motor Assessment. Int Disabil Stud. 1991;13(2):50-54.[Medline]
[Order article via Infotrieve]
- Holbrook M., Skilbeck CE An activities index for use with stroke patients. Age Ageing. 1983;12(2):166-170.[Abstract/Free Full Text]
- Ware JE, Sherbourne CD. The MOS 36-Item short-form health survey (SF-36) I. Conceptual framework and item selection. Med Care. 1992; 30(6):473-483.[Medline]
[Order article via Infotrieve]
- Hidler JM, Carroll M., Federovich EH Strength and coordination in the paretic leg of individuals following acute stroke. IEEE Trans Neural Syst Rehabil Eng. 2007;15(4):526-534.[Medline]
[Order article via Infotrieve]
- Hidler JM, Wisman W., Neckel N. Kinematic trajectories while walking within the Lokomat robotic gait-orthosis. Clin Biomech. 2008. doi:10.1016/j.clinbiomech.2008.08.004.
- Gottschall JS, Kram R. Energy cost and muscular activity required for propulsion during walking. J Appl Physiol. 2003;94(5):1766-1772.[Abstract/Free Full Text]
- Donelan JM, Shipman DW, Kram R., Kuo AD Mechanical and metabolic requirements for active lateral stabilization in human walking. J Biomech. 2004;37(6):827-835.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Israel JF, Campbell DD, Kahn JH, Hornby TG Metabolic costs and muscle activity patterns during robotic- and therapist-assisted treadmill walking in individuals with incomplete spinal cord injury. Phys Ther. 2006;86(11):1466-1478.[Abstract/Free Full Text]
- Regnaux JP, Saremi K., Marehbian J., Bussel B., Dobkin BH An accelerometry-based comparison of 2 robotic assistive devices for treadmill training of gait. Neurorehabil Neural Repair. 2007;22:348-354.
- Dietz V. Do human bipeds use quadrupedal coordination? Trends Neurosci. 2002;25(9):462-467.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Dobkin B., Apple D., Barbeau H., et al. Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI. Neurology. 2006;66(4):484-493.[Abstract/Free Full Text]
- Huang HJ, Ferris DP Neural coupling between upper and lower limbs during recumbent stepping. J Appl Physiol. 2004;97(4):1299-1308.[Abstract/Free Full Text]
- Au-yeung SS, Ng JT, Lo SK Does balance or motor impairment of limbs discriminate the ambulatory status of stroke survivors? Am J Phys Med Rehabil. 2003;82(4):279-283.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Hidler JM, Wall AE Changes in muscle activation patterns during robotic-assisted walking. Clin Biomech. 2005;20:184-193.[CrossRef][Medline]
[Order article via Infotrieve]
- Hidler, JM Inverse-dynamics based assessment of gait using a robotic orthosis. New York, NY: IEEE Engineering in Medicine and Biology Society; 2006.
- Neckel N., Nichols D., Hidler J. Joint moments exhibited by chronic stroke subjects while walking with a prescribed physiological gait pattern. J NeuroEngin Rehabil. 2008:5-18.
- Knutsson, E., Richards C. Different types of disturbed motor control in gait of hemiparetic patients. Brain. 1979;102(2):405-430.[Free Full Text]
- Yen C.-L., Wang R.-Y., Liao K.-K., Huang C.-C., Yang Y.-R. Gait training-induced change in corticomotor excitability in patients with chronic stroke. Neurorehabil Neural Repair. 2008;22:22-30.[Abstract/Free Full Text]
- Cai L., Fong A. Effects of consistency vs variability in robotically controlled training of stepping in adult spinal mice. Paper presented at: IEEE 9th International Conference on Rehabilitation Robotics; 2005; Chicago, IL.
- Emken JL, Benitez R., Sideris A., Bobrow JE, Reinkensmeyer DJ Motor adaptation as a greedy optimization of error and effort. J Neurophysiol. 2007;97:3997-4006.[Abstract/Free Full Text]
- Riener R., Lunenburger L., Colombo G. Human-centered robotics applied to gait training and assessment. J Rehab Res Dev. 2006;43(5):679-694.[Medline]
[Order article via Infotrieve]
- Lee S., Hidler J. Biomechanics of overground versus treadmill walking in healthy individuals. J Appl Phys. 2008;104:747-755.[Abstract/Free Full Text]
- Behrman AL, Lawless-Dixon AR, Davis SB, et al. Locomotor training progression and outcomes after incomplete spinal cord injury. Phys Therapy. 2005;85:1356-1371.[Abstract/Free Full Text]
- Hornby TG, Zemon DH, Campbell D. Robotic-assisted, body-weight-supported treadmill training in individuals following motor incomplete spinal cord injury. Phys Therapy. 2005;85(1):52-66.[Abstract/Free Full Text]
- Pohl M., Werner C., Holzgraefe M., et al. Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: a single-blind, randomized multicentre trial. Clin Rehabil. 2007; 21(1):17-27.[Abstract/Free Full Text]
- Mayr A., Kofler M., Quirback E., Matzak H., Frohlich K., Saltuari L. Prospective, blinded, randomized crossover study of gait rehabilitation in stroke patients using the Lokomat gait orthosis. Neurorehabil Neural Repair. 2007;21:307-314.[Abstract/Free Full Text]
- Hornby TG, Campbell DD, Kahn JH, Demott T., Moore JL, Roth HR Enhanced gait-related improvement following therapist- vs robotic-assisted locomotor training: a randomized controlled trial. Stroke. 2008;39(6):1786-1792.[Abstract/Free Full Text]
- Dobkin B., Barbeau H., Apple D., et al. The evolution of walking-related outcomes over the first 12 weeks of rehabilitation for incomplete traumatic spinal cord injury: the multicenter randomized Spinal Cord Injury Locomotor Trial. Neurorehabil Neural Repair. 2007;21(1): 25-35.[Abstract/Free Full Text]
- Duncan PW, Goldstein LB, Matchar D., Divine GW, Feussner J. Measurement of motor recovery after stroke: outcome assessment and sample size requirements. Stroke. 1992;23(8):1084-1089.[Abstract/Free Full Text]
Neurorehabilitation and Neural Repair, Vol. 23, No. 1,
5-13 (2009)
DOI: 10.1177/1545968308326632
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