Pilot study of Lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke

Abstract

Background: While manually-assisted body-weight supported treadmill training (BWSTT) has revealed improved locomotor function in persons with post-stroke hemiparesis, outcomes are inconsistent and it is very labor intensive. Thus an alternate treatment approach is desirable. Objectives of this pilot study were to: 1) compare the efficacy of body-weight supported treadmill training (BWSTT) combined with the Lokomat robotic gait orthosis versus manually-assisted BWSTT for locomotor training post-stroke, and 2) assess effects of fast versus slow treadmill training speed.

Methods: Sixteen volunteers with chronic hemiparetic gait (0.62 +/- 0.30 m/s) post-stroke were randomly allocated to Lokomat (n = 8) or manual-BWSTT (n = 8) 3x/wk for 4 weeks. Groups were also stratified by fast (mean 0.92 +/- 0.15 m/s) or slow (0.58 +/- 0.12 m/s) training speeds. The primary outcomes were self-selected overground walking speed and paretic step length ratio. Secondary outcomes included: fast overground walking speed, 6-minute walk test, and a battery of clinical measures.

Results: No significant differences in primary outcomes were revealed between Lokomat and manual groups as a result of training. However, within the Lokomat group, self-selected walk speed, paretic step length ratio, and four of the six secondary measures improved (p = 0.04-0.05, effect sizes = 0.19-0.60). Within the manual group, only balance scores improved (p = 0.02, effect size = 0.57). Group differences between fast and slow training groups were not revealed (p > or = 0.28).

Conclusion: Results suggest that Lokomat training may have advantages over manual-BWSTT following a modest intervention dose in chronic hemiparetic persons and further, that our training speeds produce similar gait improvements. Suggestions for a larger randomized controlled trial with optimal study parameters are provided.

Figure 1

Medians and lower and upper quartiles for pre-post differences in the manual and Lokomat group. A. Self-selected walk speed. B. Absolute step length ratio (negative change scores represent a shift towards symmetrical step lengths). Extreme values are greater than 3 times the interquartile distance.* Significant difference only within the Lokomat group (p < 0.05).

Figure 2

Medians and lower and upper quartiles for pre-post differences in the manual and Lokomat group. A. Fast Walk speed. B. Lower Extremity Fugl-Meyer scores (higher scores represent improved sensorimotor recovery). C. Berg Balance Scale (higher scores represent improved balance). D. Six minute walk test (distance covered). * Significant difference within Lokomat group between pre- and post-test (p < 0.05). † Significant difference within manual group between pre- and post-test (p < 0.05).