Lokomat vs. Conventional Therapy-Impact on Gait Symmetry in Hemiparetic Patients: Preliminary Clinical Study

Abstract

Background/Objectives: One of the primary goals of neurorehabilitation after stroke is gait reeducation, as it provides the patient with greater autonomy and enhances their safety in daily activities. A preliminary clinical study was undertaken to determine whether robotic gait reeducation using the Lokomat device is more effective than conventional therapy in achieving gait symmetry. Methods: The research group consisted of 107 patients, with an average age of 63.54 years, all in the subacute stage of hemiparesis. These patients underwent 4 weeks of neurorehabilitation and were assigned into experimental and control groups. The patients in the experimental group underwent neurorehabilitation (20 sessions) and twice-weekly walking on the Lokomat device (10 sessions). The control group received equivalent neurorehabilitation and conventional gait reeducation. We monitored the return of ideal limb loading (to a 50:50 ratio) and the restoration of the step length on the paretic limb to a physiological length (73 cm), as well as the subsequent restoration of gait symmetry. The measurements were performed using the HP Cosmos Zebris Treadmill FDM-T device. The Wilcoxon Signed Rank test was conducted within each group to analyze the effectiveness of gait reeducation before and after therapy. To compare the results between the two groups, the Mann-Whitney test (α = 0.05) was employed. Results: There was no significant difference between the robotic and conventional therapy groups (p = 0.432 (>0.05)). A significant change occurred only in the control group in the 50:50 limb loading parameter (p = 0.042). There were no significant changes in the other parameters. Conclusions: Under the conditions of our study, robot-guided gait reeducation did not appear to be more effective than conventional therapy. The monthly duration of gait reeducation is insufficient to achieve a symmetrical gait in patients with spastic hemiparesis.

Keywords: Lokomat; conventional therapy; gait reeducation; hemiparesis.

Figure 1

Study sample selection.

Figure 2

Consort flow diagram.

Figure 3

Gait analysis and the results on the HP Cosmos Zebris Treadmill FDM-T (authors’ archive from Zebris Medical GmbH, Isny im Allgäu, Germany).

Figure 4

Load distribution during the stance phase of the gait cycle (left hemiparesis) on the HP Cosmos Zebris Treadmill FDM-T (Authors’ archive from Zebris Medical GmbH, Isny im Allgäu, Germany).