Gait training with the newly developed ‘LokoHelp’-system is feasible for non-ambulatory patients after stroke, spinal cord and brain injury. A feasibility study

Abstract

Primary objective: To evaluate the feasibility of using a newly developed electromechanical gait device (LokoHelp) for locomotion training in neurological patients with impaired walking ability with respect to training effects and patients’ and therapists’ efforts and discomfort.

Methods and procedures: Design: Case series. Setting: A neurological rehabilitation centre for children, adolescents and young adults. Subjects: Six patients with impaired walking function: two after stroke, two after spinal cord injury and two after brain injury. Intervention: Twenty additional training sessions on a treadmill fitted with a newly developed electromechanical gait device and body weight support (BWS), performed over a study-period of 6 weeks.

Main outcomes and results: Patients’ progress was assessed with the following instruments: the Functional Ambulation Category FAC (walking ability), the 10-metre walk test (gait velocity), the Motricity Index (lower limb strength), the Berg Balance Scale (postural capacity), the modified Ashworth Scale (spasticity) and the Rivermead Mobility Index (activity). After each therapy session, therapists completed a form, thereby indicating whether manual assistance was necessary and, if so, how much physical effort was expended and how much discomfort was experienced during the therapy session. The therapists also indicated on the form information about the patient's effort and discomfort. No severe adverse events were observed during the locomotion training with the LokoHelp device. Patients improved with regard to Functional Ambulation Category (FAC) (from mean 0.7, SD = 1.6, to mean 2.5, SD = 2.1, p = 0.048), Motricity Index (from mean 94 points, SD = 50, to mean 111, SD = 52, p = 0.086), Berg Balance Scale (BBS) (from mean 20 points, SD = 23 to mean 25, SD = 23, p = 0.168) and Rivermead Mobility Index (RMI) (from mean 5 points, SD = 4, to mean 7, SD = 5, p = 0.033). Therapists required a low level of effort to carry out the training and seldom experienced discomfort. Patients described their effort during training as being low-to-exhausting. They rarely experienced discomfort, which was mostly related to difficulties with the BWS-System. Training intensity had to be adjusted in one patient who complained of knee pain.

Conclusions: Locomotion training with the newly developed ‘LokoHelp’-system is feasible in severely affected patients after brain injury, stroke and spinal cord injury. In addition, our results indicate that the described alternative method of gait training may decrease the exertion needed by therapists to carry out the training.

• Gait rehabilitation
• brain injury
• spinal cord injury
• stroke
• exercise
• physiotherapy