Over-ground and robotic-assisted locomotor training in adults with chronic stroke: a blinded randomized clinical trial

Abstract

Purpose: The purpose was to compare the effectiveness of robotic-assisted body weight supported treadmill training using the Lokomat^® to over-ground gait training (OGT) in adults with chronic stroke. Methods: Participants were randomly assigned to the Lokomat^® or OGT interventions. Both protocols included 40 sessions over 8 weeks. Primary outcome measures were the 10-meter walk test and 6-minute walk distance. Secondary measures included the Functional Independence Measure^TM locomotion score, Fugl-Meyer Lower Extremity Motor Score (FM-LE), Barthel Index, and Stroke Impact Scale. Blinded assessors tested the participants at baseline, post-intervention, and 3-month follow-up. Results: Eleven Lokomat^® and nine OGT participants completed the study. Within group differences in the FM-LE score and Barthel Index occurred over time from baseline to post-intervention and baseline to 3-month follow-up. No other within group differences and no between group differences were observed. Conclusions: Although walking measures did not show significant changes between groups, LE motor function and physical functional levels improved over time within both groups. The Lokomat^® may allow aggressive locomotor training, particularly for the lower functioning patients who wish to improve walking ability due to apparent eased therapist physical burden, when compared to OGT, although an increased risk of skin breakdown is present.

Implications for Rehabilitation

• Survivors of chronic stroke can continue to improve in motor recovery and functional ability after intensive over-ground or robotic-assisted locomotor training.

• Over-ground and robotic-assisted locomotor training appear to equivalently enhance motor recovery and functional ability in low functioning survivors of chronic stroke.

• Risk of skin breakdown is significant with roboticassisted locomotor training.

Keywords::

• Gait training
• locomotor training
• robotics
• stroke

Acknowledgements

We acknowledge the grant funding for this study by the Medallion Foundation through Memorial Hermann Clinical Innovation and Research Institute. We want to thank the following people for their assistance: Jenny Amonette, PT, NCS, Stephanie Borders, BS, Lauren Elizondo, PT, DPT, NCS, Nneka Ifejika-Jones, MD, Betty MacNeill, PT, DPT, MEd, Jill Seale, PT, PhD, NCS, Mary Watson, PhD, Josephine Ymana, PT. We also wish to thank the following people who were PT student assistants during the course of the study: Esther Coker, PT, DPT, Brittany Geiser, SPT, Kimberly Gutowsky, PT, DPT, Tamara Jungen, PT, DPT, Amy Odom, PT, DPT, Gracie Posey, PT, DPT, Diana Soberon, SPT, Chris White, PT, DPT, and Daniel Wingard, PT, DPT.

Declaration of Interest: The authors report no declaration of interest. This study was funded by the Medallion Foundation through Memorial Hermann Clinical Innovation and Research Institute. Funding ceased 04/2011, and the authors have no known conflict of interest.