Robot-assisted Treadmill Training During Rehabilitation of Stroke Patients

Abstract

An important part of rehabilitation programs for patients surviving a stroke focuses on improvement of walking ability. Patients show an increase in walking speed during the rehabilitation period and often learn to walk independently. However, the result of therapy is not always satisfactory since walking ability is not fully recovered to normal in most patients. A newly developed robotic gait orthosis (Lokomat) may provide the next step in the optimization of walking therapy for stroke patients. PURPOSE: To determine the efficacy of increasing walking ability and muscle strength of the lower limbs by weight-supported robotic treadmill (RT) training in a randomized clinical trial. METHODS: Ten subjects (8 men, 56±8yrs) with subacute (7±2 wks) stroke were treated for 8 wks, 2 × 1 h/ wk, as part of the normal physical therapy and occupational therapy routine on either the RT (n=5) or by conventional physical therapy (CPT, n=5). Before and after the training period, walking speed during a 10m-Walk test was measured and maximal voluntary isometric force of both knee extensors (MVCext) and knee flexors (MVCflex) of the paretic (P) and non-paretic (NP) legs were measured. RESULTS: For the whole group, significant (p<0.05) improvements were found in the walking speed (0.19±0.13 to 0.42±0.26 m/s; +121%), and a tendency towards an improved MVCext of the NP (141±35 to 150± 40 Nm; +6%), MVCflex of the NP leg (47±17 to 53±22 Nm; +12%), MVCext of the P leg (36±29 to 46± 40 Nm; +28%), MVCflex of the P leg (4±4 to 9±11 Nm; +121%) was found. Although preliminary analyses did not show significant differences in training responses between the RT and CPT groups, the RT group tended to have larger improvements in walking speed (212 vs 79%). CONCLUSIONS: This study shows that during the rehabilitation program, walking speed significantly increased in all patients and MVC performance tended to increase for the whole group. Furthermore, RT training may result in larger increases in walking speed, but more research is warranted to substantiate this.