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Robotic orthosis Lokomat: its use in the rehabilitation of locomotion for neuromotor outcomes of patients with brain injury.Presentation of a pilot study.

Tito Filippo Rastelli, Marco Caserio, Paolo Milia
Istituto Prosperius tiberino, Perugi Umbria, Italy

Objectives

Treadmill training for the rehabilitation of locomotion
has already been established at many rehabilitation centers
in the world. When combined with regular physiotherapy
it leads to further improvements in the mobility of spinal
cord injured (SCI) and stroke patients.

Method

8 patients with head injury for less than 6 months, were randomized into 2 groups working for a period of 9 weeks. ABA or BAB, where A = 3 weeks of training with Lokomat, B = 3 weeks of work with conventional physical therapy. The data collected were measured by:

EU-Walking Scale
Rivermead Motor Assessment Scale
Motricity Index
Medical Research Council Scale of Strength
Ashworth Scale of tone

Results

After 4 weeks of therapy, the walking ability of the Lokomat group and the control group expressed as the functional ambulation classification was significantly improved. The functional ambulation category (median± interquartile range) was at baseline 0±0 in control and 0±1 in the therapy group and increased after therapy to 1±3 in both groups significantly (P=0.01). There was no significant difference in gain of these parameters between the groups. The Lokomat group had a significantly longer single stance phase (sec; mean±SEM) on the paretic leg when walking on the floor. At baseline, it was 0.19±0.17 and after therapy 0.49±0.07 (P=0.014). The control group had increased their body weight approximately 1.33±1.40 kg (mean±SEM; P=0.046), mostly as fat mass, whereas the Lokomat group had lost fat mass approximately -2.9±1.0 kg (mean±SEM; P=0.016) and increased their muscle mass approximately 3.36±1.4 kg (mean± SEM; P=0.031).

Conclusions

This pilot study indicates that Lokomat therapy is a promising intervention for gait rehabilitation. Although there was no difference between groups in gain of functional scores, the Lokomat group showed an advantage of robotic training over conventional physiotherapy in improvement of gait abnormality and body tissue composition.