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Thread: My Lokomat Experience

  1. #1

    My Lokomat Experience

    Last week I had a chance to try a Lokomat at the VA hospital in Gainesville, FL. Some of you know that I did a clinical trial of locomotor training at the U of Florida this summer .. closely associated with the VA. Here's what happened, and my impressions of the Lokomat:

    I started by putting on the harness. The frame holding the robotic mechanism of the Lokomat swings away so one can either step up onto the treadmill or use a ramp to wheel up. My harness was attached to two support ropes that attach to a system of cranks and weight stacks that provide the body weight support.

    They swung the robotics back into place and began to fit them to my legs and pelvis. The pelvic support has two pads that clamp together just below and forward of the hip bones, providing firm and remarkably comfortable support. Each leg has three cuffs that attach to the robotic arms, one on the thigh just above the knee, another on the upper calf, the third on the ankle. There are also spring-loaded straps that support the forefoot to make sure one gets toe clearance. It takes a bit of work to get everything fitted and aligned the first time, but once done, the measurements are recorded for future sessions. At 6'-5, I may be above the height range it will support, yet it still worked for me.

    After fitting, they raised me up completely off the treadmill, started the system, and had me "airwalk" to ensure that the mechanics of everything was ok. Once certain it was, they lowered me on to the treadmill surface where the weight stacks took over my body weight support and I began really walking. There are controls on the system to adjust stride length and tune the amount of assistance provided. There are safety features that monitor the gait and will stop the system if anything abnormal, like spasticity or a stumble, happens.

    Overall, I was impressed with how natural walking in it felt and how smooth my gait was. I walked for about 25 minutes total, trying a number of different things. After walking, my legs felt tired, even though it didn't feel like I was doing much.

    Comments:

    Advantages:


    - Smooth, natural and consistent gait pattern.

    - Can be set up and run by one person, as compared to up to four people necessary for manual assistance.

    - Remarkably safe, secure feeling. I never felt as if the machine was going to do something I couldn't handle.

    - Body-weight support and pelvic support float so they can move up and down as you walk.

    - Seems that it would be very effective for someone just learning to walk.


    Drawbacks and Issues:

    - Top speed is 3.2 km/hr (2.0 mph), ok for learning but too slow for me. On the Robomedica equipment I was often training at speeds up to 2.8 mph and went as fast as 3.5 mph.

    - Handrails and robotic equipment make arm swing difficult to impossible. Because I'm tall I was able to swing my arms outside the handrails but a shorter person would have trouble. I believe arm swing to be essential to good walking, especially at higher speeds.

    - Holding handrails may cause one to lean forward, generating poor posture and body kinematics, and bearing weight through the arms that should go through the legs.

    - Pelvic constraint keeps pelvis and sholders from doing their natural rotations.

    - Weight shifts from leg to leg are difficult. This seemed better at lower body-weight support levels.

    - While smooth, the robotic assistance lacks the human sensitivity and adaptability that can come from manual assistance.

    - Because of the pelvic constraint and the two-point body-weight support, the trunk muscles are mostly isolated from the training. My experience in a much less restrictive environment was invaluable as having good trunk stability is essential for balance while walking overground.


    Conclusion: I don't mean to be overly critical of the Lokomat .. I was impressed with it and think it's an amazing system. I do wonder how I would have fared if I had used it for the 45 sessions instead of doing manual training on the Robomedica. This is a question for researchers to figure out with further well-designed trials.

    Meanwhile, right now training on the Lokomat is valuable, especially for someone who is, say, ASIA C and gaining ground. For an ASIA D, I believe that manual-assist training is probably better, and I'm very impressed with using the Robomedica equipment for that.

    The VA has purchased five Lokomats to be used in trials that they are right now working out the protocols for. These are located in Gainesville, Miami, Washington DC, New Haven and Palo Alto. They may purchase an additional four in yet-to-be-determined locations. I expect that I will hear about these trials when they start recruiting subjects, so I will let you all know that.

    Links:

    Lokomat

    Robomedica

    - Bruce

  2. #2
    Excellent report Bruce-thanks.

    C5/6 incomplete, injured Aug. 2000

  3. #3
    hey bruce

    i did a lokomat trial in chicago at 5 months post. i agree with everything you said and would like to add something from my own experience.

    i have a very high level of muscle tone and violent spasms. when i tried to follow the gait pattern of the lokomat my body would just fight it, sometimes so bad that we would have to stop the machine as it overheated from working so hard against me. the only way that i found to avoid this was to not work at all, which was just like passive range of motion and not beneficial to my recovery.

    i spent an extra 10 days after the trial doing manual treadmill training. i gained more from those 10 days then i did the previous 2 months on the lokomat. shortly after returning home from chicago i began stepping for the first time with both legs. i know that people have benefited from the lokomat--i saw it while i was there--but my opinion is that manual training is far superior for persons with high levels of tone. i believe the research is showing this as well.

    manual treadmill training may be the best but the lokomat is more likely on a wide scale, given that it's so much more cost effective. in the acute stages i think either would be invaluable for someone that is already gaining movement.

  4. #4
    buckwheat, I have heard that people with high spasticity can have trouble. Your experience is instructive for sure. You said you would stop because the machine would overheat. I thought that it would shut down if it detected a gait abnormality like a tone attack. Did that happen to you? I tried to shut it down by fighting it but couldn't.

    I get spasticity when I first stand but it goes away pretty quickly. I'm not really surprised that 10 days of manual training was better for you.

    Regarding the design of the Lokomat, one of the guys in Gainesville said it reproduces the gait pattern of a 5'-8" Swiss guy

  5. #5
    Is it pointless than for an Asia B to utilize?

    Joe

  6. #6
    What exactly do you mean by "manual training?" Is that when someone physically moves your legs while you step? Or is it something else? Thanks!

  7. #7
    What exactly do you mean by "manual training?" Is that when someone physically moves your legs while you step? Or is it something else?
    yes, manual training is where one or more people manually move your legs over the treadmill, simulating a normal gait pattern.

  8. #8
    Originally posted by NoDecafPlz:

    Is it pointless than for an Asia B to utilize?
    Not pointless .. what I know is that many with no motor function will still develop the walking pattern, but it is not likely to lead to functional walking. So far most of the research has been on ASIA C and above so it's not really known how beneficial the exercise would be for someone like you, Joe.

  9. #9
    Finally got the video out of the camera and edited. Below is a clip of me walking in the Lokomat. Note that I start out "airwalking" just above the treadmill to make sure everything is ok .. a pretty weird feeling.

    Quicktime

    Windows Media

    Each file is about 2.3 MB in size.

  10. #10
    I had a chance to walk on a Lokomat today at Theraputix in Toronto. It was amazing. I am going to be doing a training program there 2-3 days/week over the next several months.
    I just discovered Theraputix this month. I have been saving to travel to Project Walk or SCI-step and didn't know we have a great facility with state of the art equipment right here in Toronto.

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