HyperMED
CLINICAL RESEARCH - LOKOMAT
HyperMED Clinical
Research provides links with all current
publications on Hyperbaric Oxygenation, Lokomat (Robotic Gait Assisted
Walking) and other break-through we believe relevant to the objective of
NeuroRecovery.
Clinical Research:
Lokomat
ICORD
(International Collaboration On Repair Discoveries) August 2009
Lokomat Gait Assisted Walking Project
You can participate in this
study if you have had a SCI at least 12 months ago at or above
the 12th thoracic (T.12) level. In addition, you should be able
to stand or walk for at least part of your daily activities, or
alternatively, able to take steps with the help of a treadmill
and part of your body weight supported. This study will take
place at the Blusson Spinal Cord Centre (818 West 10th Ave). You
will be randomly allocated (assigned by chance, like the flip of
a coin) to one of 2 treatment groups. The 2 treatment groups
differ only in the level of assistance that the Lokomat will
provide to your leg movements while walking. You will not be
informed of the group to which you have been assigned. Both
treatment groups involve 45-minute treadmill training sessions,
3 times per week for 12 weeks (3 months) of training. You may
take rest breaks during the sessions, but the total walking time
must total 45 minutes. Given time for set-up and rest breaks,
you can expect to spend about 1.5 hours in the laboratory for
each visit. After the end of the 12 weeks of training, you will
be asked to return to the laboratory for 2 follow-up tests, 1
month and 6 months later. The total amount of time for
participating in this research will be 64-68hours (40 laboratory
visits) over a 9-month period (including follow-up and medical
visits).
Effectiveness
of Robotic Assisted Gait Training in Children With Cerebral
Palsy (PeLoGAIT)
The purpose of the study is
to investigate the effectiveness of robotic-assisted locomotor
therapy on improvements of functional gait parameters in
ambulatory children with cerebral palsy.
Effect of
Robot-assisted Gait Training on Freezing of Gait in Parkinson's
Disease
Freezing of gait
(FOG) is a common yet poorly understood motor
symptom in persons with Parkinson's disease (PD).
Previous studies have shown that bilateral
uncoordinated gait and gait asymmetry are related to
FOG, and that intensive treadmill training in PD
patients can improve gait. However, no group has yet
studied the effect of robot-assisted gait training (RAGT)
on FOG. The primary aim of this study is to collect
pilot data on the effect of robot-assisted gait
training in reducing episodes of freezing in PD.
Subjects with
Parkinson's disease that experience freezing of gait
will be recruited and enrolled following informed
consent and screening for eligibility. Each of the
10 training session will last approximately one
hour. Neurological evaluations, testing of gait
parameters, and quality of life assessments will be
conducted. Participants will also be asked to return
for 1- and 3-month post-intervention assessments to
see if the training has any lasting effects.
Approximately 10-20 subjects will be enrolled, and
the study will last up to 6 months.
Robot-assisted
gait training will be conducted with the
Lokomat (a treadmill
with supplemental robot-assistance for moving the
hip and knee). We will monitor changes in freezing
by conducting various assessments.
There are
approximately 1 million Americans with PD in the US.
PD is a significant cause for reduced functional
ability and quality of life, progressive disability.
Patients with PD with FOG have indicated that this
is one of their most disturbing symptoms, as there
are no effective treatments. Therefore it is
important that additional and alternative
interventions for FOG be tested and developed.
Lokomat
Training Effects On Multiple Sclerosis Gait Abnormalities
Multiple
sclerosis is a degenerative disease that affects
more than 400,000 people in the US alone. MS is in
fact the most common disabling neurological disorder
in young adults. Symptoms of the disease can include
problems with balance, walking, fatigue, weakness
and vision. Over 85% of people with Multiple
Sclerosis have problems walking. This can cause them
to fall or have a constant fear of falling. To
prevent falling, MS patients rely on equipment, such
as walkers and canes. These costs can cause
financial difficulties for MS patients and families.
A significant
problem that is only recently being studied is the
relationship between falling and MS. Recent studies
have shown that MS patients fall more often than
those without MS, and also fall more than the
elderly population. The consequent fear of falling
is also an important problem, as those worried about
falling will probably change their daily habits to
lower their risk. This can mean keeping from certain
physical and social activities or even staying
indoors. Thus, falls and fear of falling can have
negative medical, physical, psychological, and
social consequences for the patient.
Improving
patients' walking may help reduce falls and the fear
of falling. Treadmill training has been shown to
improve walking in patients with MS and to lower
their risk of falling. One way to train patients on
a treadmill is with the use of robots that can help
move their limbs in a more normal way. This kind of
robot-assisted treadmill training may provide even
greater benefits than treadmill training alone.
The study is
expected to last 6-7.5 months. One group of
participants will receive weekly telephone calls and
will be asked questions on other physical
activities, falls, and activity limitations the
patient had during the week. Participants assigned
to robot-assisted treadmill training will receive
twice weekly training session for 8 weeks, for a
total of 16 sessions. Each session will last about
65 to 90 minutes.
The goal of this
study is to see if robot-assisted treadmill training
will reduce falls and fear of falling in patients
with MS. Robot-assisted treadmill training has been
shown to be effective in reducing falls and fear of
falling in Parkinson's disease patients. This type
of training has not been tested in patients with
Multiple Sclerosis. The proposed study will help to
address this gap and also provide additional data on
other possible improvements due to robot-assisted
treadmill training including ambulation, social
participation, fatigue, and balance.
Effect of Passive Gait Training on the Cortical
Activity in Patients With Severe Traumatic Brain
Injury
Severe traumatic brain injury,
especially after a high energy
trauma, is characterised with focal
lesions and diffuse axonal injury,
which leads to the dysfunction in
the cortico-spinal, cortico-
cortical connections and reticular
activation system. Formatio
reticularis plays an important role
in arousal. Tactile and
proprioceptive stimulation with a
view to improving level of
consciousness in coma patients is
popular in the western world despite
insufficient evidence of its
effectiveness.
Affolter-Bobath-Coombes-concept is
the most commonly used tool in the
rehabilitation of brain damaged
patients. This concept is based on
the theory that tactile,
proprioceptive and oral stimulation
develops new connections in the
brain and thereby stimulates
consciousness and behaviour. Elliot
et al shows improvement in level of
consciousness due to postural
changes from a lying position to a
standing posture in 8 of 12 patients
using Wessex Head Injury Matrix.
Passive movements result in
proprioceptive stimulation; the
effect of which is close to that
achieved by physiological voluntary
activity. PET and fMRI studies show
that passive movements activate
several areas in the motor cortex.
In order to increase afferent
cortical input, passive gait
training in the body weight support
robotic gait orthosis could be used
in patients with impaired
consciousness, inability to
cooperate and poor balance. This
device gives the possibility to
establish therapeutically correct
upright body position and passive
legs movement simultaneously.
To our knowledge there are no
studies, which illustrate the
effects of passive gait training on
cortical activity in patients with
impaired consciousness due to severe
traumatic brain injury.
Our hypothesis is that passive gait
training of this group of patients
increases arousal, which can be
shown in an increased EEG
(electroencephalogram)-frequency and
increased conductivity speed of the
cognitive P300-component of ERP
(Event Related Potentials).
Comparison(s): EEG- and ERP-activity
after a single training session in
robotic gait orthosis in patients
with severe traumatic brain injury,
compared to EEG- and ERP-activity
after a single training session in
robotic gait orthosis in healthy
persons.
Effect of Robot-assisted Training on Foot Drop in
Multiple Sclerosis
The
primary aim of this study is to:
-
Collect pilot data on the effect of
task-specific lower extremity
training using the Anklebot on
subjects with Multiple Sclerosis
(MS) and who have foot drop;
-
Collect pilot data on the use of
combination therapy on improving
gait in subjects with MS. This
therapy will use both Anklebot
training and robot-assisted gait
training.
Hypothesis: Both trainings will result
in improved walking performance, but the
combination therapy will result in
greater gains than ankle training alone.
Functional
and Physiological Responses to Lokomat
Therapy (Pilot Study)
Individuals with neurological
deficiencies such as those who have spinal cord injury, stroke,
traumatic brain injury, Parkinson's disease, and multiple
sclerosis often lose their ability to ambulate over ground. Loss
of functional mobility not only impedes everyday life, but may
also affect many systems and organs in the body. The
investigators are interested in obtaining a wide variety of data
in order to obtain a better understanding of changes that occur
as a result of receiving Lokomat
therapy. The investigators will be studying body composition,
cardiac, pulmonary, endocrine, metabolic, and molecular changes
after a 12-week clinical therapy program.
HyperMED
Clinical Research/STROKE-2009-563247v2-Hornby.pdf
Locomotor training
improves daily stepping activity and gait efficiency in
individuals post stroke who have reached a 'plateau' in recovery
Prof George Hornby
Pilot study of
Lokomat versus manual-assisted treadmill training for locomotor recovery
post-stroke
Results
suggest that Lokomat training may have
advantages over manual-BWSTT following a
modest intervention dose in chronic
hemiparetic persons and further, that our
training speeds produce similar gait
improvements.
Cardiovascular Fitness for Robotically
Assisted Treadmill Training in Persons With
Chronic Incomplete Spinal Cord Injury
This proposal investigates the hypothesis
that progressive aerobic exercise with
Lokomat is feasible in people with motor
incomplete spinal cord injury, and three
months of training will improve
cardiovascular fitness and gait
functionality when compared to physical
therapy...
Effect of Robot-assisted Gait Training on
Freezing of Gait in Parkinson's Disease
Freezing of gait (FOG) is a common yet
poorly understood motor symptom in persons
with Parkinson's disease (PD). Previous
studies have shown that bilateral
uncoordinated gait and gait asymmetry are
related to FOG, and that intensive treadmill
training in PD patients can improve gait.
However, no group has yet studied the effect
of robot-assisted gait training (RAGT) on
FOG. The primary aim of...
Feasibility and Practice Characteristics of
FNS and Gait Robot
Conventional therapies do not restore normal
gait for many stroke survivors. The
long-term goal of this work is to restore
volitional lower limb motor control and gait
following stroke. In our prior work, we
demonstrated that it was feasible to provide
a clinically operated, combined treatment of
body weight supported treadmill training
alone (BWSTT) + functional
neuromuscular stimulation (FNS) using
intramuscular (IM) electrodes (FNS-IM).
Specific Aims and Hypothesis The purpose or
Specific Aim of the study is to test the
feasibility and gait training potential of
combining the Lokomat and FNS-IM for stroke
survivors. Given the feasibility of our
clinically operated combination of BWSTT +
FNS-IM, we propose to test the feasibility
of the combination of Lokomat +
FNS-IM. Hypothesis I. It is feasible to
utilize a clinically operated combination of
Lokomat + functional neuromuscular
stimulation (FNS) with intramuscular (IM)
electrodes (FNS-IM). Treatment Procedures.
The subjects will be treated for three
months, four sessions/week (for a total of
48 treatment visits). A given session will
be 1½ hrs, with the time divided into thirds
as follows: 1) ½ hr coordination exercise;
2) ½ hr over ground gait training; and 3) ½
hr Lokomat gait training. FNS-IM will be
used in all three aspects of the protocol,
unless the subject is capable of
volitionally executing a given movement or
gait component. Population. The subjects
will be chronic stroke survivors (>6 months
after the stroke).
HyperMED/Lokomat - Australian Experience
HyperMED NeuroRecovery.pdf
Gait Training for
Persons With Stroke -
Full Text View -
ClinicalTrials.gov
... is to
investigate the effects
of an automatic gait
trainer (Lokomat)
handled by physical
therapists compared with
categorized gait
training ... used
to evaluate study
effects. Hypotheses: 1)
The Lokomat improves
stroke patients gait
speed distance and
symmetry more than
categorized gait
training. ...
http://www.clinicaltrials.gov/ct2/show/NCT00612300?cond=%22Cerebral+Infarction%22
Healogica: NCT00883142 -
Functional and
Physiological Responses
to Lokomat Therapy
Trial Summary
Individuals with
neurological
deficiencies such as
those who have spinal
cord injury, stroke,
traumatic brain injury,
Parkinson's disease, and
multiple sclerosis often
lose their ability to
ambulate over ground.
Loss of functional
mobility not only
impedes everyday life,
but may also affect many
systems and organs in
the body. The
investigators are
interested in obtaining
a wide variety of data
in order to obtain a
better understanding of
changes that occur as a
result of receiving
Lokomat therapy. The
investigators will be
studying body
composition, cardiac,
pulmonary, endocrine,
metabolic, and molecular
changes after a 12-week
clinical therapy
program. Any patient who
is already eligible for
Lokomat therapy is
a candidate for this ....
ClinicalTrials.gov
processed this record on
April 16,
2009
https://www.healogica.com/trials/multiple.../NCT00883142/
Limb alignment and
kinematics inside a
Lokomat robotic orthosis.
... systems has
become commonplace
world-wide. In
particular the
Lokomat robotic
orthosis (Hocoma AG
Volketswil Switzerland)
... Here we
report differences in
kinematic trajectories
between walking in the
Lokomat and walking
on a treadmill as well
as the relative ...
Alterations in muscle
activation patterns
during robotic-assisted
walking.
... Activity in
the quadriceps and
hamstrings was
significantly higher
during the swing phase
of Lokomat walking than
treadmill walking while
activity in the ankle
flexor ... was
reduced throughout most
of the gait cycle in the
Lokomat.
CONCLUSIONS: Walking
within a robotic
orthosis that limits ...
Load-Regulating
Mechanisms in Gait and
Posture: Comparative
Aspects -- Duysens et
al. 80 (1): 83 --
Physiological Reviews
... Prospective
Blinded Randomized
Crossover Study of Gait
Rehabilitation in Stroke
Patients Using the
Lokomat Gait
Orthosis Neurorehabil
Neural Repair July 1
2007; ...
http://physrev.physiology.org/cgi/content/abstract/80/1/83?ck=nck
Evidence Based
Multicenter Randomized Clinical Trial Evaluating
the Effectiveness of the Lokomat in Subacute
Stroke -- Hidler et al. 23 (1): 5
... This Article Services Citing
Articles Google Scholar PubMed Social
Bookmarking Multicenter
Randomized Clinical Trial Evaluating the
Effectiveness of the Lokomat
in Subacute Stroke Joseph Hidler PhD Department
of Biomedical Engineering Catholic University
Washington DC; ... To compare the
efficacy of robotic-assisted gait training with
the Lokomat to
conventional gait training in individuals with
subacute stroke. ...
http://nnr.sagepub.com/cgi/content/abstract/23/1/5
Patient-Driven Cooperative Gait Training with
the Rehabilitation ...www.springerlink.com
© Springer-Verlag Berlin Heidelberg
2009. Patient-Driven Cooperative Gait Training with
the ... treadmill speed during
Lokomat training [6] provides free
...
Lokomat impedance controller by a set point
generation ...
“The Use of the
Lokomat System in Clinical Research”
February 12,
2009. “The Use of the
Lokomat System in Clinical Research”. Keith
Tansey, MD, PhD. Director, Spinal Cord Injury
Research ...
www.inrs2009.com/.../Tansey_TheUseofTheLokomatSystemInClinicalResearch_INRS2009.pdf
-
Neurorehabilitation and Neural Repair 
... Neurorehabilitation and Neural
Repair http://nnr.sagepub.com Prospective
Blinded Randomized
Crossover Study of Gait Rehabilitation in Stroke
Patients Using the Lokomat
Gait Orthosis Andreas Mayr Markus Kofler Ellen
Quirbach Heinz Matzak Katrin Fröhlich and
Leopold Saltuari ... potential efficacy
of using an electromechanical-driven gait
orthosis (Lokomat) for
treadmill training. Methods. ...
http://nnr.sagepub.com/cgi/reprint/21/4/307.pdf
Speed-Dependent Treadmill Training in Ambulatory
Hemiparetic Stroke Patients: A Randomized
Controlled Trial -- Pohl et al. 33 (2
... Multicenter Randomized Clinical
Trial Evaluating the Effectiveness of the
Lokomat in Subacute
Stroke Neurorehabil Neural Repair January 1
2009; ... Prospective Blinded Randomized
Crossover Study of Gait Rehabilitation in Stroke
Patients Using the Lokomat
Gait Orthosis Neurorehabil Neural Repair July 1
2007; ...
http://stroke.ahajournals.org/cgi/content/abstract/strokeaha;33/2/553
Medical
News: Living Therapists Outclass Robots in Post-Stroke
Rehab - in Neurology, Strokes from MedPage Today
...
Half received assistance from a therapist as needed and
half had constant guidance from a robotic orthosis
called Lokomat. ...
http://www.medpagetoday.com/Cardiology/Strokes/tb/9394
Effects of
Locomotion Training With Assistance of a Robot-Driven Gait
Orthosis in Hemiparetic Patients After Stroke. A Randomized
Controlled Pilot Study.
Husemann B, Müller F, Krewer C, Heller S, Koenig E. American
Stroke Association; Stroke; 2007;38:349-354.
Biofeedback for
robotic gait rehabilitation
Luenenburger L, Colombo G, Riener R. Journal of
NeuroEngineering and Rehabilitation; 4:1, 2007.
Prospective,
blinded, randomized crossover study of gait rehabilitation
in stroke patients using the Lokomat gait orthosis. Mayr
A, Kofler M, Quirbach E, Matzak H, Fröhlich K, Saltuari L.
Neurorehabil Neural Repair. 2007 Jul-Aug;21(4):307-14.
Robot-assisted
gait training for children with central motor disorders
Meyer-Heim A, Reiffer C, Borggraefe I. praxis ergotherapie,
Heft 1/2007, verlag modernes lernen, D-44287 Dortmund,
Germany
The influence
of different Lokomat walking conditions on the energy
expenditure of hemiparetic patients and healthy subjects.
Krewer C, Müller F, Husemann B, Heller S, Quintern J, Koenig
E. Gait Posture. 2006 in press
(doi:10.1016/j.gaitpost.2006.10.003).
Human-centered
robotics applied to gait training and assessment.
Riener R, Luenenburger L, Colombo G. J Rehabil Res Dev. 2006
Sep-Oct; 43(5):679-94.
Robotic-assisted, body-weight-supported treadmill training
in individuals following motor incomplete spinal cord
injury. Hornby
TG, Zemon DH, Campbell D. Physical Therapy 85(1):52-66,
2005.
Therapeutic
Effects of Robotic-Assisted Locomotor Training on
Neuromuscular Properties.
Mirbagheri MM, Tsao C, Pelosin E, Rymer WZ. Proceedings of
the IEEE 9th International Conference on Rehabilitation
Robotics (ICORR), Chicago USA, 561-564, 2005.
Changes in
supraspinal activation patterns following robotic locomotor
therapy in motor-incomplete spinal cord injury.
Winchester P, McColl R, Querry R, Foreman N, Mosby J, Tansey
K, Williamson J. Neurorehabil Neural Repair 19: 313-24,
2005.
Effectiveness
of automated locomotor training in patients with chronic
incomplete spinal cord injury: a multicenter trial. Wirz
M, Zemon DH, Rupp R, Scheel A, Colombo G, Dietz V, Hornby
TG. Arch Phys Med Rehabil 86:672-80, 2005.
Driven gait
orthosis for improvement of locomotor training in paraplegic
patients.
Colombo G, Wirz M, Dietz V. Spinal Cord 39:252-255,
2001.
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