What is the duration of effect of Lokomat (Locomotor Training) therapy in stroke patients?

Duration of Lokomat Training Effect in Stroke Patients

The duration of effect of Lokomat (robotic-assisted locomotor training) in stroke patients is not well established in current guidelines, but evidence suggests that improvements may last for at least 8 weeks following a standard training protocol, with continued practice needed to maintain gains.

Evidence on Lokomat Training Effects

Lokomat is a robotic-assisted gait orthosis used for treadmill training with partial body weight support, which has shown promising results in stroke rehabilitation. The available research provides some insights into the effectiveness and duration of benefits:

• Studies show that Lokomat training can produce significant improvements in gait parameters, functional mobility, and psychological well-being in stroke patients 1, 2, 3.

• In a 2014 study, patients with chronic hemiplegia (lasting at least 12 months) showed significant improvements after just 2 weeks of Lokomat training (5 sessions per week for 2 weeks), with benefits measured at the 8-week follow-up point 2.

• Another study demonstrated that Lokomat training not only facilitated gait and physical function but also improved psychological status in chronic stroke patients after an 8-week intervention (40 one-hour sessions) 3.

Factors Affecting Duration of Effect

Several factors may influence how long the benefits of Lokomat training persist:

1. Chronicity of Stroke:

   • Acute/subacute stroke patients may experience different retention patterns compared to those with chronic stroke
   • Early intervention appears to yield better long-term outcomes 4

2. Training Protocol:

   • Intensity, frequency, and duration of training sessions affect retention
   • Higher intensity levels for longer durations show better outcomes 2

3. Continued Practice:

   • Maintenance of gains likely requires ongoing physical activity
   • The American Heart Association guidelines emphasize that regular exercise should be continued to maintain benefits 4

4. Individual Factors:

   • Severity of initial impairment
   • Presence of other comorbidities
   • Patient's overall physical activity level

Maintaining Training Effects

To maximize and extend the duration of Lokomat training effects:

• Regular Exercise: Continue with structured exercise interventions complemented by increased daily lifestyle activities 4

• Strength Training: Include strengthening exercises 2-3 days per week as recommended for stroke survivors 4

• Balance Training: Incorporate balance-specific activities to maintain improvements in postural control 4

• Monitoring: Regular assessment of gait parameters to identify when refresher sessions might be needed

Clinical Implications

While specific guidelines on the duration of Lokomat effects are lacking, clinicians should:

• Expect that without continued practice or follow-up training, effects may diminish over time
• Consider periodic reassessment and potential "booster" sessions for patients showing regression
• Develop home exercise programs that reinforce the movement patterns trained during Lokomat sessions

The limited evidence on long-term follow-up after Lokomat training highlights the need for further research specifically addressing the retention of training effects over extended periods.