What is the duration of effect of Lokomat (Locomotor Training) training in stroke patients before its benefits are lost?

Duration of Effect of Lokomat Training in Stroke Patients

The benefits of Lokomat (robotic-assisted gait training) in stroke patients appear to diminish over time without continued practice, with significant improvements potentially lasting up to 1 year after training cessation, though maintenance training is recommended to sustain gains.

Evidence on Duration of Effects

The available guidelines and research do not provide explicit timeframes for how long the effects of Lokomat training persist before being lost. However, we can draw some conclusions from the available evidence:

Long-term Follow-up Studies

• A high-intensity treadmill training study showed that significant gains in peak VO2 were maintained at 1-year follow-up, though improvements in walking economy were not maintained at the 1-year mark 1.
• Another study examining resistance training found that strength differences remained significant at 4-year follow-up compared to controls, though walking performance differences were no longer present 1.

Factors Affecting Duration of Benefits

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

1. Training Intensity: Higher-intensity training directly correlates with the degree of improvement observed in peak VO2 after 1 year 1.

2. Continued Practice: The evidence suggests that without continued practice or maintenance training, some functional gains may diminish over time.

3. Type of Outcome Measure: Different outcomes show different patterns of retention:

   • Cardiovascular fitness improvements may persist longer
   • Walking economy improvements may diminish more quickly
   • Balance improvements appear significant but may require reinforcement 2, 3

Clinical Implications

Recommended Approach to Maintain Benefits

1. Initial Training Protocol:

   • Implement Lokomat training as an adjunct to conventional therapy for patients with mild-to-moderate gait dysfunction 1
   • Aim for higher-intensity training when possible, as this correlates with longer-lasting benefits 1

2. Maintenance Strategy:

   • Consider periodic "booster" sessions to maintain gains
   • Incorporate complementary strengthening exercises, as lower-extremity muscle strength is correlated with gait speed and function 1

3. Monitoring for Decline:

   • Regular assessment of gait parameters, balance (using Berg Balance Scale), and functional mobility (using Timed Up and Go test) 2, 3
   • Reinitiate training if significant decline is observed

Benefits Beyond Motor Function

It's worth noting that Lokomat training may have psychological benefits that complement motor improvements:

• Improvements in psychological well-being have been observed even in chronic stroke patients 4
• These psychological benefits may influence patient motivation and adherence to continued exercise

Common Pitfalls and Caveats

1. Overreliance on Technology: Lokomat should be used as an adjunct to conventional therapy, not as a replacement 1

2. Patient Selection: Not all stroke patients will benefit equally; those with mild-to-moderate dysfunction may see the greatest benefit 1

3. Outcome Measurement: Different assessment tools may show different results - the Berg Balance Scale has shown inconclusive results in some meta-analyses, while Timed Up and Go and Rivermead Mobility Index have shown more consistent improvements 2

4. Expectation Management: Patients should understand that continued practice is necessary to maintain gains, and that some decline may occur without maintenance training

In summary, while the exact timeframe for loss of Lokomat training effects is not precisely defined in the literature, the evidence suggests that some benefits may persist for up to a year, with continued practice or periodic "booster" sessions likely necessary to maintain optimal functional outcomes in stroke patients.