How long do the effects of Lokomat (robot-assisted gait training) last after completion of the training program?

Duration of Lokomat Effects After Training Completion

The benefits of Lokomat (robot-assisted gait training) typically decline toward baseline after 6-12 months following completion of the training program, though some benefits may remain improved compared to pre-training levels for up to 1 year. 1

Evidence on Duration of Effects

The duration of benefits from robot-assisted gait training follows similar patterns to those observed in other rehabilitation interventions:

• Limited studies suggest that benefits of pulmonary rehabilitation (which follows similar principles to gait rehabilitation) decline toward baseline after 6-12 months but remain improved compared to control subjects after 1 year 1
• Health-related quality of life benefits appear better preserved than exercise performance measures, sometimes being sustained up to 2 years after intervention 1
• In some studies, benefits appear to be maintained in the absence of specific maintenance therapy, suggesting that a change in lifestyle may alter behavior 1

Factors Affecting Duration of Benefits

Several factors influence how long the effects of Lokomat training last:

1. Training intensity and duration: Higher-intensity training programs tend to produce more lasting effects

   • Studies examining high-intensity training at 60-80% of heart rate reserve reported improved peak VO₂ that was maintained at 1-year follow-up 1

2. Maintenance strategies: Without continued exercise or maintenance programs, benefits tend to diminish

   • In a study by Willenheimer and colleagues, trained patients had a decrease in habitual physical activity similar to non-exercising control groups, with no sustained benefit 6 months after termination of training 1
   • Only small improvements in quality of life were sustained in the exercise group 1

3. Severity of condition: Initial impairment level affects retention of benefits

   • Both moderately and severely impaired children with cerebral palsy showed maintained improvements in muscle strength and walking capacities at 6-month follow-up after Lokomat training 2

Maintenance Strategies

To extend the duration of benefits from Lokomat training:

• Continuous rehabilitation: Continuing rehabilitation for a prolonged period shows small additional benefits 1
• Maintenance programs: Monthly interventions and telephone support show benefit while applied, but effects wear off rapidly with discontinuation 1
• Repeated courses: Repeating a course of rehabilitation can reproduce short-term gains but does not result in long-term advantage over a single course 1

Clinical Implications

For optimal long-term outcomes after Lokomat training:

• Patients should continue to remain active either in a formal exercise program or at home for an indefinite period 1
• Regular follow-up assessments are recommended to monitor maintenance of benefits and determine if additional intervention is needed
• Support systems such as caregiver education, self-help support groups, or community exercise sessions may help maintain benefits, though substantive data supporting these approaches is limited 1

Pitfalls and Caveats

• Benefits from even brief 2-week inpatient programs can be obtained, but conventional rehabilitation programs of 8-12 weeks generally provide more lasting effects 1
• The rate of improvement in exercise performance and quality of life may differ, with quality of life measures often showing more sustained improvement 1
• Without continued exercise, patients typically return to pre-training baseline levels of function within 6-12 months 1
• Individual response to training varies significantly, so some patients may maintain benefits longer than others

In summary, while Lokomat training provides significant benefits for gait rehabilitation, these benefits will gradually diminish without continued physical activity or maintenance programs. Patients should be advised that ongoing exercise is necessary to maintain the functional improvements achieved during the initial training period.