What are the outcome measures for Lokomat (Locomotor Training) training?

Outcome Measures for Lokomat (Locomotor Training)

The most appropriate outcome measures for Lokomat training should include standardized assessments of mobility, balance, and functional independence, with specific emphasis on gait parameters, timed walking tests, and validated functional scales.

Primary Outcome Measures

Mobility and Gait Assessment

• Timed Up and Go (TUG) Test: Highly sensitive measure for Lokomat training effects, showing significant improvements in stroke patients (pooled mean difference = -3.40,95% CI -4.35 to -2.44; p < 0.00001) 1
• Walking speed/gait velocity: Essential parameter that directly measures locomotor improvement
• 6-minute walk test: Measures walking endurance and has shown significant improvements with Lokomat training 2
• Functional Ambulation Category (FAC): Evaluates the level of walking independence and has demonstrated significant improvements following Lokomat training 3, 4

Balance Assessment

• Berg Balance Scale (BBS): Standard measure of static and dynamic balance, though results with Lokomat have been inconclusive in some studies 1
• Rivermead Mobility Index (RMI): Shows favorable results for balance recovery in stroke survivors treated with Lokomat (pooled mean difference = 0.40,95% CI 0.26-0.55; p < 0.00001) 1

Functional Independence

• Spinal Cord Independence Measurement (SCIM): Particularly useful for spinal cord injury patients, with significant improvements shown in the motor subscales following Lokomat training 3
• Functional Independence Measure (FIM): Specifically the motor subscale, which has shown significant improvements after Lokomat training 5

Secondary Outcome Measures

Neurological and Motor Function

• Lower Extremity Motor Score (LEMS): Measures strength in the lower extremities and has shown significant improvements with Lokomat training 2
• Motricity Index: Evaluates muscle strength and has demonstrated significant improvements in Lokomat groups compared to conventional therapy 4
• Modified Ashworth Scale (MAS): Measures spasticity, with significant reductions observed in robotic training groups 4

Lokomat-Specific Parameters

• Guidance force reduction: Measures patient's active participation during training
• Body weight support reduction: Indicates improved weight-bearing capacity
• Treadmill speed increase: Reflects improved locomotor capability 5

Quality of Life and Psychosocial Impact

• Psychosocial Impact of Assistive Device Scale (PIADS): Evaluates the psychosocial impact of using the Lokomat, with positive scores reported across ability, adaptability, and self-esteem subscales 5

Measurement Timing and Considerations

• Assessment should be performed at baseline and after completion of the Lokomat training program
• For chronic conditions, follow-up assessments at 3 and 6 months are recommended to evaluate retention of gains
• The most recent evidence suggests that outcome assessments at 6 months may provide the most clinically relevant data 6

Clinical Implementation

When implementing Lokomat training and selecting outcome measures:

1. Choose measures that align with the patient's specific condition (stroke, spinal cord injury, etc.)
2. Include both impairment-level measures (strength, spasticity) and activity-level measures (walking, balance)
3. Consider using kinematic and kinetic measures when available, as these can distinguish between true neural restitution and behavioral compensation 6
4. Standardize assessment protocols across sessions to ensure reliable measurement

Limitations and Considerations

• Many outcome measures were originally developed for specific conditions (e.g., stroke) and may need adaptation for other neurological conditions
• The lack of standardization in outcome measures across studies makes direct comparisons challenging 6
• Technological outcome measures (TOMs) show promise but require further validation 6
• When possible, include measures that can distinguish between true neurological recovery and compensatory strategies 6

Lokomat training has demonstrated effectiveness for improving mobility, balance, and functional independence across various neurological conditions, with outcome measures showing improvements comparable to or better than conventional physical therapy in most studies.