What is the recommended frequency and number of Lokomat (Locomotor Training) sessions for stroke patients?

Lokomat Session Frequency and Duration for Stroke Rehabilitation

Based on current evidence, stroke patients should receive Lokomat therapy for 3-5 sessions per week, with each session lasting 30-60 minutes, for a total treatment duration of at least 4-8 weeks to optimize functional outcomes and gait parameters.

Evidence-Based Recommendations for Lokomat Training

Frequency and Duration Parameters

• Sessions per week: 3-5 sessions weekly 1
• Session duration: 30-60 minutes per session 1, 2
• Total treatment period: Minimum 4-8 weeks 2, 3, 4
• Total therapy time: Should be part of the recommended minimum 3 hours of daily rehabilitation on at least 5 days per week 1

Integration with Comprehensive Rehabilitation

Lokomat training should be incorporated within a broader rehabilitation framework that includes:

• Conventional physiotherapy
• Occupational therapy
• Speech and language therapy (if needed)
• Balance and coordination training

Scientific Rationale and Evidence

The American Heart Association/American Stroke Association recommends that stroke survivors undertake regular aerobic exercise to increase aerobic capacity and improve gait efficiency 1. Treadmill training with body weight support (like Lokomat) offers distinct advantages:

1. It enables task-specific training (walking)
2. Allows patients with significant impairments to participate through handrail support and unweighting devices
3. Can be adjusted in intensity by modifying speed and incline 1

Recent studies demonstrate that Lokomat training provides significant benefits:

• Improved mobility and walking speed in chronic hemiplegia patients with 10 sessions (5 sessions/week for 2 weeks) of 30-minute duration 2
• Enhanced functional status and psychological well-being with 40 sessions (5 times/week for 8 weeks) 5

Specific Protocols Based on Stroke Phase

Subacute Phase

• More intensive protocols may be beneficial: 10-20 sessions over 4 weeks 3
• Should be combined with conventional therapy for optimal results 6

Chronic Phase

• Even patients with chronic hemiplegia (>12 months post-stroke) benefit from Lokomat training 2
• 10 sessions (5 sessions/week for 2 weeks) showed significant improvements in mobility and walking speed 2

Important Considerations and Caveats

• Patient tolerance: Initial sessions may need to be shorter with gradual progression to longer durations
• Monitoring: Regular assessment of gait parameters, functional independence, and psychological well-being
• Complementary therapies: Lokomat should not replace but augment conventional therapy 4, 6
• Duration of benefits: A minimum of 4 weeks may be needed to see significant improvements in gait parameters 3

Clinical Decision-Making Algorithm

1. Assessment: Evaluate patient's baseline walking ability, motor function, and cardiovascular fitness
2. Initiation: Begin with shorter sessions (20-30 minutes) at lower intensity
3. Progression: Gradually increase duration to 30-60 minutes as tolerated
4. Frequency: Schedule 3-5 sessions per week
5. Duration: Continue for minimum 4-8 weeks
6. Re-evaluation: Assess progress using standardized measures (TUG, walking speed, FAC)
7. Adjustment: Modify parameters based on patient response and progress

The most recent evidence suggests that combining Lokomat training with conventional therapy yields better outcomes than conventional therapy alone, particularly for improving gait parameters, mobility, and walking speed in stroke patients 6.