Duration of Treatment Effect of Lokomat for Gait Training
The treatment effect of Lokomat robotic-assisted gait training typically lasts 6-12 weeks after completion of the intervention, with benefits not consistently sustained beyond this period without continued rehabilitation.
Evidence on Duration of Treatment Effects
Short-term Effects (0-6 weeks)
- Immediate improvements in gait parameters are well-documented following Lokomat training
- The 2007 randomized crossover study by Husemann et al. showed significant improvements in EU-Walking Scale, Rivermead Motor Assessment Scale, and 6-minute walking distance within each 3-week interval of Lokomat training compared to conventional therapy 1
- These initial gains are most pronounced during and immediately after the intervention period
Medium-term Effects (6-12 weeks)
- The 2025 randomized controlled trial by Al-Sharman et al. demonstrated significant improvements in gait parameters, mobility, and walking speed after 12 weeks of Lokomat training combined with conventional physical therapy 2
- These improvements were greater than those achieved with conventional therapy alone, suggesting a sustained effect through this period
Long-term Effects (Beyond 12 weeks)
- According to the 2016 AHA/ASA guidelines, the long-term sustainability of gains from mechanically assisted walking devices like Lokomat remains uncertain 3
- The 2005 stroke rehabilitation guidelines noted that in studies of intensive gait-focused physical therapy, improvements in gait velocity at 6 weeks were not sustained at 3 and 6 months follow-up 3
- The 2014 study by Dundar et al. showed greater improvements with Lokomat training compared to conventional home exercise within an eight-week interval, but did not assess longer-term maintenance of these gains 4
Factors Affecting Duration of Treatment Effect
Training Protocol Characteristics
- Intensity: Higher intensity training (77%-95% of maximal heart rate) may lead to more durable improvements in walking performance 3
- Frequency: Training at least three times per week for sessions of at least 30 minutes appears optimal 3
- Duration: Program duration of at least 12 weeks is recommended for more lasting effects 3
Patient-Specific Factors
- Stroke chronicity: Patients in the subacute phase may show better long-term retention of gains than those in chronic phases
- Severity of impairment: The 2025 study by Kociova et al. found that a month of gait reeducation (including Lokomat) was insufficient to achieve symmetrical gait in patients with spastic hemiparesis 5
Optimizing Long-Term Benefits
Maintenance Strategies
- Continuing with conventional physical therapy after Lokomat training appears necessary to maintain gains
- The 2024 Praxis Medical Insights guidelines recommend continuing rehabilitation for as long as the patient continues to achieve treatment goals, even after hospital discharge 6
- Combining Lokomat training with other interventions may enhance durability of effects:
- Conventional physical therapy
- Strengthening exercises
- Balance training
- Functional electrical stimulation when appropriate
Clinical Implications and Recommendations
- Initial intensive Lokomat training (at least 3 times weekly for 12 weeks) should be followed by a maintenance program of conventional therapy to sustain gains
- Regular reassessment of gait parameters is necessary to determine when refresher Lokomat sessions might be beneficial
- For patients with chronic hemiplegia, longer training periods may be necessary, as the 2014 study suggests benefits even in patients with hemiplegia lasting at least 12 months 4
The evidence indicates that while Lokomat provides significant short-term benefits for gait training, these improvements tend to diminish over time without continued rehabilitation efforts. A structured maintenance program is essential to preserve functional gains achieved during the initial intensive robotic-assisted training period.