Lokomat Robotic Gait Rehabilitation

The Lokomat is a state of the art robot-assisted gait training device. Patients are supported in a harness above a treadmill while the robotic device moves their legs through a "normal" gait cycle. As treatment progresses weight bearing is increased, and assistance from the robotic legs is reduced requiring the patient to gradually assume greater responsibility for the coordinated movements involved during walking.

Indications

The Lokomat is used in the rehabilitation of patients with walking disabilities caused by cerebral, neurogenic, spinal, or orthopaedic disorders affecting the coordination of the lower extremities. Specifically, the Lokomat system can be used with patients with any of the following conditions:

• Stroke (CVA)
• Multiple Sclerosis (MS)
• Cerebral Palsy (CP)
• Parkinson's Disease
• Partial Paraplegia (Spinal Cord Injury)
• Traumatic Brain Injury (TBI)

Contraindications and Precautions

As for any other therapy, it is the responsibility of the patient's physician and therapist to determine if there are any medical or physical reasons that a patient may not safely participate in Lokomat therapy. The following list of contraindications is to serve only as a guideline:

• Body weight greater than 300lbs. (135 Kg)
• Severely fixed joint contractures
• Severe osteoporosis
• Bone instability
• Skin lesions on the lower extremities or torso
• Circulatory problems
• Severe vascular disorders of the lower extremities
• Cardiac contraindications for exercise
• Severe cognitive deficits
• Uncooperative or aggressive behavior
• Mechanical ventilation
• Extreme or uncorrected leg length discrepancy
• Severe scoliosis
• Hip, knee, ankle arthrodesis/fusion

*The Lokomat can accommodate individuals with femur length of 35cm-47cm (13.75inces-18.5inches). This is measured from the greater trochanter (hip) to the knee joint line.

**For more information about the Lokomat and a video demonstration visit: www.hocoma.com

Scheduling

Although not mandatory it is strongly recommended that patients obtain an order/prescription specific for Lokomat training from their referring physician. This may be done either prior to or immediately following the Physical Therapy Evaluation (PTE). Our team will need to help educate our referral sources regarding appropriate referrals for Lokomat training.

Persons referred specifically for Lokomat training are initially scheduled for a one hour Physical Therapy Evaluation (PTE). The patient will not use the Lokomat during this initial evaluation, but during the course of this session the Physical Therapist will determine the appropriateness of Lokomat training for the individual and identify any potential contraindications or precautions. The Physical Therapist will advise the patient about proper clothing for Lokomat training, expectations/prognosis, and address any potential patient specific precautions in preparation to begin training during follow up appointments.

Operation of the Lokomat requires specialized training of the physical therapist to properly measure and fit the patient to the device. The process of applying the harness and adjusting the lower extremity straps takes a minimum of 20 minutes. The patient then completes a training session of 20-60 minutes during which time the therapist provides cues to improve gait quality and appropriate sequencing of lower extremity muscle contractions. Additionally, the therapist is constantly assessing the patient's performance and making adjustments to the Lokomat to increase or decrease the challenge to the patient by changing the amount of un-weighting through the harness system and/or changing the amount of guidance force from the robotic legs.

Persons traveling from more than 40 miles away may schedule a two hour Physical Therapy Evaluation (PTE) that will include initial Lokomat patient set up and training. The evaluating Physical Therapist will call the patient prior to their scheduled appointment to advise the patient about proper clothing for Lokomat training, expectations/prognosis, and address any potential patient specific precautions in preparation to begin training.

Referral for Lokomat Training from a Physical Therapist

A Physical Therapist may be the best qualified healthcare professional to judge whether or not a patient would safely benefit from Lokomat training. A Physical Therapist from another facility may refer/transfer care of their patient to our facility by following this procedure:

• 1. Call Shore Rehabilitation at Easton 410-822-3080 and ask to speak with a Physical Therapist who works with the Lokomat. Discuss the patient briefly to determine if there are any contraindications or precautions to address prior to scheduling an appointment.
• 2. Follow the procedure above to schedule an appointment.

Shore Rehabilitation at Easton is the ONLY facility on Maryland's Eastern Shore offering Lokomat robot-assisted gait training. We will make every effort to accommodate patients referred for the Lokomat. A typical treatment plan for Lokomat training would involve three one hour long sessions per week for 4-8 weeks. As with any Physical Therapy (PT) intervention, utilization of the Lokomat and the overall duration of the course of treatment are based on patient progress.