van Kammen Klaske, Boonstra Anne M, van der Woude Lucas H V, Visscher Chris, Reinders-Messelink Heleen A, den Otter Rob
University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands.
Rehabilitation Center "Revalidatie Friesland", Beetsterzwaag, The Netherlands.
Disabil Rehabil. 2020 Oct;42(21):2977-2985. doi: 10.1080/09638288.2019.1579259. Epub 2019 Apr 11.
The Lokomat is a commercially available robotic gait trainer, applied for gait rehabilitation in post-stroke hemiparetic patients. Selective and well-dosed clinical use of the Lokomat training parameters, i.e. guidance, speed and bodyweight support, requires a good understanding of how these parameters affect the neuromuscular control of post-stroke hemiparetic gait. Ten stroke patients (unilateral paresis, 7 females, 64.5 ± 6.4 years, >3months post-stroke, FAC scores 2-4)) walked in the Lokomat under varying parameter settings: 50% or 100% guidance, 0.28 or 0.56m/s, 0% or 50% bodyweight support. Electromyography was recorded bilaterally from Gluteus Medius, Biceps Femoris, Vastus Lateralis, Medial Gastrocnemius, and Tibialis Anterior. Pressure sensors placed under the feet were used to determine the level of temporal gait symmetry. Varying guidance and bodyweight support had little effect on muscle activity, but increasing treadmill speed led to increased activity in both the affected (Biceps Femoris, Medial Gastrocnemius, Tibialis Anterior) and unaffected leg (all muscles). The level of temporal symmetry was unaffected by the parameter settings. The Lokomat training parameters are generally ineffective in shaping short term muscle activity and step symmetry patients with hemiparetic stroke, as speed is the only parameter that significantly affects muscular amplitude. d.n.a.IMPLICATIONS FOR REHABILITATIONThe Lokomat is a commercially available gait trainer that can be used for gait rehabilitation in post-stroke hemiparetic patients.This study shows that muscle amplitude is generally low during Lokomat guided walking, and that treadmill Speed is the main training parameter to influence muscular output in stroke patients during Lokomat walking.Varying Guidance and Bodyweight Support within a clinical relevant range barely affected muscle activity, and temporal step symmetry was unaffected by variation in any of the training parameters.Based on the findings it is advised to increase speed as early as possible during Lokomat therapy, or use other means (e.g. feedback or instructions) to stimulate active involvement of patients during training.
Lokomat是一种商用的机器人步态训练器，用于中风后偏瘫患者的步态康复。要对Lokomat训练参数（即引导、速度和体重支持）进行有选择性且剂量合适的临床应用，需要充分了解这些参数如何影响中风后偏瘫步态的神经肌肉控制。10名中风患者（单侧轻瘫，7名女性，64.5±6.4岁，中风后超过3个月，功能性步行能力分级（FAC）分数为2 - 4级）在不同参数设置下于Lokomat中行走：50%或100%引导、0.28或0.56米/秒、0%或50%体重支持。双侧记录了臀中肌、股二头肌、股外侧肌、腓肠肌内侧头和胫骨前肌的肌电图。置于脚下的压力传感器用于确定步态时间对称性水平。不同的引导和体重支持对肌肉活动影响不大，但跑步机速度增加会导致患侧（股二头肌、腓肠肌内侧头、胫骨前肌）和健侧腿部（所有肌肉）的活动增加。时间对称性水平不受参数设置的影响。Lokomat训练参数在塑造中风偏瘫患者的短期肌肉活动和步幅对称性方面通常无效，因为速度是唯一显著影响肌肉幅度的参数。
对康复的启示
Lokomat是一种可用于中风后偏瘫患者步态康复的商用步态训练器。
本研究表明，在Lokomat引导行走期间肌肉幅度通常较低，并且跑步机速度是影响中风患者在Lokomat行走期间肌肉输出的主要训练参数。
在临床相关范围内改变引导和体重支持对肌肉活动几乎没有影响，并且任何训练参数的变化都不会影响时间步幅对称性。
基于这些发现，建议在Lokomat治疗期间尽早提高速度，或使用其他方法（如反馈或指导）来刺激患者在训练期间积极参与。
