Automated treadmill rebuilds muscles after stroke

NEW YORK (Reuters Health) - Treadmill training with assistance of robot-driven leg supports, a device called the Lokomat, helps build muscle mass in partially paralyzed stroke patients, German researchers report in the February issue of Stroke.

Dr. Britta Husemann and colleagues at the Neurology Hospital Bad Aibling note that the success of physical rehabilitation after a stroke depends on active walking exercises. However, the disabling after-effects of stroke often initially make such exercises impossible.

The Lokomat, they explain, was developed to facilitate treadmill training in paraplegic patients. The device "assists walking movements of gait-impaired patients on the treadmill," and it is "adjustable in force, body weight support, and speed, so that even severely handicapped patients can exercise in an environment delivering as much challenge as can be handled."

In a pilot investigation of the effects of Lokomat, the researchers studied 30 stroke survivors who were randomly assigned to 30 minutes of robotic treadmill training and 30 minutes of conventional physiotherapy daily, or two 30-minute sessions of conventional physiotherapy daily. The researchers note that comparison with conventional treadmill training was not possible.

After 4 weeks, both groups achieved a significant and similar improvement in walking ability. However, when walking on the floor, patients in the Lokomat group were able to stand significantly longer on the paralyzed leg.

This, say the investigators, is important because weakness and sensory impairment in the paralyzed leg will cause the patient to limp.

In addition, the Lokomat group lost an average of about 6.4 pounds of fat mass and gained muscle mass of around 7.4 pounds. The conventional physiotherapy group increased their body mass by approximately 2.9 pounds, most of which was fat mass.

Husemann told Reuters Health that "the Lokomat has a considerable number of positive side effects on muscle restoration and gait parameters. Because of this, we feel that a large multicenter trial is justified in order to determine its overall efficiency."

SOURCE: Stroke, February 2007.