Effects of robotic gait rehabilitation with Lokomat(R) in vascular hemiplegia

IntroductionGait rehabilitation after a stroke is a major concern in physical medicine and rehabilitation. Since 2007, << Le Normandy>> rehabilitation center is equipped with robotic assisted gait training named "Lokomat"; vascular hemiplegic patients benefit from it. This study was conducted to investigate the effect of Lokomat on the walking performance of hemiplegic patients after a stroke and to identify the influence of certain factors. MethodsThis was a retrospective, observational study conducted at << Le Normandy >> rehabilitation center in Granville, France. All adult patients hospitalized between 2007 and 2018 for a first stroke within the last six months who completed a full Lokomat program were included. Medical data were collected : sex, age, type of stroke, time since the onset, modified Functional Ambulation Category (mFAC), date of stroke and results of the six minutes walking test (6MWT) before and after rehabilitation. The outcome was the difference between the 6MWT before and after the rehabilitation to determine the evolution of the walking capacity and factors associated with a gain. ResultsWe included 235 patients. The median gain on the 6MWT was 18 meters (p<0,01). Two factors were significantly associated with the 6MWT gain : rehabilitation phase and severity of stroke. The median gain was 21.22 meters (95% CI [1.86 ; 44.93]) for patients in early rehabilitation phase versus late rehabilitation phase. The median gain was 34.22 meters (95% CI [16.20 ; 74.69]) for ambulatory patients at the onset compared to non-ambulatory patient. There were no significant difference of median gain between men and women (3.22 meters 95% CI [-11.86 ; 19.48]), between ischemic and hemorrhagic strokes (1.67 meters 95% CI [-10.59 ; 17.03]) and between the post-2016 and pre-2016 periods (6.22 meters 95% CI [-7.99 ; 32.78]). There was a decrease of 0.56 meters (95% CI [-0.99 ; 0.16]) per year at the 6MWT, and this result was not significant. ConclusionThere was a significant improvement in the 6MWT after robotic rehabilitation by Lokomat. This improvement was greater in patients in early rehabilitation phase and when the patient was initially ambulatory.