I think this is it, you can see that this would be quite expensive. Might be cheaper since only one leg is strapped in. My doctor thought the Lokomat wasn't worth it but I convinced him I was going to use it. It was the only thing that could tame my spasticity. And once again the crutch of further studies needed is used to explain why their research did not create a protocol.
Persistent Effect of Gait Exercise Assist Robot Training on Gait Ability and Lower Limb Function of Patients With Subacute Stroke: A Matched Case–Control Study With Three-Dimensional Gait Analysis
Yiji Wang1,2,3, 
Masahiko Mukaino1*, 
Satoshi Hirano1, 
Hiroki Tanikawa4, Junya Yamada5, Kei Ohtsuka4, 
Takuma Ii5, Eiichi Saitoh1 and 
Yohei Otaka1- 1Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
- 2Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Capital Medical University, Beijing, China
- 3School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- 4Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
- 5Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
Introduction: Gait exercise assist robot (GEAR), a
gait rehabilitation robot developed for poststroke gait disorder, has
been shown to improve walking speed and to improve the poststroke gait
pattern. However, the persistence of its beneficial effect has not been
clarified. In this matched case–control study, we assessed the
durability of the effectiveness of GEAR training in patients with
subacute stroke on the basis of clinical evaluation and
three-dimensional (3D) gait analysis.
Methods: Gait data of 10 patients who underwent
GEAR intervention program and 10 patients matched for age, height, sex,
affected side, type of stroke, and initial gait ability who underwent
conventional therapy were extracted from database. The outcome measures
were walk score of Functional Independence Measure (FIM-walk), Stroke
Impairment Assessment Set total lower limb motor function score
(SIAS-L/E), and 3D gait analysis data (spatiotemporal factors and
abnormal gait patter indices) at three time points: baseline, at the end
of intervention, and within 1 week before discharge.
Results: In the GEAR group, the FIM-walk score,
SIAS-L/E score, cadence, and single stance time of paretic side at
discharge were significantly higher than those at post-training (p
< 0.05), whereas the stance time and double support time of the
unaffected side, knee extensor thrust, insufficient knee flexion, and
external rotated hip of the affected side were significantly lower (p
< 005). However, no significant differences in these respects were
observed in the control group between the corresponding evaluation time
points.
Conclusion: The results indicated significant
improvement in the GEAR group after the training period, with respect to
both clinical parameters and the gait pattern indices. This improvement
was not evident in the control group after the training period. The
results possibly support the effectiveness of GEAR training in
conferring persistently efficient gait patterns in patients with
poststroke gait disorder. Further studies should investigate the
long-term effects of GEAR training in a larger sample.
Introduction
Various assisted gait exercise robots have been
developed and used in clinical practice. Previous studies have shown the
effectiveness of several robots, such as Lokomat and Gait Trainer, in
improving the walking ability of stroke patients when used in
combination with routine physiotherapy compared with physiotherapy alone
(Pohl et al., 2007; Schwartz et al., 2009; Morone et al., 2011).
The gait exercise assist robot (GEAR) is a type of gait
rehabilitation robot developed to support gait practice of patients with
poststroke severe hemiplegia (Hirano et al., 2017).
Most of the previously reported gait exercise robots provide gait
training of symmetrical gait pattern with the robotic devices worn on
both lower limbs (Hesse et al., 1999; Colombo et al., 2000; Van Der Kooij et al., 2006).
However, patients with severe hemiplegia need to walk with an
asymmetrical gait pattern because of compensatory motion; therefore, the
aim of gait practice is not to acquire the normal, symmetrical gait but
to establish the best efficient gait pattern within the limitations of
motor impairment. The GEAR is a stationary, one-leg GEAR designed to
assist only the hemiplegic lower limb. The device is highly adjustable
and incorporates various feedback mechanisms. The adjustability in the
level of assistance enables the patients to deal with the changes in the
severity of motor impairment during the subacute phase of stroke; in
addition, the feedback facilitates motor learning of the patients.
Previous studies have shown that the use of GEAR in addition to
conventional physiotherapy helps achieve markedly improved walking
ability and gait parameters compared with those in control patients who
undergo physiotherapy alone (Katoh et al., 2019; Tomida et al., 2019).
Notably, a kinematic analysis study with three-dimensional (3D) motion
analysis system revealed the effectiveness of GEAR training in reducing
abnormal patterns, as assessed by spatiotemporal and kinematic indices (Katoh et al., 2019).
However, many of the abnormal gait patterns are
attributable to the compensatory movements in response to poststroke
motor impairment and may be optimal for the level of hemiplegia.
Therefore, it is possible that the improvement in the abnormal gait
patterns merely reflect the temporal changes due to the GEAR-induced
forced gait pattern; in effect, these changes may be negated after a
certain period of time after completion of GEAR training. No previous
studies have evaluated the durability of the improved gait patterns
conferred by GEAR training using 3D gait analysis. In this context, it
should be meaningful to evaluate the persistence of the effects of GEAR
intervention on walking ability.
The purpose of this retrospective study was to
investigate the persistent effect in gait ability with 3D gait analysis
after the completion of GEAR training by comparing with that of strictly
matched control subjects who did not undergo GEAR training.
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