Lokomat Therapy

Robotic Treadmill May Enable Some Patients With Spinal Cord Injuries or Stroke to Learn to Walk Again

UM Rehabilitation & Orthopaedic Institute is one of only two facilities in Maryland, and one of 25 centers in the U.S., with Lokomat

UM Rehabilitation & Orthopaedic Institute, the largest orthopaedic and rehabilitation center in Maryland, has a state-of-the-art robotic treadmill that doctors believe may help some patients with spinal cord injuries learn to walk again. The Swiss-made device, known as Lokomat, may also benefit patients partially paralyzed by stroke.

UM Rehabilitation & Orthopaedic Institute is one of approximately 25 hospitals and rehabilitation centers in the United States to have Lokomat, and one of only two facilities in Maryland.

The robot-assisted training device supports patients in a parachute harness while moving their legs on a treadmill. It creates a smooth repetitive motion that may help stimulate areas of the spinal cord thought to control the ability to walk.

"This new technology takes gait-training to the next level, with a robot powering the lower extremities," says Peter H. Gorman, M.D., a neurologist who is chief of rehabilitation and director of the spinal cord injury program at UM Rehabilitation & Orthopaedic Institute, as well as director of the outpatient spinal cord injury clinic at the Baltimore VA Medical Center. "Our goal is to see if this type of repetitive motion will, over the course of weeks and months, restore the ability of some patients to walk again."

"Lokomat really does the work of two physical therapists, who would otherwise have to pick up and move a patient's legs, one at a time, in a walking motion," adds Dr. Gorman, who is also an associate professor of neurology at the University of Maryland School of Medicine. "The manual therapy is exhausting for therapists and doesn't provide the uniform steps that Lokomat does."

Research with animals suggests that specific neural circuits within the lower spinal cord are largely responsible for a person's ability to walk. "Able-bodied people walk and really don't think about it. We walk automatically and that is probably being processed by our nervous system at a lower level than the brain, most likely in the spinal cord," explains Dr. Gorman.

"In patients with partial spinal cord injuries, those neural circuits are thought to be at least partially intact. If these circuits can get input from a sensation of locomotion, it might be possible to restore their automatic function," he says.

UM Rehabilitation & Orthopaedic Institute is using Lokomat to treat people who have had a stroke or a partial, or incomplete, spinal cord injury who meet certain weight and strength criteria and have some motor control. Dr. Gorman is studying whether the robotic treadmill will help patients with partial spinal cord injuries regain function even more than 18 months after they were hurt.

Lokomat provides what is known as automated locomotion therapy. Developed by Hocoma AG Medical Engineering of Zurich, Switzerland, the equipment was first introduced in the United States in 2001.

UM Rehabilitation & Orthopaedic Institute, which is part of the University of Maryland Medical System, bought the $235,000 piece of equipment in 2004 with the help of a donation from Snow Time, Inc., a company that operates ski resorts in Pennsylvania, Maryland and New York. The UM Rehabilitation & Orthopaedic Institute Foundation provided the remaining funds.

James E. Ross, the chief executive officer of UM Rehabilitation & Orthopaedic Institute, says, "This robotic treadmill will significantly expand the type of rehabilitative services that we are able to offer patients who have had strokes or spinal cord injuries. This advanced technology is just the latest in cutting-edge therapies that we provide to our patients."

Lokomat can be adjusted to a patient's height, weight, strength and individual treatment program. The new equipment has built-in safety features. "You really need to have a whole different level of sophistication and sensory engineering to use this type of machinery with patients. It's not just taking the robotic technology that is well developed in automated assembly line work and moving it into the clinic," Dr. Gorman says.

For example, he says, if a patient were to falter or appear to be having difficulty during the exercise session, built-in sensors would shut the machine off automatically. The patient or the physical therapist supervising the therapy can also turn off the machine.

UM Rehabilitation & Orthopaedic Institute is the state's largest hospital specializing in orthopaedics and rehabilitation. Staffed by specially trained doctors, nurses and therapists, the William Donald Schaefer Rehabilitation Center at Kernan provides the full range of care, including physical, occupational and recreational therapy, speech and language therapy, and psychological and behavioral services.

To learn more about Lokomat and to find out if you may be a candidate for this treatment, contact the OP Therapy Manager at 410-448-6802.