Discussion
Lokomat, stroke
STROKE, STS
It was feasible and well-tolerated to incorporate an additional three hours per week of gait training therapy into all participants’ schedules over a large portion of their inpatient stay. On average, study participants received 11.3 supplemental therapy sessions (12.8 CGT, 9.8 Lokomat®). It has been noted that other aspects of each individual’s plan of care and stage of recovery can be an obstacle to supplemental therapy [Enrolled participants tolerated additional exercise well. The cardiorespiratory inclusion criteria for study participants biased us to expect this. There was a slight reduction in therapists' perceived exertion in the entire cohort over the course of the study. Neither individual treatment group analysis showed statistical significance given the small group size, the relatively small change (0.7 for each group) and the relatively high variability (1.1 Lokomat®, 2.4 CGT) of that change within each group. The Lokomat® group showed a medium effect size (0.62).Receiving The reference group having higher intake average FIM score can be viewed in two ways. First, having higher function may allow them to achieve more during gait training. Alternatively, the lower the intake score, the more One additional benefit of the supplemental therapy was that both groups showed an Outcome variables linked to functional gains showed the majority of the improvements in both groups. FAC, FIM, 5xSTS, 2MWT, and 10MWT showed large effect sizes (>0.8) in both groups – as well as a trend towards, though not statistically significant, differential effect between groups. FAC and FIM showed average improvements of greater than 1.25 and almost 25, respectively. The average FAC at admission was between 1 and 2, indicating participants required continuous support for weight bearing/balance or intermittent support with balance/coordination during walking. The average score at discharge was just below 3, indicating the requirement of physical support for walking was mostly eliminated. As noted previously, the 5×STS times also improved considerably. There was a notable differential in improvement in STS time between the groups. The Lokomat® group improved by just over 50% (45s at admission vs. 22s at discharge) whereas the CGT group improved by just under 30% (29s at admission to 21s at discharge). We wish to highlight that 9 participants could not complete the STS task at admission and 5 of these could at discharge (see note a). Though these data did not contribute to above reported % changes and statistical analyses, their functional gains were just as important, if not more so, than being able to stand Overall, an important point this work helped to establish is that standard of care plus supplemental therapy can lead to many desired improvements and lack of decline, and this can be done in a fairly efficient manner during the inpatient stay without undue burden on therapist (vis-à-vis reduced RPE scores). Additional studies need to be done to further refine the supplemental protocol, including defining optimal intensity and duration, patient demographics as well as delivery mode. The use of robotics can be an important factor in the practical implementation of supplemental therapy as trying to balance therapist time and physical demands with increasing dosage, timing and scheduling during increasingly shorter inpatient stays can be challenging.Based on the above noted possible differences in effects between treatment groups, we formally explored whether there was a statistical effect of modality. A post-hoc overarching statistical analysis of robotic vs. conventional (CGT) therapy did not show a statistically significant differential effect (MANOVA p=0.21, Pillai Trace). We compared only the interval variables (ankle and knee PROM, 2MWT, 10MWT and 5xSTS) using a single factor MANOVA with post-hoc ANOVAs to compare differences in individual variables. Only these 5 variables were compared since a MANOVA analysis The potential differential effect favoring robotic therapy is particularly striking given that, though not by design, the Lokomat® group received less overall number of supplemental sessions than the CGT group. The Lokomat® training group had approximately 30% fewer sessions per IRF stay, but the stepping intensity of the gait specific training was higher with this device compared to the CGT intervention. This assessment of increased stepping is Recent work, including reviews and meta-analyses of a moderate body of previous work also suggests but does not clearly indicate differential benefits of robotic training for patients in the acute and subacute phases of stroke [