title: Robot-Assisted Training Early After Cardiac Surgery.
abstract: BACKGROUND
  To assess feasibility and safety of a robot-assisted gait therapy with the Lokomat® system in patients early after open heart surgery.
  
  
  METHODS
  Within days after open heart surgery 10 patients were subjected to postoperative Lokomat® training (Intervention group, IG) whereas 20 patients served as controls undergoing standard postoperative physiotherapy (Control group, CG). All patients underwent six-minute walk test and evaluation of the muscular strength of the lower limbs by measuring quadriceps peak force. The primary safety end-point was freedom from any device-related wound healing disturbance. Patients underwent clinical follow-up after one month.
  
  
  RESULTS
  Both training methods resulted in an improvement of walking distance (IG [median, interquartile range, p-value]: +119 m, 70-201 m, p = 0.005; CG: 105 m, 57-152.5m, p < 0.001) and quadriceps peak force (IG left: +5 N, 3.8 7 N, p = 0.005; IG right: +3.5 N, 1.5-8.8 N, p = 0.011; CG left: +5.5 N, 4-9 N, p < 0.001; CG right: +6 N, 4.3-9.8 N, p < 0.001) in all participants. Results with robot-assisted training were comparable to early postoperative standard in hospital training (median changes in walking distance in percent, p = 0.81; median changes in quadriceps peak force in percent, left: p = 0.97, right p = 0.61). No deep sternal wound infection or any adverse event occurred in the robot-assisted training group.
  
  
  CONCLUSIONS
  Robot-assisted gait therapy with the Lokomat® system is feasible and safe in patients early after median sternotomy. Results with robot-assisted training were comparable to standard in hospital training. An adapted and combined aerobic and resistance training intervention with augmented feedback may result in benefits in walking distance and lower limb muscle strength (ClinicalTrials.gov number, NCT 02146196).
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Schoenrath
authors.affiliation: Clinic for Cardiovascular Surgery, University Heart Center, Zurich, Switzerland.
authors.forename: Susanne
authors.initials: S
authors.lastname: Markendorf
authors.affiliation: Clinic for Cardiology, University Heart Center, Zurich, Switzerland.
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Brauchlin
authors.affiliation: Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zurich, Zurich, Switzerland.
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Clinic for Cardiovascular Surgery, University Heart Center, Zurich, Switzerland.
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Wilhelm
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.affiliation: Sensory-Motor Systems Lab, ETH, Zurich, Switzerland.|University Hospital Balgrist, University of Zurich, Zurich, Switzerland.
authors.forename: Robert
authors.initials: R
authors.lastname: Riener
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.affiliation: Clinic for Cardiology, University Heart Center, Zurich, Switzerland.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Schmied
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000534:rehabilitation*; D005240:Feasibility Studies; D025461:Feedback, Physiological / Q000502:physiology; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D026741:Physical Therapy Modalities; D011184:Postoperative Period; D052097:Quadriceps Muscle / Q000502:physiology; D012371:Robotics / Q000379:methods*; D056346:Sternotomy / Q000534:rehabilitation*; D013997:Time Factors; D016138:Walking / Q000502:physiology*