title: A Comparison of Locomotor Therapy Interventions: Partial-Body Weight-Supported Treadmill, Lokomat, and G-EO Training in People With Traumatic Brain Injury.
abstract: BACKGROUND
  Literature in the application of gait training techniques in persons with traumatic brain injury (TBI) is limited. Current techniques require multiple staff and are physically demanding. The use of a robotic locomotor training may provide improved training capacity for this population.
  
  
  OBJECTIVE
  To examine the impact of 3 different modes of locomotor therapy on gait velocity and spatiotemporal symmetry using an end effector robot (G-EO); a robotic exoskeleton (Lokomat), and manual assisted partial-body weight-supported treadmill training (PBWSTT) in participants with traumatic brain injury.
  
  
  METHODS
  Randomized, prospective study.
  
  
  METHODS
  Tertiary rehabilitation hospital.
  
  
  METHODS
  A total of 22 individuals with ≥12 months chronic TBI with hemiparetic pattern able to walk overground without assistance at velocities between 0.2 and 0.6 m/s.
  
  
  METHODS
  Eighteen sessions of 45 minutes of assigned locomotor training.
  
  
  METHODS
  Overground walking self-selected velocity (SSV), maximal velocity (MV), spatiotemporal asymmetry ratio, 6-Minute Walk Test (6MWT), and mobility domain of Stroke Impact Scale (MSIS).
  
  
  RESULTS
  Severity in walking dysfunction was similar across groups as determined by walking velocity data. At baseline, participants in the Lokomat group had a baseline velocity that was slightly slower compared with the other groups. Training elicited a statistically significant median increase in SSV for all groups compared with pretraining (Lokomat, P = .04; G-EO, P = .03; and PBWSTT, P = .02) and MV excluding the G-EO group (Lokomat, P = .04; PBWSTT, P = .03 and G-EO, P = .15). There were no pre-post significant differences in swing time, stance time, and step length asymmetry ratios at SSV or MV for any of the interventions. Mean rank in the change of SSV and MV was not statistically significantly different between groups. Participants in the G-EO and PBWSTT groups significantly improved their 6MWT posttraining (P = .04 and .03, respectively). The MSIS significantly improved only for the Lokomat group (P = .04 and .03). The data did not elicit between-groups significant differences for 6MWT and MSIS. There was less use of staff for Lokomat than G-EO.
  
  
  CONCLUSIONS
  Locomotor therapy using G-EO, Lokomat, or PBWSTT in individuals with chronic TBI increased SSV and MV without significant changes in gait symmetry. Staffing needed for therapy provision was the least for the Lokomat. A larger study may further elucidate changes in gait symmetry and other training parameters.
  
  
  METHODS
  II.
authors.affiliation: MossRehab Gait and Motion Analysis Laboratory, 60 Township Line Rd, Elkins Park, PA 19027(∗). Electronic address: aesquena@einstein.edu.
authors.forename: Alberto
authors.initials: A
authors.lastname: Esquenazi
authors.affiliation: MossRehab Gait and Motion Analysis Laboratory, Elkins Park, PA(†).
authors.forename: Stella
authors.initials: S
authors.lastname: Lee
authors.affiliation: MossRehab Gait and Motion Analysis Laboratory, Elkins Park, PA(‡).
authors.forename: Amanda
authors.initials: A
authors.lastname: Wikoff
authors.affiliation: MossRehab Gait and Motion Analysis Laboratory, Elkins Park, PA(§).
authors.forename: Andrew
authors.initials: A
authors.lastname: Packel
authors.affiliation: MossRehab Gait and Motion Analysis Laboratory, Elkins Park, PA(¶).
authors.forename: Theresa
authors.initials: T
authors.lastname: Toczylowski
authors.affiliation: MossRehab Gait and Motion Analysis Laboratory, Elkins Park, PA(#).
authors.forename: John
authors.initials: J
authors.lastname: Feeley
mesh_terms: D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000175:diagnosis; D005080:Exercise Test / Q000295:instrumentation*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology / Q000503:physiopathology*; D000071939:Stroke Rehabilitation / Q000379:methods; D016896:Treatment Outcome; D016474:Weight-Bearing