By Chuck Hofvander
I had my stroke on March 21, 2004. It left me partially paralyzed on my dominant right side. When you’re a toddler you expect to fall. When you’re an adult, you’re afraid to fall but you’re not paralyzed by fear. But when you’ve had a stroke you’re terrified of falling. Every step taken is about overcoming fear. You have to concentrate on every step. Pre-stroke, I took walking for granted. Post-stroke; I’d have given anything just to be able to walk without fear.
I met George Hornby PT, PhD in May, 2004 at Alexian Brothers Rehab Hospital just a few weeks after my stroke. . He told me about a device he was testing at the Rehabilitation Institute of Chicago (RIC) that assisted in restoring normal patterns of walking. I wasn’t interested in it because I thought I would recover soon.
A month later, while researching experimental therapies, my wife learned about the Lokomat, the device George told me about. At RIC, not only do they offer in and out patient care but many experimental forms of therapies.
The Lokomat is based on “Unweighting” a portion of a person’s body’s weight. It does so by a combination of a treadmill, parachute harness, and the Lokomat. The Lokomat is a computer driven machine that mimic’s the walking motion. The Lokomat is designed to help those with brain, spine, and other forms of paralysis regain their walking ability. I was part of a study that would determine if it would be useful for stroke survivors. The Lokomat is explained in detail on the web site http://www.ric.org/walktherapy/
The process begins when you are wheeled or walked up to a treadmill and hooked up into the parachute harness. Its purpose is to hold you up during the session. The placement must be right because the original purpose of the parachute was to hold you when you jumped from an airplane. The designers of the parachute thought you would be only in it for less than 5 minutes not for 45 minutes. Chafing in sensitive areas can be a real problem.
After the harness is on, the Lokomat is moved into place. The Lokomat is strapped to your lower body and consists of motors, straps, hinges, and levers. Computers operate braces, braces that force your legs to go through a walking motion. By forcing your legs to move it hopes to retrain your brain.
The sessions were for 45 minutes, three times a week, for 12 weeks. You came in, they hooked you into the Lokomat, and then the machine was turned on. A computer screen gives visual feedbacks on your performance. If you fell below or above a certain walk level you’ll see it. The therapists are always there to encourage, harass you if you don’t try, and to check the operation of the Lokomat.
I interviewed George Hornby after the research on stroke ended. His answers on the Lokomat are surprising.
Something must have driven you to go into research, what was it?
What drove me into human research was a class in neuroscience which showed a video of a patient with a stroke. We watched the patient and his inability to move quickly or in a coordinated manner to drink from a cup of water. I had asked what was there that we could do for these individuals, and they said nothing could be done and this was all the function that the man would get back after his injury. That didn’t seem like a sufficient answer, since I knew some studies had been done to show improvements in people post-stroke.
How did you become involved in this particular project?
I was really interested in recovery of walking, and the Lokomat was a good was to get into this type of research.
What was the project about?
We wanted to look at how the Lokomat could facilitate improvements in walking ability in people post-stroke, particularly as compared to conventional rehabilitation or treadmill walking without the Lokmat.
When did RIC get the Lokomat and begin testing on stroke patients and how many subjects were involved in testing?
March 2002, in two different studies, about 100.
Was it successful? Did people see any improvement?
People improve following Lokomat training, but about the same as conventional physical therapy.
What was your biggest surprise?
When patients are provided simple treadmill walking at the same speeds and durations as Lokomat walking, they double their improvements compared to Lokomat training.
What was your biggest disappointment?
No disappointments; the data simply reaffirm that goal-directed, internally driven (not externally guided) walking training can facilitate substantial improvements in walking ability.
George’s answers to the question “What was your biggest surprise” startled me. I’d gone through months of traditional therapy but I didn’t make the improvement that I made on the Lokomat. At first, I was pushed in a wheel chair up a ramp into the machine. By the end I was walking up to it. At first, I was held up by counter weights, by the end there were none. But it only works if you make an effort, you can’t just stand there and let the Lokomat move your legs. It takes a great deal of concentration on your part to make it work. You’ve got to remember how to walk and for stroke survivors that can be difficult.
After months of traditional therapy, stretching, walking, balancing on one leg, etc. nothing helped me as much as the Lokomat. But data doesn’t lie but perhaps in my case it fibbed. As the noted walker and author Gary Yanker said “Your body is built for walking.” I walk now without a cane or walking stick around the house. Only when I go outside do I use them for support. And remember “He who limps is still walking.” ~Stanislaw J. Lec
Copyright © October 2007
The Stroke Network, Inc.
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