- The Washington Times - Wednesday, November 17, 2004

Edgewater, Md., resident Saul Friedman takes strong, measured strides on a treadmill twice a week despite having suffered a debilitating stroke last year.

The 75-year-old’s footfalls get a boost from Lokomat, a Swiss-made device that helps his body replicate healthy movements in the hope that it will spur it to re-create those steps.

Kernan Hospital, just outside Baltimore, is one of 12 hospitals and rehabilitation centers nationwide to operate a Lokomat. The National Rehabilitation Hospital in Northeast recently purchased its second Lokomat. Its first, acquired in 2001, was used for clinical trials.

Lokomat was introduced domestically three years ago and costs about $235,000.

The elaborate treadmill is intended to increase mobility rates with partially paralyzed patients and those who have suffered strokes.

Some rehabilitation centers approximate walking movements using two therapists manually helping patients take their strides. That led to exhausted, if not injured, therapists whose results couldn’t be reproduced with the same consistency Lokomat provides.

The robot-assisted equipment supports a patient in a parachute harness while much of his or her torso is carefully strapped into the device over the treadmill. The machine then helps the patient’s legs through the walking motion.

Neurologist Dr. Peter Gorman, chief of rehabilitation and director of the spinal-cord-injury program at Kernan Hospital, says the medical jury is still out on just how much help Lokomat provides.

About six patients are regularly using Lokomat at Kernan, and Dr. Gorman says the hospital’s specialists are still learning who will benefit the most from the technology. Now, with several months of use achieved, the hospital will start new research to give definitive measures of just how Lokomat is improving patients’ movement.

They hope to capture measures such as the number of steps a patient can take before undergoing Lokomat treatment and after to test their theory that it stimulates movement.

Dr. Gorman says the science behind the Lokomat is based in part on research on partially paralyzed cats walking on treadmills. Studies have shown that cats without any sensation in their limbs were able to walk on a treadmill after being coaxed into repeated walking motions by recruiting other nerve bundles to help in the effort.

“That gives evidence that the lumbar spinal cord allows for repetitive movement,” Dr. Gorman says. Those with partial spinal-cord injuries may still have some of their neural circuitry intact, some of which can still get input from the sensation of movement.

Dr. Gorman says the robotic heart of the Lokomat isn’t revolutionary on its own, but the ability to reproduce a natural walking motion and the machine’s various safety features make it novel.

“It allows it to stop if there’s any chance of harming the patient,” he says. “If you trip, it’ll shut off.”

The patient also can punch a big red button to stop the treadmill at any time, and the overseeing therapist can trigger a grip device to stop it. Sensors built into the machinery also can detect if a limb is not in the right spot or a body part isn’t moving properly.

Mr. Friedman, who began using the Lokomat four months ago at Kernan Hospital, compares the experience to being inside a robot.

“It’s weird to look at but not as weird to be in it. It’s comforting to see your legs move in the way they ought to move,” Mr. Friedman says of the device, which produces a quiet whooshing sound when activated.

Researchers still don’t know what precise improvements the treadmill can offer patients such as Mr. Friedman, but he says the machine, at the least, is improving his stamina.

“When I started it, I was able to do only 10 minutes at a time before being winded,” he says. “Now I can do 40 minutes without breaking a sweat.”

He also sees improvement in his right leg, which was affected by the stroke.

“My leg moves, at times, almost normally,” he says.

Normal movement doesn’t come easy for a robot, says Charles Remsberg, head of sales and marketing with Hocoma, producer of the Lokomat.

The machine’s inventor, Hocoma CEO Dr. Gery Colombo, began working on the device in 1992. He wanted to find a way to let patients go through natural ranges of motion without relying on physical therapists.

The first Lokomat robot came into being in 1996, with the first clinically used model debuting two years later.

The device has undergone some modifications since then to allow for stroke patients. Stroke survivors commonly suffer paralysis to one side of the body, while partially paralyzed patients deal with more evenly distributed movement loss.

Mr. Remsberg says the theory behind Lokomat draws, in part, on a similar locomotive drive built into babies.

If one were to take a newborn child and hold him or her over a flat surface, the baby will soon emulate a walking motion, he says.

“It’s built in,” he says. The company hopes the machine restimulates that ability to learn the basic walking movements.

Dr. Joseph Hidler, director of the Center for Applied Biomechanics and Rehabilitation at the National Rehabilitation Hospital, says researchers generally agree that repetitive movements can have positive effects for those who have lost muscle control due to stroke or other trauma.

What some Lokomat critics contend, Dr. Hidler says, is that the strict walking motion provided by the machinery might be too restricted to stimulate dormant nerve cells.

“Because of how you’re put into the device, there’s not a lot of movement in the trunk,” Dr. Hidler says. “The big question we ask is, ‘What motions do you need?’”

Dr. Gorman says some specialists foresee the technology working with other spinal-cord treatments to help bring some mobility back to patients. It’s no miracle cure but another way doctors can improve patients’ lives, he says.

Mr. Friedman, a journalist by trade, remains pragmatic about Lokomat’s potential.

“I understand that making the brain connections is a little iffy, but recovery from stroke, especially after a year or year and a half, is exceedingly slow. It’s there, but it comes very slowly. I’m watching and waiting.”

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