Lokomat

Lokomat helps patients learn to walk again

Alan Amerson is going for a stroll. The 56-year-old is at Oregon Health & Science University's Center for Health & Healing, on a terrace overlooking the March Wellness fitness center's basketball court. He appears relaxed but determined as his upper body bobs slightly up and down, his legs moving at a leisurely pace of just over one mile per hour.

High-tech mechanical legs to which Amerson's own legs are strapped quietly whir and buzz as they move back and forth in rhythmic cadence over a slow-moving treadmill, forcing his legs to move along with them. A rope attached to a vest-like harness Amerson is wearing keeps his upper torso above his legs, automatically lifting and dropping him just enough to simulate a natural stride.

Retraining the nervous system

Amerson, president of Amerson Precision Sheet Metal Inc. in McMinnville, is using a Lokomat, an automated intensive locomotion therapy machine manufactured by Hocoma AG of Volketswil, Switzerland, that combines treadmill training with robotics to create a unique gait orthosis. Its purpose is to improve mobility that's been lost or reduced due to stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, and other neurological diseases and injuries.

"The idea behind the Lokomat is to allow retraining – in effect, repatterning – of neurological function, after nervous system injury," said Kim Burchiel, M.D., professor and chairman of neurological surgery, OHSU School of Medicine. "If a patient has spinal cord or brain damage – in Alan's case, damage caused by a tumor – it may allow the nervous system to practice using other circuits to permit and perform movement in a way that passive physical therapy cannot."

In January 2005, Burchiel removed a tennis ball-size tumor from Amerson's brain during a 10-hour operation. The slow-growing meningioma was not cancerous, but it had grown down between the two hemispheres of Amerson's brain, pushing one of the halves off to one side. He was in the hospital for three weeks, including two weeks in intensive care.

"Following surgery, not only didn't I have use of my legs, but I couldn't move my hands, I couldn't move anything," Amerson recalls.

A generous gift that will help more than the donor

Over the following seven weeks, Amerson regained some use of his hands and was able to eat on his own, but he still couldn't walk. With help from his physical therapists in McMinnville and at OHSU, Amerson went on a hunt for a device that would help him learn to walk again.

"I called clinics that had different pieces of equipment," recalls Marvin Smith, D.P.T., one of OHSU's lead neurological therapists who works with Amerson. The Lokomat "seemed to be the most user-friendly, the most ergonomically designed for our patients, and it was also the nicest looking."

Amerson was so enthralled by Lokomat's potential as a therapeutic tool that he donated the nearly $300,000 it would take OHSU to purchase the machine for its neurological rehabilitation program.

"It doesn't make any sense for me to have one of these things in my home," Amerson says. "This is something that I'd like to see anybody who can benefit from it, use it. It makes me feel good that people in my condition are able to use it."

According to Hocoma's Web site, the Lokomat Pro can measure a patient's activity through "force transducers" fitted directly to the machine's drives that allow the level of gait assistance to be adjusted for each leg. It also has a system that monitors the patient's gait and provides real-time visual performance feedback to motivate the patient. And it can measure hip and knee stiffness, the isometric force generated by the patient, and range of motion in the hip an knee.

For Smith, the Lokomat minimizes the need for multiple physical therapists assisting one patient. "Obviously, there's less strain on the person assisting the patient. That is a huge advantage for the therapists because we can actually assess the person from the whole picture, including stepping back and seeing how it's helping them, and determining what areas of the machine we need to tweak to make it a more natural-looking walk and, ultimately, beneficial to the patient once off the machine," he says.

Burchiel considers such technology the future of neurological rehabilitation therapy. "Our center has a concentrated effort in rehabilitative, medical and surgical treatment of the worst nervous system disorders and injuries. As such, we need the best and most advanced therapies for rehabilitation, which is exactly what the Lokomat represents," he says. "Very few centers in the U.S. have such advanced tools."

Jonathan Modie