Using augmented performance feedback activities during Lokomat® therapy results in moderate intensity cardiovascular exercise in subacute stroke

Ms Nicole Prideaux1, Associate Professor Maayken van den Berg2, Associate Professor Claire Drummond2, Associate Professor Christopher Barr2

1SA Health, Adelaide, Australia, 2Flinders University of South Australia, Adelaide, Australia


Background: Stroke precedes low cardiovascular (CV) fitness reported to limit successful participation in activities. Conventional stroke rehabilitation does not meet National Stroke Guidelines for CV exercise, particularly in non-ambulant patients. The Lokomat® robotic potentially provides a way to achieve CV exercise with these patients.


Aim: To determine whether sustained moderate intensity CV exercise can be achieved, as per National Stroke Guidelines, using the Lokomat® Augmented Performance Feedback (APF) activities in mobility-dependent adults with subacute stroke.


Methods: Ten subacute patients with stroke, mean (SD) age of 63.4 (13) years, participated in six 20-minute Lokomat® sessions, completing per session a randomised order of three 5-minute APF activities. The COSMED K5 collected metabolic data and participants rated perceived exertion (RPE) on the CR-10 BORG scale. Lokomat® settings were also recorded.


Results: Moderate intensity CV exercise was achieved in all three APF activities, demonstrated with a mean (SD) VO2 of 8.0 (3.8) ml/kg/min (estimated 52% VO2max) and mean (SD) MET of 3.1 (1.3). This was supported by BORG scores between 3 and 5. VO2 and MET were not affected by type of APF activity (p=0.110 and 0.240) and VO2, MET and BORG results were maintained over 15 minutes. Lokomat® settings significantly progressed (p<0.05) as per clinical practice without significant changes in VO2 or MET over the six sessions (p=0.380 and 0.527).


Conclusions: Sustained moderate intensity CV exercise, in line with recommended guidelines, can be achieved in mobility-dependent patients with subacute stroke using the Lokomat® APF activities and optimal device settings.


Nicole Prideaux is a Senior Physiotherapist within SA Health with over 20 years of clinical experience. She has recently completed her Master in Clinical Rehabilitation through research into the area of cardiovascular exercise on the Lokomat robotic and transition to body-weight supported treadmill therapy in patients with subacute stroke. Areas of interest include neurological physiotherapy and rehabilitation, exercise therapy, and mind-body connections to health.

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