Image 1: team photo with Jose Lopez- Occupational Therapist and CEO of CEN (Main Author), Cristina Vazquez COO, Jorge Alegre, Loles Villalobos, Andrea Riendas, Alicia Blázquez, Sara Ortega and Elena Maraboto

Centro Europeo de Neurociencias, Madrid,Spain

We would like to share our clinical experience with a patient with a left hemiplegia.

The patient arrived in our clinic after his diagnosis of a massive haemorrhagic stroke.

We applied a tailored rehabilitation program of intensive and specialized therapy, following the continuum of therapy for gait and balance. We progressively applied the most optimal technology for each phase of recovery moving from intensive therapy with the LokomatPro to functional therapy with the RYSENTM and then to challenging therapy with the C-Mill VR+.

The patient’s experience with the intensive episode of care and improved outcomes motivated us to share how a combined program of robotic rehabilitation can be incorporated into the treatment of this patient population.


Initial Evaluation

Luismi is a 56 years old man.

He suffered a haemorrhagic stroke, staying two months in coma and one more month at the ICU.

After coma he was diagnosed with the following functional conditions:

  • Trunk control test (TCT) lower than 40
  • Hip muscle strength = 0
  • Severe deep sensation injury
  • Neglect on left hemicorps, all his body weight shifted to the right side
  • According to TWIST algorithm = dependent for walking
  • Initial FAC = 0
  • Baseline Berg Balance Scale = 4
  • Wheelchair-bound, needing the help of two people for one step
  • Without active movement on his left leg, someone always needed to move his left leg in order to do a step.

The rehabilitation started six months after injury and his motivation and main goal were to walk again independently with the use of a walking aid.


Treatment with the Lokomat, Rysen™ and C-Mill VR+

  • The patient accomplished one hour per day intensive gait training during the five months the therapy lasted. In the first three months, this was done exclusively with the Lokomat, the fourth month with the RYSENTM , and the fifth month by combining RYSENTM and C-Mill VR+.
  • The patient started with practicing walking on the LokomatPro.
  • He had one hour training per day, five days a week, for 12 weeks. This resulted in over 100 km walking in a total of 60 sessions Day by day he became more confident about it .
  • The patient was able to move his left leg more and more. He also became capable of walking overground with a mountain stick and supervision and was even capable of doing some steps without walking aid. Therefore he could start training in the RYSENTM
  • Because of his progress, the exercises could become more challenging and complex. Therefore, the patient also started practicing gait adaptability, coordination, and dual tasks on the C-Mill VR+.
  • The technological therapy was complemented with other balance, strength, and motor control exercises and FES.
  • The total amount of therapy was four hours a day, five days a week.

Video 1: journey of the patient at CEN

Image 2: 6 minutes walk Test evolution during 7 assessments

The initial assessment was done in November 2019, the last one in March 2020. In this case, there was a two-months’ period between the first and the second assessment, as the patient was unable to walk during the first two months. After that, the assessments were done every two weeks, approximately.

Image 3: 10 meter walk test evolution at normal and fast speed during 6 assessments

Image 4: lower limb Fugl Meyer score evolution during 3 assessments

Image 5: Time up and go (TUG) test evolution during 6 assessments

Image 6: Berg balance scale evolution during 5 assessments

Image 7: initial spatial temporal parameters from the C- Mill

Image 8: Last spatial temporal parameters from the C- Mill

There’s a two weeks difference between graphs, the first one done at the beginning of March and the second mid of March

Image 9: Initial Butterfly representation on the C-Mill

Image 10: Last Butterfly representation on the C-Mill

There’s a two weeks difference between graphs, the first one done at the beginning of March and the second mid of March


The objective data gathered during the different assessments allow us to conclude that there were improvements:

  • Walking distance increased: from not being able to walk to walking a distance of 289 meters on the 6 min walk test (image 2)
  • Walking speed increased: from not being able to walk to 3.05 km/hour (image 3).
  • The Fugl Meyer score for lower extremity, indicating the function of the lower extremity, increased from 7 to 18 points (image 4).
  • The time up and go test (TUG) decreased from 70 seconds to 16.86 s (image 5).
  • The score on the Berg Balance Scale, indicating balance ability, increased from 4 to 45 points (image 6).
  • The step length on the right side increased from 24% to 42%, because the stance time (especially single stance time) of the left leg increased, so better acceptance of weight on the paretic leg. Results provided by the C-Mill VR+ software (image 7).
  • The symmetry and “normative” shape of the butterfly improved (image 8).
  • At home, the patient recovered his independence: no walking aid was needed at home, and he used a mountain stick to walk outside

We believe that these good outcomes were due to the intensive therapy that we could provide in our center, due to the motivation of the patient and due to the help of the family.

About us

CEN is an intensive and individualized research and therapy center which offers the latest technologies for the evaluation and treatment of neurological diseases. A team of professionals with broad international experience.




This clinical experience report is meant to serve as an example of how the Lokomat®, RYSEN™ and C-Mill VR+ are  integrated into one particular rehabilitation center. It is not necessarily a standard recommendation from Hocoma.