Latest Developments in Locomotor Training

Locomotor training can support a wide range of individuals with different mobility impairments.

Locomotor training continues to grow and evolve as new research and technology shape how physical therapists approach walking/gait recovery. It focuses on improving someone’s walking ability through task-specific practice, often involving repetitive stepping patterns and weight-bearing exercises. As research and evidence in neurorehabilitation and gait recovery grows, locomotor training is being applied across more conditions and age groups. 

This article explores the latest trends and developments in locomotor training, including equipment, techniques, and interdisciplinary approaches. It also highlights how therapists can apply these advancements to improve patient mobility and independence. 

Related physical therapy CE course: Latest Developments in Locomotor Training

What is locomotor training?  

Locomotor training is a rehabilitation strategy designed for retraining walking through repetitive movement, sensory feedback, and postural alignment. The goal is to activate neural pathways and improve functional mobility using principles of motor learning. 

Physical therapists often use treadmill-based training with or without body weight support, as well as overground practice to reinforce learned movement. This type of intervention is especially great for individuals recovering from neurological injuries or conditions that affect gait. 

Key populations who benefit from locomotor training 

Locomotor training can support a wide range of individuals with different mobility impairments. It is often used for: 

• Stroke survivors
• People with spinal cord injuries (SCI)li>
• Children with cerebral palsy
• Individuals with Parkinson’s disease
• Patients recovering from brain injuries
• Older adults with balance or strength deficits
• Individuals with multiple sclerosis or other progressive neurological conditions

Latest trends and advancements 

Many innovations have improved the way locomotor training is delivered. These updates focus on improving feedback, increasing engagement, and allowing for more precise control over movement patterns. 

Some of the latest trends and advancements include: 

Robotic-assisted gait training 

Robotic systems provide guided assistance during treadmill or overground walking. They help standardize movements while helping lower therapist fatigue. 

Benefits include: 

• Offers adjustable support and resistance
• Promotes symmetry and consistency in gait cycles
• Allows real-time adjustments to challenge the patient
• Encourages active participation and repetition

Examples include the Lokomat, Ekso Bionics, and ReWalk systems. 

Virtual reality (VR) use 

Virtual reality platforms are now being used to add immersive elements to gait training. VR can simulate environments or present tasks that encourage dynamic balance and coordination. VR: 

• Improves motivation and patient engagement
• Challenges cognitive and visual-motor skills
• Provides immediate visual feedback on movement
• ffers distraction from discomfort during sessions

Overground training with exoskeletons 

Wearable exoskeletons are becoming more common for individuals with spinal cord injuries and stroke. These devices allow for upright walking in real-world environments. 

Some of their benefits include: 

• Promotes mobility outside of just a clinic or hospital setting
• Facilitates weight-bearing and bone health
• Lowers sedentary behavior
• Encourages reintegration into everyday settings

Biofeedback and wearable sensors 

Advances in wearable technology provide physical therapists and patients with objective data on movement quality. 

Wearable sensors are great because they: 

• Track step counts, gait speed, and limb symmetry
• Offer real-time feedback to improve stride and alignment
• Encourage self-monitoring and accountability
• Support long-term progress outside the clinic

Body weight support systems (BWSS) 

Suspension systems that offload part of the patient’s body weight allow for early walking practice during different types of injuries or movement limitations. 

Benefits include: 

• Reduces the fear of falling
• Enables stepping practice for patients with low strength
• Supports gradual progression toward unassisted walking
• Encourages more natural gait mechanics in a safe setting

Some systems include dynamic BWSS that respond to movement, offering more adaptable and individualized training, although these can be more expensive. 

Interdisciplinary collaboration 

Locomotor training can often require input from a team of different types of providers. Coordinated care makes sure that all aspects of mobility—muscle strength, joint flexibility, neurological recovery, and cardiovascular fitness—are addressed, making a collaborative approach very important for the overall improvement of the patient. 

Team members may include: 

• Physical therapists: Lead gait retraining and mobility exercises, assess walking patterns, and adjust interventions to support safe, functional ambulation.
• Occupational therapists: Focus on improving the motor skills and coordination needed for activities of daily living that rely on mobility, such as transfers, dressing, or navigating the home environment.
• Physicians and physiatrists: Provide medical oversight, manage underlying conditions, and support referral pathways for therapies, assistive devices, or medication adjustments.
• Kinesiologists and exercise physiologists: Assist with structured exercise programs to build strength and endurance that complement gait training.
• Orthotists and prosthetists: Design and fit braces, orthotics, or prosthetic limbs that improve gait mechanics and safety during locomotor training.
• Assistive technology specialists: Recommend and set up equipment such as walkers, mobility aids, or tech-enhanced tools that support independent movement.
• Speech-language pathologists: Help patients with communication or cognitive challenges that might affect their ability to follow gait training instructions or coordinate movement.

Functional goals in locomotor training 

Beyond improving gait mechanics, locomotor training supports more goals related to daily living and community integration. 

Functional outcomes often include: 

• Walking household or community distances
• Navigating obstacles and uneven surfaces
• Improving transfers and standing balance
• Gaining confidence with independent movement
• Returning to work or recreational activities

Patients often report improved quality of life when walking becomes easier or more efficient, even in short distances. 

Tips for physical therapists implementing locomotor training 

Therapists incorporating the latest methods into practice should consider: 

• Conducting thorough assessments before starting (e.g. gait analysis, endurance, muscle testing)
• Selecting equipment based on access, safety, and patient tolerance
• Using clear verbal cues and visual feedback during training
• Setting realistic goals and adjusting progression based on response or progress
• Documenting outcomes and adjusting interventions as needed
• Coordinating follow-up to keep the gains made in therapy

Combining newer technologies with established therapeutic principles allows for flexible and patient-centered care. Consistent re-evaluation helps keep therapy aligned with individual progress, making it an important step. 

Looking ahead: Where the field is headed 

Ongoing developments in artificial intelligence, machine learning, and motion capture could further improve how physical therapists assess and adjust locomotor training. 

Some examples of what could help physical therapists with locomotor training in the future are: 

• AI-driven gait analysis could allow for faster and more detailed assessments
• Predictive modeling could help anticipate recovery timelines more accurately
• More affordable devices could expand access to community clinics

Researchers are also studying the emotional and psychological benefits of improved mobility, highlighting how walking confidence affects participation in daily life. 

Conclusion 

Locomotor training continues to grow as an important part of neurorehabilitation and mobility recovery. With constant growth happening in robotics, virtual reality, wearable sensors, and biofeedback, physical therapists now have more tools to support their patients in regaining walking ability. 

These developments offer new ways to motivate patients, improve outcomes, and support long-term function. As the field continues to evolve, physical therapists are in a great position to lead innovative programs that help individuals move with more confidence and ease.  

Staying current with new approaches allows clinicians to adapt care for a wider range of needs and goals as well.