Overview
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Hocoma AG is a Swiss medical technology company headquartered in Volketswil, Switzerland, specializing in the development and manufacture of robotic rehabilitation devices for patients with neurological disorders. Founded in 1996 as a spin-off from the Swiss Federal Institute of Technology (ETH Zurich), Hocoma has grown to become one of the world's leading providers of robot-assisted rehabilitation therapy solutions, with products deployed in over 1,000 clinical and research facilities across 40+ countries["@hocoma"].
The company's product portfolio addresses the full spectrum of neurorehabilitation, from early mobilization through to advanced gait training and upper limb recovery. Hocoma's devices are used to treat patients recovering from [stroke](/diseases/stroke), [Parkinson's disease](/diseases/parkinsons-disease), [multiple sclerosis](/diseases/multiple-sclerosis), [spinal cord injury](/diseases/spinal-cord-injury), [traumatic brain injury](/diseases/traumatic-brain-injury), and other neurological conditions that impair motor function. Hocoma operates as a subsidiary of DIH Holding AG, a global provider of rehabilitation solutions that includes subsidiaries in the United States (DIH), China, and Europe.
Company History
Founding and Academic Roots
Hocoma was founded in 1996 by Professor Leonardi and Professor Colombo at ETH Zurich, with the goal of translating robotics research into clinical rehabilitation applications. The company's early focus was on gait rehabilitation, driven by the recognition that repetitive, high-intensity task-specific training was essential for neuroplastic recovery — yet traditional therapy approaches were constrained by therapist fatigue and limited session duration. The founding team developed the first prototype of what would become the Lokomat system in collaboration with clinicians and researchers at the Swiss Paraplegic Centre[@hocoma].
Growth and Product Expansion (2000-2010)
During the 2000s, Hocoma expanded its product portfolio significantly:
- 2000: Launch of the first commercial Lokomat system
- 2001: Introduction of the Passive Motion Exerciser (PAM)
- 2004: Launch of the Armeo arm therapy system
- 2006: Introduction of Erigo tilt table for early mobilization
- 2008: ArmeoSpring for pediatric applications
- 2010: Hocomatraining software platform released
The company established its US subsidiary in 2005 and expanded into Asian markets through distribution partnerships. During this period, Hocoma accumulated extensive clinical evidence supporting the efficacy of robot-assisted therapy, positioning the company as a market leader.
International Expansion and DIH Acquisition (2011-Present)
Following 2010, Hocoma continued expanding globally:
- 2012: Expansion of manufacturing facilities in Switzerland
- 2015: Launch of VALEO functional electrical stimulation system
- 2017: Strategic partnership with DIH Medical
- 2019: DIH acquired majority stake in Hocoma, creating a global rehabilitation platform group
Today, Hocoma maintains its primary R&D and manufacturing operations in Switzerland, with global sales and support operations through DIH's international network.
Products and Solutions
Gait Rehabilitation Systems
Lokomat
The Lokomat is Hocoma's flagship product — a robotic gait training system that enables patients with neurological disorders to practice walking with accurate, repeatable, high-intensity training[@lokomat].
System Components:
| Component | Description |
|-----------|-------------|
| LokomatPro | Full-featured gait orthosis with dynamic body weight support |
| LokomatNano | Compact version for space-constrained facilities |
| Dynamic Body Weight Support (DynaPS) | Active weight relief system allowing natural gait patterns |
| Hocomatraining | Software platform for protocol management and progress tracking |
| Sensorimotor Gait Analysis | Built-in measurement of gait parameters |
Technical Specifications:
- Robotic Actuators: 4 DOF (hip flexion/extension, knee flexion/extension per leg)
- Gait Pattern: Individually adjustable stride length, cadence, and trajectory
- Body Weight Support: 0-80 kg adjustable dynamic support
- Patient Capacity: Up to 135 kg patient weight
- Therapy Modes: Fully assisted, guidance force adjustable, resistance mode
Clinical Utility: The Lokomat allows patients to practice walking with a physiological gait pattern from the earliest stages of rehabilitation, even before they can bear full weight. The system provides precise, repeatable training that is difficult or impossible to achieve with manual assisted walking[@hidler2009]. The dynamic body weight support system allows natural vertical movement during gait, avoiding the "treadmill gait" pattern that static support systems can produce[@hornby2008].
Evidence for Parkinson's Disease: Multiple studies have evaluated Lokomat training in PD patients, demonstrating improvements in gait velocity, stride length, cadence, and functional mobility[@meer2017][@gall2014]. The intensive, task-specific nature of Lokomat training aligns with principles of neuroplasticity that suggest high-repetition, meaningful movement drives neural reorganization in the damaged motor system.
ErigoPro
The ErigoPro is an advanced tilt table with integrated robotic leg movement for early mobilization and circulation recovery[@evocraft]:
- Verticalization: Gradual transition from supine to upright position
- Robotic Leg Movement: Lower extremity cycling to prevent deconditioning
- Load Bearing: Gradual introduction of weight through legs
- Integrated Monitoring: Cardiovascular and neurological assessment tools
Clinical Applications:
- Early mobilization of ICU and rehabilitation patients
- Cardiovascular conditioning during bed rest
- Preparation for subsequent gait training
- Management of orthostatic intolerance
Upper Limb Therapy Systems
Armeo Power
The ArmeoPower provides robot-assisted arm therapy for patients with moderate to severe upper limb impairment[@armeo]:
- 6 DOF Arm Manipulator: Supports arm and hand movement
- Adaptive Assistance: Software adjusts support based on patient performance
- Integrated Games: Engaging exercise scenarios for motivation
- Progress Documentation: Objective measurement of motor recovery
Therapeutic Approach: The ArmeoPower uses an "assist-as-needed" control strategy — the robot provides exactly as much assistance as the patient requires to complete the movement, gradually reducing support as the patient's abilities improve. This approach promotes active patient participation while ensuring successful movement completion.
Evidence: Research demonstrates that Armeo therapy combined with conventional rehabilitation produces greater improvements in arm function than conventional therapy alone, with effect sizes most pronounced in the subacute phase after stroke[@winstein2014][@schroter2009][@mayer2019].
Armeo Spring
The ArmeoSpring provides arm weight support for patients with mild to moderate impairment:
- Gravity Compensation: Springs offset arm weight, enabling active movement
- ARMin End-Point Robot: 3 DOF for functional arm training
- Self-Directed Practice: Enables independent exercise sessions
- Compact Footprint: Suitable for smaller clinical settings
Armeo Boom
The ArmeoBoom provides over-ground arm training support:
- Ceiling-Mounted Arm Support: Full 3D arm movement workspace
- Compact Design: No floor-standing components
- Child-Specific Version: ArmeoBoom Pediatric for younger patients
Additional Systems
VALEO System
The VALEO functional electrical stimulation (FES) system integrates electrical stimulation with movement training[@valeo]:
- FES + Movement Integration: Combines electrical stimulation with active exercise
- Surface Electrodes: Non-invasive electrode placement
- Programmable Protocols: Customizable stimulation patterns
- Clinical Applications: Foot drop correction, muscle strengthening, circulation support
Foot Drop Application: VALEO addresses foot drop — a common gait impairment in [Parkinson's disease](/diseases/parkinsons-disease) and stroke — by electrically stimulating the tibialis anterior muscle during swing phase, producing a more natural dorsiflexion pattern.
Clinical Evidence
Parkinson's Disease
Research on robot-assisted gait training with Hocoma systems in PD patients has grown substantially over the past decade:
Meer et al. (2017)[@meer2017]:
- Evaluated Lokomat training in 17 PD patients (Hoehn-Yahr stage 2-4)
- 30-minute sessions, 3x/week for 8 weeks
- Significant improvements in 10-meter walk test, 6-minute walk distance, and UPDRS motor scores
- Improvements maintained at 4-week follow-up
Galli et al. (2014)[@gall2014]:
- Systematic review of robot-assisted gait training in PD
- 6 studies with Lokomat and similar systems
- Concluded that robotic gait training is safe and can improve gait parameters in PD
- Noted that optimal protocols remain to be established
Calabrò et al. (2014)[@calabr2014]:
- Compared Lokomat training to conventional therapy in PD
- Robotic training showed greater improvements in stride length and walking speed
- Authors suggested robotic training may be particularly valuable for patients who cannot achieve sufficient training intensity with manual assistance
Mehrholz et al. (2017) — Cochrane Review[@mehrholz2017]:
- Systematic review of electromechanical-assisted training after stroke
- Included 36 trials, some with PD patients
- Found moderate-quality evidence that electromechanical-assisted gait training improves walking ability
- Electromechanical devices included Lokomat and similar systems
Stroke
Hidler et al. (2009)[@hidler2009]:
- Multi-site randomized trial of Lokomat training in chronic stroke
- Robotic training produced greater improvements in gait velocity than conventional training
- Results particularly strong in patients with moderate impairment
Hornby et al. (2008)[@hornby2008]:
- Compared enhanced Lokomat training (increased speed and reduced guidance) to standard training
- Enhanced training produced significantly greater improvements in walking speed and distance
- Highlighted importance of training intensity and challenge level
Schroter et al. (2009)[@schroter2009]:
- Armeo therapy in chronic stroke patients
- Significant improvements in Fugl-Meyer upper extremity scores
- Dose-response relationship observed — more therapy time correlated with greater gains
Comparative Evidence
The broader evidence base for robot-assisted rehabilitation supports Hocoma's technology:
Meta-analyses consistently show that robot-assisted therapy improves motor outcomes in stroke and other neurological conditions, with strongest evidence for gait and arm function recovery
Intensive training is critical — robot-assisted therapy enables higher training doses than manual therapy alone
Adaptive protocols that adjust difficulty based on patient performance show superior outcomes to fixed-assistance approaches
Long-term maintenance of gains is possible when home programs or ongoing therapy are integratedParkinson's Disease-Specific Applications
Gait Dysfunction
[Parkinson's disease](/diseases/parkinsons-disease) is characterized by gait impairment including reduced velocity, shortened stride length, shuffling, and in some patients, freezing of gait. The Lokomat addresses these symptoms through:
Pattern Normalization: The robotic gait orthosis guides patients through a physiological gait pattern with full stride length and proper swing/stance phase characteristics. Over repeated sessions, this intensive practice may help retrain the motor system to generate more normal movement patterns.
Intensity: The Lokomat enables training sessions of 30-60 minutes with consistent, accurate assistance — far exceeding what therapists can provide manually. Research suggests that gait recovery depends on achieving high step counts and intensive practice.
Visuomotor Feedback: Patients can observe their gait pattern on screen, providing real-time feedback that may support motor learning through visual error correction.
Freezing of Gait
Freezing of gait — a sudden, episodic inability to initiate or continue walking — is a particularly disabling PD symptom. Robot-assisted gait training may help address freezing through:
- Intensive practice of the step initiation process
- Repeated exposure to gait cycles that may help re-establish automatic stepping
- Cardiovascular conditioning that supports motor function
Balance and Fall Prevention
Postural instability and falls are major causes of disability and injury in PD. While the Lokomat focuses on gait training, Hocoma's systems can be integrated with balance training to address this domain:
- Training on the ErigoPro with progressive upright positioning
- Gait training that challenges balance in a controlled environment
- Integration with clinical balance assessment and training programs
Non-Motor Symptoms
Exercise has been shown to benefit non-motor symptoms of PD including depression, fatigue, and cognitive impairment. The intensive nature of robot-assisted training may amplify these benefits:
- High-intensity aerobic exercise during gait training
- Engagement and motivation from interactive therapy software
- Confidence and self-efficacy improvements from successful motor practice
Hocomatraining Software
The Hocomatraining software platform provides:
- Patient Management: Patient profiles, session history, and progress tracking
- Protocol Management: Pre-configured and customizable therapy protocols
- Outcome Measurement: Built-in assessment tools and data export
- Motivation Features: Games, challenges, and progress visualization
- EHR Integration: Connectivity with electronic health record systems
Adaptive Control Systems
Hocoma devices use several advanced control strategies:
"Assist-as-Needed" Control: The robot provides only the assistance required for successful task completion, gradually reducing support as the patient improves. This approach maximizes patient engagement and motor learning.
Guidance Force Control: Adjustable resistance that guides the patient through the intended movement while allowing some deviation for error correction learning.
Performance-Based Progression: Software algorithms adjust difficulty based on real-time assessment of patient performance, ensuring optimal challenge level.
Safety Systems
Hocoma devices incorporate multiple safety features:
- Emergency Stop: Immediately halts all robot movement
- Patient-Operated Stop: Patient can halt therapy at any time
- Force Limiting: Physical compliance to prevent injury from unexpected contact
- Clinical Monitoring: Real-time display of patient status and therapy parameters
Competitive Landscape
Hocoma competes in the rehabilitation robotics market with several established companies:
| Company | Key Products | Market Position |
|---------|-------------|----------------|
| Hocoma | Lokomat, Armeo, Erigo | Market leader in gait robotics |
| Tyromotion | TYMO, AMADEO, PABLO | Strong in gaming-integrated therapy |
| Reo (Japan) | ReoGo, ReoArm | Asian market leader |
| Ekso Bionics | EksoGT, EksoNR | Exoskeleton focus, US market |
| Bionik | InMotion robots | Research-focused |
| Cyberdyne | HAL exoskeleton | Advanced robotics, Japan focus |
Hocoma Differentiation:
- Deepest evidence base in gait robotics
- Swiss engineering quality and manufacturing precision
- Comprehensive product portfolio covering full rehabilitation spectrum
- Global service and support infrastructure through DIH network
Regulatory Status
| Region | Status | Products |
|--------|--------|----------|
| FDA (USA) | 510(k) cleared | Lokomat, ArmeoPower, ArmeoSpring, Erigo |
| CE Mark (EU) | Class IIa medical device | Full product line |
| PMDA (Japan) | Approved | Gait and arm therapy systems |
| TGA (Australia) | Approved | Full product line |
| NMPA (China) | Approved via DIH | Gait and arm therapy systems |
Global Presence
Hocoma operates globally through the DIH network:
- Headquarters: Volketswil, Switzerland (R&D and manufacturing)
- North America: DIH Technology Corp., Hopkinton, MA
- Europe: Direct operations in DACH region, distribution elsewhere
- Asia-Pacific: DIH subsidiaries and distribution partners in China, Japan, Korea, Australia
- Service Network: 200+ certified service engineers worldwide
Future Directions
Hocoma and DIH continue developing next-generation rehabilitation technologies:
Software and AI
- Performance Prediction: Machine learning models to predict recovery trajectories
- Adaptive Protocols: AI-driven automatic protocol adjustment
- Home Integration: Software for remote monitoring and home-based training
Hardware Evolution
- Lightweight Designs: Reduced footprint and easier installation
- Wireless Systems: Elimination of cables for improved usability
- Soft Robotics: Continuation of work on soft, compliant actuators
- Pediatric Specialization: Device variants optimized for children
Market Expansion
- Home Healthcare: Systems adapted for home-based rehabilitation
- Emerging Markets: Affordable solutions for developing healthcare systems
- Telehealth: Remote therapy supervision and coaching features
See Also
- [Parkinson's Disease](/diseases/parkinsons-disease)
- [Rehabilitation Robotics](/technologies/rehabilitation-robotics)
- [Gait Disorders in PD](/diseases/parkinsons-disease)
- [Tyromotion](/companies/tyromotion)
- [Stroke Rehabilitation](/diseases/stroke)
- [Neuroplasticity](/mechanisms/neuroplasticity)
- [Deep Brain Stimulation](/technologies/deep-brain-stimulation)
External Links
- [Hocoma Official Website](https://www.hocoma.com)
- [DIH Medical (Parent Company)](https://www.dihmedical.com)
- [PubMed - Robot-Assisted Gait Training](https://pubmed.ncbi.nlm.nih.gov/?term=locomat+parkinson)