Hocoma AG

Overview

Overview

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

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

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

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

• 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

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

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

• 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

• 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

• 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

• 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

• 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:

Parkinson'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

Technology Platform

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)