BackgroundCerebral Palsy (CP) is a disorder of posture and movement due to a defect in the immature brain. The use of robotic devices as alternative treatment to improve the gait function in patients with CP has increased. Nevertheless, current gait trainers are focused on controlling complete joint trajectories, avoiding postural control and the adaptation of the therapy to a specific patient. This paper presents the applicability of a new robotic platform called CPWalker in children with spastic diplegia.FindingsCPWalker consists of a smart walker with body weight and autonomous locomotion support and an exoskeleton for joint motion support. Likewise, CPWalker enables strategies to improve postural control during walking. The integrated robotic platform provides means for testing novel gait rehabilitation therapies in subjects with CP and similar motor disorders. Patient-tailored therapies were programmed in the device for its evaluation in three children with spastic diplegia for 5 weeks.After ten sessions of personalized training with CPWalker, the children improved the mean velocity (51.94 ± 41.97 %), cadence (29.19 ± 33.36 %) and step length (26.49 ± 19.58 %) in each leg. Post-3D gait assessments provided kinematic outcomes closer to normal values than Pre-3D assessments.ConclusionsThe results show the potential of the novel robotic platform to serve as a rehabilitation tool. The autonomous locomotion and impedance control enhanced the children’s participation during therapies. Moreover, participants’ postural control was substantially improved, which indicates the usefulness of the approach based on promoting the patient’s trunk control while the locomotion therapy is executed. Although results are promising, further studies with bigger sample size are required.Electronic supplementary materialThe online version of this article (doi:10.1186/s12984-016-0206-x) contains supplementary material, which is available to authorized users.

BackgroundCerebral Palsy (CP) is the most common cause of permanent serious physical disability in childhood. Although many platforms have been developed, so far there are still not precise guidelines for the rehabilitation of the population with CP. The CPWalker is a robotic platform for the rehabilitation of children with CP, through which they can start experiencing autonomous locomotion in the rehabilitation environment. It allows the possibility of free movement and includes physical and cognitive interfaces into the therapy. The main objective of this work is to evaluate the effects of the CPWalker-based rehabilitation intervention in children with CP by comparing different gait parameters before, during and after the use of the platform.FindingsThe evaluation was divided in three stages where the gait parameters and symmetry indexes of eight subjects with CP were evaluated. In the first stage patients walked only with the help they receive normally in daily life. During the second stage they walked with the CPWalker and finally, in the third stage, they repeated their gait without the platform. In all stages they wore an inertial G-Sensor Ⓡ while walking through the hospital facilities. The results showed statistical significant differences in several spatio-temporal parameters, pelvic angles and general gait cycle parameters, with and without the use of the robotic device. For the eight patients: cadence, speed and stride length presented similar values when comparing before and after the therapy. However, they decreased during the intervention (both means and standard deviations). No significant differences were found in the symmetry indexes with the use of the platform. In spite of this, a reduction in the pelvic angles ranges and propulsion was observed.ConclusionsThe effect of using the device was analyzed for spatio-temporal parameters, pelvic girdle angles and general gait cycle parameters. Among the eighteen initial parameters, seven presented a statistical significant difference when comparing stage 2 of the intervention with stages 1 and 3. Those changes showed the potential of the CPWalker to improve muscular strength and gait patterns of the patients with CP in the long term and to provide useful information for the design of the future generations of rehabilitation robotic devices.

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Existen diversas evidencias que indican que los déficits motores en los pacientes de parálisis cerebral se asocian con problemas en la planificación motora que, a su vez, apuntan a una mermada capacidad para imaginar movimientos. La imaginación motora se ha revelado como una herramienta efectiva en el aprendizaje y la adquisición de habilidades motoras ya que comparte estructuras neuronales similares con la ejecución motora. En este trabajo se presenta un paradigma basado en un juego de realidad virtual para guiar la actividad mental del paciente que sirve a dos fines: estudiar su capacidad de imaginar movimientos e implicar y motivar al paciente en el entrenamiento de dicha capacidad. El estudio ha involucrado cuatro niños con parálisis cerebral espástica (edad media = 13.25 años, DS = 1.5) con lesión cerebral bilateral. Los resultados obtenidos del análisis de su actividad electroencefalográfica muestran que estos pacientes son capaces de emplear la imaginación motora en una tarea de marcha, indicada por la presencia del fenómeno ERD (Event Related Desynchronization) en zonas corticales motoras, independientemente de su nivel funcional y de los miembros afectados.

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