Effect of robot-assisted gait training on motor functions in adolescent and young adult patients with bilateral spastic cerebral palsy: A randomized controlled trial

Abstract

BACKGROUND: Robot-assisted gait training (RAGT) allows an intensive gait training in patients with cerebral palsy (CP). There are few evidences on the effectiveness of RAGT in adults with CP. OBJECTIVE: To assess the effect of RAGT on gross motor function in adolescent and adult patients with bilateral spastic CP and to compare the effect of RAGT with conventional kinesiotherapy. METHODS: Forty-seven patients (mean age 21.2±5.33 years) with bilateral spastic CP were divided into two groups. Twenty-one patients underwent 20 therapeutic units of RAGT and 26 patients underwent 20 therapeutic units of conventional therapy/training (CON). The following parameters were evaluated before (V1) and after the therapy (V2): dimension A (lying and rolling), B (sitting), C (crawling and kneeling), D (standing), E (walking, running and jumping) of the Gross Motor Function Measure (GMFM-88). In patients in the experimental RAGT group, these parameters were also evaluated 3–4 months later (V3). RESULTS: Comparing the mean improvements in endpoints in both groups (RAGT vs. CON) after 20 TUs, we observed the statistically significant difference (p < 0.001) and large effect size in all GMFM dimensions and total GMFM improvement in favour of the RAGT group. In RAGT patients, the improvement persisted even 3–4 months after RAGT (p < 0.001). CONCLUSION: We demonstrated that the intensive RAGT regimen is more effective than conventional therapy in terms of improvements in gross motor functions in adolescent and adult patients with bilateral spastic CP.

Is robotic gait training effective for individuals with cerebral palsy? A systematic review and meta-analysis of randomized controlled trials

“…The overall effect was not significantly different between the robotic gait training and control intervention for both Gross Motor Function Measure-D (95% CI: −0.29, 0.39; P = 0.77; Figure 4) and -E (95% CI: −0.11, 0.57; P = 0.19; Figure 5). Four of the five studies 18,19,21,22 evaluating Gross Motor Function Measures-D and -E used a Lokomat device, and a Lokomat-specific pooled effect on these measures was also not significantly different from the control interventions tested (GMFM-D 95% CI: −0.25, 0.49; P = 0.52; GMFM-E 95% CI: −0.10, 0.65; P = 0.15; Appendix B).…”

“…The majority of studies 16,[18][19][20][21][22] utilized a Lokomat device (Supplementary Figure 2(b)) for their robotic gait training. Briefly, the Lokomat is able to unload a user's body weight while also providing assistive forces at the hips and knees.…”

“…Five studies, [17][18][19]21,22 with no significant heterogeneity (Gross Motor Function Measure-D: P = 0.76, I 2 = 0%; Gross Motor Function Measure-E: P = 0.83, I 2 = 0%) and comprising 65 robotic gait training participants and 70 control participants, assessed changes in Gross Motor Function Measure-D and -E scores. The overall effect was not significantly different between the robotic gait training and control intervention for both Gross Motor Function Measure-D (95% CI: −0.29, 0.39; P = 0.77; Figure 4) and -E (95% CI: −0.11, 0.57; P = 0.19; Figure 5).…”

“…The overall effect was not significantly different between the robotic gait training and control intervention for both Gross Motor Function Measure-D (95% CI: −0.29, 0.39; P = 0.77; Figure 4) and -E (95% CI: −0.11, 0.57; P = 0.19; Figure 5). Four of the five studies 18,19,21,22…”

A Review on Recent Advances of Cerebral Palsy

“…There was a positive effect on all the measures of gross motor function after this intervention. It also improved the locomotor ability in ambulatory children [ 19 ]. Functional gait training or practice walking on a treadmill with limited body weight support helps in standing erect with a decreased load on the lower extremity joint.…”