Effects of Robotic-Assisted Gait Training in Children and Adolescents with Cerebral Palsy: A Network Meta-Analysis

Abstract

Gait disturbances are common in children and adolescents with cerebral palsy (CP). Robotic-assisted gait training (RAGT) is becoming increasingly widespread, and hence it is important to examine its effectiveness. A network meta-analysis (NMA) of clinical trials comparing treatments with RAGT vs. other physical therapy treatments was carried out. This study was conducted according to the NMA version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-NMA) guidelines and following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. The outcome variables used were the D and E dimensions of the Gross Motor Function Measure (GMFM), gait speed, resistance, and stride length. Among 120 records, 8 trials were included. This NMA did not find statistically significant results for any of the comparisons examined in any of the outcomes studied and the magnitude of the effect size estimates was low or very low. Our NMA results should be interpreted with caution due to the high clinical heterogeneity of the studies included.

Treatment with robot-assisted gait trainer Walkbot along with physiotherapy vs isolated physiotherapy in children and adolescents with cerebral palsy. Experimental study.

“…In children with CP, reviews and meta-analyses have not found signi cant differences in the use of the walking robot compared to other physiotherapy treatments aimed at rehabilitating walking function (22,28,29). In a recent meta-analysis that included 8 clinical trials (2 nonrandomized), no signi cant differences were found compared to physical therapy treatments (22).…”

“…Some previous clinical trials have demonstrated improvements in walking ability in participants with neurological damage, such as stroke and spinal cord injury, who used a walking robot in their rehabilitation (10)(11)(12)(13)(14). In children with CP, reviews and meta-analyses have not found signi cant differences in the use of the walking robot compared to other physiotherapy treatments aimed at rehabilitating walking function (22,28,29). In a recent meta-analysis that included 8 clinical trials (2 nonrandomized), no signi cant differences were found compared to physical therapy treatments (22).…”

“…The RAGT provides conditions that support motor learning principles such as intensity, repetition, task speci city, and participation (7)(8)(9), as well as presenting bene cial effects for improving walking in subjects with brain and spinal cord damage (10)(11)(12)(13)(14). Some studies have investigated the effects of the RAGT in improving gait function in CP subjects, showing an overall improvement in gait parameters (mainly gait speed, stride length and frequency), endurance, and gross motor function (Gross Motor Function Measure-88 (GMFM-88) dimensions D and E (15-21) A recent network meta-analysis of clinical trials concluded that although there is evidence to suggest that RAGT treatments are effective in children and adolescents with CP, no signi cant difference was found between RAGT and physiotherapy treatments in improving gait and standing (22). Among the RAGT systems, there is the Walkbot (P&S Mechanics, Seoul, Korea) which consists of an exoskeletal RAGT system that is attached to the patient and helps him move his lower extremities on a treadmill, being attached by a harness to a crane, generating a personalized gait pattern for the patient (23), and provides ambulation that is closest to human kinematics and kinetics (24).…”

Treatment with robot-assisted gait trainer Walkbot along with physiotherapy vs. isolated physiotherapy in children and adolescents with cerebral palsy. Experimental study

“…The RAGT provides conditions that support motor learning principles such as intensity, repetition, task specificity, and participation [ 7 – 9 ]; as well as presenting beneficial effects for improving walking in subjects with brain and spinal cord damage [ 10 – 14 ]. Some studies have investigated the effects of the RAGT in improving gait function in CP subjects, showing an overall improvement in gait parameters (mainly gait speed, stride length and frequency), endurance, and gross motor function (Gross Motor Function Measure-88 (GMFM-88) dimensions D and E [ 15 – 21 ] A recent network meta-analysis of clinical trials concluded that although there is evidence to suggest that RAGT treatments are effective in children and adolescents with CP, no significant difference was found between RAGT and physiotherapy treatments in improving gait and standing [ 22 ]. Among the RAGT systems, there is the Walkbot (P&S Mechanics, Seoul, Korea) which consists of an exoskeletal RAGT system that is attached to the patient and helps him move his lower extremities on a treadmill, being attached by a harness to a crane, generating a personalized gait pattern for the patient [ 23 ], and provides ambulation that is closest to human kinematics and kinetics [ 24 ].…”

Safety and Feasibility of Robot-assisted Gait Training in Adults with Cerebral Palsy in an Inpatient Setting – an Observational Study

“…Studies with other exoskeletons without EMG biofeedback on patients with CP using i.e. the Lokomat only focus on children with CP and do not find any statistically significant changes in outcome variables such as walking speed or step length (Olmos-Gómez et al, 2021 ).…”