Feasibility of robotic‐assisted locomotor training in children with central gait impairment

Abstract

Intensive, task-specific training enabled by a driven gait orthosis (DGO) may be a cost-effective means of improving walking performance in children. A paediatric DGO has recently been developed. This study was the first paediatric trial aimed to determine the feasibility of robotic-assisted treadmill training in children with central gait impairment (n=26; 11 females, 15 males; mean age 10y 1mo [SD 4y]; range 5y 2mo-19y 5mo). Diagnoses of the study group included cerebral palsy (n=19; Gross Motor Function Classification System Levels I-IV), traumatic brain injury (n=1), Guillain-Barré syndrome (n=2), incomplete paraplegia (n=2), and haemorrhagic shock (n=1), and encephalopathy (n=1). Sixteen children were in-patients and 10 were outpatients. Twenty-four of the 26 patients completed the training which consisted of a mean of 19 sessions (SD 2.2; range 13-21) in the in-patient group and 12 sessions (SD 1.0; range 10-13) in the outpatient group. Gait speed and 6-Minute Walking Test increased significantly (p<0.01). Functional Ambulation Categories and Standing dimension (in-patient group p<0.01; outpatient group p<0.05) of the Gross Motor Function Measure improved significantly. DGO training was successfully integrated into the rehabilitation programme and findings suggest an improvement of locomotor performance.Locomotor therapy for regaining walking capacity is based on the principle of enhancing neuroplasticity by task-specific training; this therapy has been well established in the (re)habilitation process of patients with central gait disorders. 1-4 Conventional over-ground gait training (COGT) in adults has been enhanced by the body-weight supported treadmill training, thereby gaining functional benefits such as improved symmetry and increased walking speed. 5,6 However, the assign ment of human resources for manual assistance in these methods is considerable. 7 Controlled trials of adult patients with traumatic brain injury (TBI) or incomplete spinal cord injury showed no difference between body-weight supported treadmill training and COGT regarding functional improvement, when applied at the same frequency. [8][9][10] In children with cerebral palsy (CP) general functionalstrength training has been shown to improve functional performance. 11-13 Promising evidence exists that intensive body-weight supported treadmill training can improve walking capacity in these children. [14][15][16] To the authors' knowledge, locomotor treatment with treadmill training in children with acquired central gait disorders caused by stroke or TBI has not yet been studied conclusively. To restore walking ability, repetition and intensity of training seem to be crucial for motor (re)learning. 17 To this end, automated gait-training devices have been developed during the last decade to improve gait training. 18,19 The feasibility and effectiveness of retraining gait using the driven gait orthosis (DGO) has been investigated in gait rehabilitation of adults with spinal cord injury. 18,20 These devices allow an intensification of lo...

A Method of Estimating the Degree of Active Participation During Stepping in a Driven Gait Orthosis Based on Actuator Force Profile Matching

“…Robot-assisted gait training with the driven gait orthosis Lokomat was shown to be an effective way of restoring walking ability in patients with neurological gait disorders due to stroke [6], [7], incomplete spinal cord injury [8]- [11], multiple sclerosis [12], and in children with cerebral palsy [13], [14]. The main advantage of mechanized gait training in comparison to manually assisted gait training or conventional physical therapy is that the therapist is relieved from the high physical strain when guiding the legs and stabilizing the body of the patient.…”

“…To increase the spatial precision of the movement, the mechanical impedance of the linear drives is high. The feasibility and effectiveness of training programs with the DGO Lokomat were shown in subjects having suffered stroke [6], [7], incomplete spinal cord injury [8]- [11], multiple sclerosis [12], and in children with cerebral palsy [13], [14]. A clear advantage of training with the DGO Lokomat-as well as with other gait training devices-is that the therapist is relieved from the physical strain of manually guiding the patients' legs or stabilizing the patient's torso [6].…”

Se déplacer entre les marges et le centre

“…Finalement, diverses implications de cette recherche, en ce qui a trait aux conceptions de la réinsertion sociale et à l'organisation des services de réhabilita-tion, sont soulignées. AUTOMNE 2009/ PRINTEMPS 2010 recherches sur la création et l'évaluation de stratégies de réadaptation qui tentent de résoudre ces problèmes -à travers des moyens aussi variés que la physiothérapie et l'ergothérapie (Loney, 2008), les programmes d'intégration sociale (Geurtsen et al, 2008), les méthodes de stimulation cognitive (Powell, 2008) et les systèmes de réadaptation locomotrice par robotique (Meyer-Heim et al, 2007) -repré-sentent le deuxième courant de recherche dans ce secteur.…”

Virtual environments increase participation of children with cerebral palsy in robot-aided treadmill training

“…On each orthosis, two motors (one at the hip joint and one at the knee joint) guide the patient's legs on a physiological walking pattern. A pediatric version of the Lokomat has been recently developed and provides automated treadmill training for children aged four and up [14].…”