The effect of patient-specific factors on responsiveness to robot-assisted gait training in patients with bilateral spastic cerebral palsy

Abstract

BACKGROUND: No general recommendations are yet available for the application of robot-assisted treadmill therapy for children with cerebral palsy regarding the length and intensity of the intervention. OBJECTIVE: The aim of the study was to evaluate patient-specific determinants of responsiveness to robot-assisted gait training (RAGT) in patients with bilateral spastic cerebral palsy. METHOD: During 12 months, the patients underwent 1–4 blocks of RAGT, representing 16–82 TUs. The following parameters were evaluated before (V0) and after each therapeutic block (V1–V4): 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). We evaluated the change in motor functions in relation to the severity of disability, age, gender and number of therapeutic units. RESULTS: Ninety-seven patients aged between 3.7 and 27 years (mean age 10.02 years (SD±5.29); Gross Motor Function Classification System level I [n = 5], II [n = 25], III [n = 48], IV [n = 19]) underwent 16–82 TUs (overall average number 34.06 TUs, SD±16.41) of RAGT. In the patient group, we recorded clinically meaningful improvement and statistically significant improvement (p < 0.001) in gross motor functions with gradual increase in the effect size after each therapeutic block. Using correlation and regression analysis, we found a statistically significant associations between the number of therapeutic units, severity of disability, and improvement in motor functions after RAGT. CONCLUSION: We have identified two determinants –the severity of disability and the number of therapeutic units –which could have a decisive and predictive character in setting rehabilitation/designing programmes. The duration of the applied RAGT period, frequency and intensity could be a crucial factor for the potential of improvement in children with BS-CP.

The Effect of Robotic Rehabilitation on Hand Functions and Quality of Life in Children with Cerebral Palsy: A Prospective Randomized Controlled Study

“…Very few studies exist on robot-assisted therapy in children with CP, and the literature provides limited data on cost-effectiveness. 30 Further studies evaluating cost-effectiveness are needed.…”

Cost-effectiveness analysis of robot-assisted gait training in patients with bilateral spastic cerebral palsy

“…We deliberately selected patients who were not expected to exhibit motor improvement according to the developmental motor curves. The assessment of the clinical effectiveness of RAGT in children with CP has been the focal point of our previous studies [ 27 , 28 ]. The inclusion of a cost-effectiveness analysis would certainly enhance the level of these investigations.…”

Improvement of Gait after Robotic-Assisted Training in Children with Cerebral Palsy: Are We Heading in the Right Direction?

“…Similar results have been found for children with CP [ 34 ], although these data are controversial [ 35 , 36 ]. Other attempts to find correlations between responsiveness and diagnostic factors in stroke [ 37 , 38 , 39 ] and spinal cord injury [ 40 ] have not been very successful. We believe that the main purpose of robotic devices is to support CP patients to promote a better gait through the implementation of this modern robotic goal-oriented therapy in current clinical practice.…”