The Effect of Robot-Assisted Gait Training on Locomotor Function and Functional Capability for Daily Activities in Children with Cerebral Palsy: A Single-Blinded, Randomized Cross-Over Trial

Abstract

Purpose: The effectiveness of robot-assisted gait training (RAGT) in children with cerebral palsy (CP), especially in terms of improving the performance of daily activities, remains unclear. Therefore, we aimed to investigate the effectiveness of RAGT in children with CP. Methods: In this single-center, single-blinded, randomized cross-over trial, we enrolled 20 children with CP with Gross Motor Function Classification System (GMFCS) levels II–IV (13 males; age range, 6.75 ± 2.15 years). The participants were randomized into the RAGT/standard care (SC) (n = 10) and SC/RAGT/SC sequence groups (n = 10). Using a Walkbot-K system, the RAGT program comprised 3 × 30-min sessions/week for 6 weeks with a continued SC program. The SC program comprised 2–4 conventional physiotherapy sessions/week for 6 weeks. The Gross Motor Function Measure-88 (GMFM-88), the pediatric functional independence measure (WeeFIM), and the Canadian occupational performance measure (COPM) scores were assessed pre- and post-RAGT or SC periods and treatment, period, follow-up, and carry-over effects were analyzed. Energy expenditure and body composition were measured pre- and post-RAGT. Results: Significant treatment effects were observed in dimensions D and E of the GMFM (D: p = 0.018; E: p = 0.021) scores, WeeFIM mobility subtotal (p = 0.007), and COPM performance (p < 0.001) and satisfaction (p = 0.001) measure scores. The period, follow-up, and carry-over effects were not statistically significant. The gross energy cost significantly decreased (p = 0.041) and the skeletal muscle mass increased (p = 0.014) at post-RAGT assessment. The factors associated with functional outcomes showed significant improvements in the GMFM D scores and were mainly observed in children with GMFCS levels II–III compared to those classified at level IV (p = 0.038). Conclusion: RAGT had training benefits for children with CP. Specifically, it improved locomotor function and functional capability for daily activities. These effects were better in ambulatory children with CP. However, as SC interventions continued during the RAGT period, these improvements may be also related to multiple treatment effects.

Comparative effects of community-based family-child-centered care and conventional pediatric rehabilitation for cerebral palsy

“…The Walkbot system interactively adjusted the walking speed and resistive torque parameters while attempting to minimize kinematic trajectory errors. The assistance guidance force was systematically reduced from 100% (passive mode) to 0% (active mode), where the Walkbot system automatically adjusted the body weight bearing load, resistance, and inertia to accomplish the symmetrical, optimal gait pattern, as it can apply a differential mode to each lower extremity for individuals with hemiparetic CP (Jin et al, 2020). For the intervention strategies of the cognitive domain, a licensed occupational therapist provided the interventions based on the evaluation and selected clinical evidence.…”

“…For the intervention strategies of the physical domain, a licensed physical therapist provided the interventions based on the evaluation and selected clinical evidence. The corresponding interventions included stretching (Katalinic et al, 2010), strengthening (Effgen & McEwen, 2008), hippotherapy (Park & You, 2018;Park et al, 2014), treadmill training (Damiano & DeJong, 2009), NDT (Gündüz et al, 2019), and RAGT (Jin et al, 2020;Park et al, 2020). For the intervention strategies of the cognitive domain, a licensed occupational therapist provided the interventions based on the evaluation and selected clinical evidence.…”

A Review on Recent Advances of Cerebral Palsy

“…This facilitates gait training with good posture and control and is most effective in GMFCS grades IV and V. It can be done with or without a treadmill. Virtual reality and biofeedback can be incorporated; it produces a positive effect [ 19 , 20 ]. Biofeedback is a common strategy used in rehabilitation that can be used to represent any biological parameters and their changes.…”

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

“…Other published articles have investigated the effectiveness of RAGT in children with CP, but they were not included in this NMA because they did not meet the inclusion criteria. Some of these show evidence of a general improvement, mainly in gait speed and endurance [ 13 , 39 , 40 , 41 , 42 ], and in gross motor function (dimensions D and E of the GMFM) [ 39 , 40 , 41 , 42 , 43 , 44 , 45 ], and therefore show some promise for RAGT to be considered as a therapeutic option in the pediatric setting.…”