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

Abstract

Background: Improving walking ability is a key objective in the treatment of children and adolescents with cerebral palsy (CP), since it directly affects their activity and participation. In recent years, robotic technology has been implemented in gait treatment, which allows training of longer duration and repetition of the movement. To know the effectiveness of a treatment with the robotic-assisted gait trainer (RAGT) Walkbot combined with physiotherapy compared to the isolated physiotherapy treatment in children and adolescents with CP, we carried out a clinical trial. Methods: 23 participants (mean age 8.56), were divided into two groups: experimental (EG) and control (CG). During 5 weeks, both groups received their physiotherapy sessions scheduled, in addition EG received 4 sessions per week of 40 minutes of RAGT. An evaluation of the participants was carried out before the intervention, at the end of the intervention, and at follow-up (two months after the end of the intervention). Gait was assessed with the Gross Motor Function Measure-88 (GMFM-88) dimensions D and E, strength was measured with a hydraulic dynamometer, and range of motion (ROM) was assessed using the goniometer. A mixed ANOVA was performed when the assumptions of normality and homoscedasticity were met, and a robust mixed ANOVA was performed when these assumptions were not met. Statistical significance was stipulated at p < 0.05. For the effect size, η2 was calculated. Results: Significant differences were found regarding the time x group interaction in the GMFM-88 in dimension D [η2= 0.016], in the flexion strength of the left [η2=0.128] and right [η2=0.142] hips, in the extension strength of the right hip [η2=0.035], in the abduction strength of the left hip [η2=0.179] and right [η2=0.196], in the flexion strength of the left knee [η2=0.222] and right [η2=0.147], and in the ROM of left [η2= 0.071] and right [η2=0.053] knee flexion. Conclusions: Compared to treatments without walking robot, physiotherapy treatment including RAGT Walkbot improves standing, muscle strength, and knee ROM in children and adolescents with CP. Trial registration: ClinicalTrials.gov: NCT04329793.