Walking in the Hibbot, an innovative walking aid improves gait characteristics in children with cerebral palsy: a cross-sectional study

Abstract

Background: Crouch gait is a common gait impairment in children with cerebral palsy (CP). Growing up and gaining weight, lever arm dysfunctions further deteriorate and walking efficiency progressively worsens over time with risk of losing ambulant capacity in adolescent life. The purpose of this study is to evaluate whether walking in an innovative walking aid can reduce the flexed gait pattern by improving alignment of the lower extremity joints and improving weight bearing. Methods: A semi-robotic walking aid called “Hibbot has been designed, which can be used in rehabilitation and daily-life settings. In a cross-sectional study, five children with CP, aged 3-7 years, were familiarized with the Hibbot, by using the walking aid for 30 minutes, twice a week during 3 months under the supervision of their physiotherapists, who were instructed how to use the Hibbot. Using 3D gait analysis kinematics of the lower limb and trunk as well peak vertical ground reaction forces were compared between walking in their habitual (or no) walking aid and walking in the Hibbot, using a paired samples t-test (p < 0.05, spm1d.org). Results: After the familiarization period of 3 months, a significant improvement in hip extension (mean difference 9.4 ± 1.4°) and knee extension (mean difference 10.1 ± 0.5°) during stance was observed when walking in the Hibbot compared to habitual walking. Improvements were also observed in trunk posture. However, differences in peak forces between habitual walking and walking in the Hibbot could not be confirmed. Conclusions: These results are promising as to the possibility of the Hibbot walking aid in counteracting a flexed gait pattern. Further research is necessary to investigate the net joint moments and muscle forces explaining the higher knee and hip extension and improved trunk posture while walking in the Hibbot. Furthermore research should focus on determining which children with CP would benefit most, what are contraindications and what dose effects are to be expected. Trial Registration: ClinicalTrials.gov, NCT04172324. Registered November 21 st , 2019 - Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT04172324