About 70% of children and adolescents with cerebral palsy experience gait impairments which affect their autonomy and well-being. Robotic-assisted gait training using the Lokomat is particularly promising for rehabilitation as it provides a standardized environment favoring the massive repetition of the movement, in which physical demands are low on the therapist and high training loads can be achieved. As no guidelines exist regarding training protocols and Lokomat settings, the goal of this narrative review was to summarize previously published information on the use of RAGT in children and adolescents with cerebral palsy and to provide an opinion on possibilities for improving future research. The thirteen studies reviewed reported both positive and null effects of Lokomat training on gait. Half of the studies combined the Lokomat with other types of training, and only five used a control intervention to assess its benefit. Overall, training was administered 1–5 times per week for 20–60 min, over 1–12 weeks. Although Lokomat settings were not always described, progressively decreasing body weight support and guidance while increasing the treadmill speed appeared to be prioritized. The variety of training protocols and settings used did not allow pooling of the studies to assess the effects of interventions on gait parameters in children and adolescents with cerebral palsy. This narrative review highlights the need for homogenization of interventions so that clear guidelines can emerge and be applied in rehabilitation centers.

Objective Assessing violinists’ motor and musical performance adaptations to dynamic assistive support (DAS) provided by a passive device, using a force-field adaptation paradigm. Background Up to 93% of instrumentalists are affected by musculoskeletal injuries and particularly violinists. The repetitive nature of their work may lead to muscle fatigue, an injury risk factor. DAS has been used in occupational settings to minimize muscle activations and limit fatigue accumulation. DAS may however affect motor and musical performance. Method Fifteen expert violinists were equipped with reflective markers and surface and intramuscular electromyography (EMG) sensors. Movements, muscle activations, and sound were recorded while participants completed three experimental conditions for which they continuously played a 13-s musical excerpt: Control (no DAS), Adaptation (DAS), and Washout (no DAS). DAS was applied at the left elbow (violin-holding side). Conditions were repeated 1 week later. Participants later listened to their own audio recordings playing with and without DAS and blindly assessed their performances. Linear mixed models were used to compare DAS and no-DAS conditions’ kinematic, EMG, and musical performance data. Results DAS perturbed user kinematics but reduced mean activations of left medial deltoid and superior trapezius. Joint kinematic and muscle activation patterns between DAS and no DAS conditions however remained similar. Musical performance was unchanged with DAS. Conclusion Though DAS modified violinists’ upper-limb configurations, resulting kinematics were not detrimental to musical performance. Reduced muscle activations with DAS could contribute to lessening muscle fatigue. Application Although its effect on muscle fatigue should be further investigated, DAS might be useful in preventing violinists’ injuries.

About 70% of children and adolescents with cerebral palsy experience gait impairments which affect their autonomy and well-being. Robotic-assisted gait training using the Lokomat is particu-larly promising for rehabilitation as it provides a standardized environment favoring the massive repetition of the movement, in which physical demands are low on the therapist and high training loads can be achieved. As no guidelines exist regarding training protocols and Lokomat settings, the goal of this study was to review the literature on Lokomat-assisted gait therapy and possibly make training recommendations. The twelve studies reviewed reported both positive and null effects of Lokomat training on gait. Half of the studies combined Lokomat with other types of training and only five used a control intervention to assess its benefit. Overall, training was administered 1-5 times per week for 20-60 minutes, over 1-12 weeks. Although Lokomat settings were not always described, progressively decreasing body-weight support and guidance, while increasing treadmill speed appear to be prioritized. The variety of training protocols and settings used did not allow pooling of the studies to assess effects of interventions on gait parameters in children and adoles-cents with cerebral palsy. This review highlights the need for homogenization of interventions so that clear guidelines can emerge and be applied in rehabilitation centers.

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