Objective To determine whether applying an assistance force to the pelvis and legs during treadmill training can improve walking function in children with cerebral palsy (CP). Design Twenty-three children with CP were randomly assigned to the robotic or treadmill only group. For participants who were assigned to the robotic group, a controlled force was applied to the pelvis and legs during treadmill walking. For participants who were assigned to the treadmill only group, manual assistance was provided as needed. Each participant trained 3 times/week for 6 weeks. Outcome measures included walking speed, 6-minute walking distance, and clinical assessment of motor function, which were evaluated pre, post training, and 8 weeks after the end of training, and were compared between two groups. Results Significant increases in walking speed and 6-minute walking distance were observed after robotic training (p = 0.03), but no significant change was observed after treadmill training only. A greater increase in 6-minute walking distance was observed after robotic training than that after treadmill only training (p = 0.01). Conclusions Applying a controlled force to the pelvis and legs, for facilitating weight-shift and leg swing, respectively, during treadmill training may improve walking speed and endurance in children with CP.

Objective To determine whether applying controlled resistance forces to the legs during the swing phase of gait may improve the efficacy of treadmill training compared to applying controlled assistance forces in children with cerebral palsy (CP). Design Randomized controlled study. Setting Research unit of rehabilitation hospital. Participants Children with spastic CP (n = 23, average age 10.6 years old, ranged from 6–14, GMFCS levels: I to IV). Interventions Participants were randomly assigned to receive controlled assistance (n=11) or resistance (n=12) loads applied to the legs at the ankle. Participants underwent robotic treadmill training 3 times a week for 6 weeks (18 sessions). A controlled swing assistance/resistance load was applied to both legs starting from toe-off to mid-swing phase of gait during training. Main outcome measures Outcome measures consisted of overground walking speed, 6 minute walking distance, and GMFM scores, and were assessed pre, post 6 weeks of training, and 8 weeks after the end of training. Results Following 6 weeks of treadmill training for participants from the resistance training group, fast walking speed and 6 minute walking distance significantly improved (18% and 30% increases, respectively), and 6 minute walking distance was still significantly greater than baseline (35% increase) 8 weeks after the end of training. In contrast, overground gait speed and 6 minute walking distance had no significant changes after robotic assistance training. Conclusion Results from the current study indicated that robotic resistance treadmill training is more effective than assistance training in improving locomotor function in children with CP.

A considerable proportion of TIA/mild stroke survivors have ongoing rehabilitation needs that are poorly addressed. The need for rehabilitation in these patients is often overlooked, and available assessment tools lack the sensitivity to identify common subtle impairments in cognition, mood, language and fatigue. Active and accessible education interventions need to be initiated early after the event, and integrated with ongoing rehabilitation management. Priority areas in need of future development in this field are highlighted and discussed. Implications for rehabilitation Survivors of mild stroke and TIA have ongoing unmet rehabilitation needs and require a unique approach to rehabilitation and education. Rehabilitation needs are difficult to assess and poorly addressed in this cohort, where available assessment tools lack the sensitivity required to identify subtle impairments. Education needs to be initiated early after the event and involve active engagement of the patient in order to improve stroke knowledge, mood and motivate adherence to lifestyle modifications and secondary prevention. Rehabilitation physicians are currently an underutilized resource, who should be more involved in the management of all patients following TIA or mild stroke.

Treadmill training has been used for improving locomotor function in children with cerebral palsy (CP), but the functional gains are relatively small, suggesting a need to improve current paradigms. The understanding of the kinematic and EMG responses to forces applied to the body of subjects during treadmill walking is crucial for improving current paradigms. The objective of this study was to determine the kinematics and EMG responses to the pelvis and/or leg assistance force. Ten children with spastic CP were recruited to participate in this study. A controlled assistance force was applied to the pelvis and/or legs during stance and swing phase of gait through a custom designed robotic system during walking. Muscle activities and spatial-temporal gait parameters were measured at different loading conditions during walking. In addition, the spatial-temporal gait parameters during overground walking before and after treadmill training were also collected. Applying pelvis assistance improved step height and applying leg assistance improved step length during walking, but applying leg assistance also reduced muscle activation of ankle flexor during the swing phase of gait. In addition, step length and self-selected walking speed significantly improved after one session of treadmill training with combined pelvis and leg assistance.