A Narrative Review on Robotic-Assisted Gait Training in Children and Adolescents with Cerebral Palsy: Training Parameters, Choice of Settings, and Perspectives

Abstract

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.

Cost-effectiveness analysis of robot-assisted gait training in patients with bilateral spastic cerebral palsy

“…In accordance with the works of foreign authors, we have confirmed that RAGT has a positive effect on the motor functions of patients with CP [ 10 , 11 ]. A meta-analysis of studies suggests that gait training has a more significant effect on motor function than conventional rehabilitation [ 12 ].…”

Effect of Robotic-Assisted Gait at Different Levels of Guidance and Body Weight Support on Lower Limb Joint Kinematics and Coordination

“…Although there is some evidence from clinical trials that BWS and Guidance Lokomat settings are important to maximize patient benefits [47], there are currently no guidelines for best practices. This lack of guidelines and the difficulty in defining optimal settings present a major constraint in achieving the expected goals using Lokomat therapy [16,48]. Based on the present results, a combination of high levels of BWS and Guidance tended to mitigate the effect of Lokomat on lower limb kinematics.…”

“…There is some, albeit limited, evidence from clinical trials that Guidance and BWS Lokomat settings might be essential to increase the impact of this technology on the gait biomechanics in individuals with neuromotor disorders [13][14][15]. However, the existing literature has not yet sufficiently investigated how Lokomat settings influence lower limb gait patterns [16,17].…”

Within- and between-therapist agreement on personalized parameters for robot-assisted gait therapy: the challenge of adjusting robotic assistance

“…As a consequence, specific information about the therapy content is missing in many studies evaluating the effectiveness of physiotherapeutic interventions [ 6 ]. This applies also to modern robotic gait therapies [ 7 , 8 ]. In the case of conventional therapies, reasons for the lack of information include missing tools which can quantify and describe the therapist-patient interactions.…”