Baseline Gross Motor Function Affects the Outcome of Robot-Assisted Therapy in Ambulatory Individuals with Spastic Cerebral Palsy

Abstract

Robotic-assisted therapy (RAT) is a task-specific approach for treating gait disorders in individuals with neurological impairments. However, the effectiveness of RAT is not clear for different severities of involvement, pathologies, and ages. This study aimed to assess the functional and clinical status outcomes after RAT in individuals with cerebral palsy (CP). Twenty-eight individuals with bilateral spastic CP were enrolled (female = 10; male = 18; age = 15.2 ± 2.0 years). The RAT program consisted of 30 sessions: five sessions weekly for six weeks. Gross Motor Function Measure (GMFM) and clinical physical examinations were evaluated before and after RAT. Our results suggested that the RAT program with the described protocol can improve the general gross motor functions of individuals with CP in Gross Motor Function Classification System (GMFCS) levels I and II, and primarily improves performance on less complex GMFM items for those in GMFCS levels III and IV. The lower baseline functional level was related to a greater functional improvement. Older individuals were noticed to improve more in GMFM dimension D. Regarding impairments evaluated by clinical examinations, no change was found after RAT intervention. It is worth mentioning that the strength of knee muscles was not affected either.

Effect of robot-assisted gait training on functional capabilities in individuals with cerebral palsy: a systematic review and meta-analysis

“…Study quality assessment classifies randomized trials of four [9][10][11][12] as low risk and three as medium risk. Among the non-randomized studies, eight studies [16][17][18][19][20][21][22][23] were rated as low risk and two papers [24,25] as medium risk.…”

“…Ten studies analyzed gait speed using the 6MWT (10,11,13,15,16,(19)(20)(21)26,27). Ten articles analyzed the GMFM total [9,12,15,17,18,21,23,25], and the D and E dimensions of the GMFM were presented in eight papers [9,10,12,13,15,17,19,23]. The meta-analysis results for all variables are shown in Figures 3-6, respectively.…”