Electromechanical and Robotic Devices for Gait and Balance Rehabilitation of Children with Neurological Disability: A Systematic Review

Abstract

In the last two decades, a growing interest has been focused on gait and balance robot-assisted rehabilitation in children with neurological disabilities. Robotic devices allow the implementation of intensive, task-specific training fostering functional recovery and neuroplasticity phenomena. However, limited attention has been paid to the protocols used in this research framework. This systematic review aims to provide an overview of the existing literature on robotic systems for the rehabilitation of gait and balance in children with neurological disabilities and their rehabilitation applications. The literature search was carried out independently and synchronously by three authors on the following databases: MEDLINE, Cochrane Library, PeDro, Institute of Electrical and Electronics Engineers, ScienceDirect, and Google Scholar. The data collected included three subsections referring to clinical, technical, and regulatory aspects. Thirty-one articles out of 81 found on the primary literature search were included in the systematic review. Most studies involved children with cerebral palsy. Only one-third of the studies were randomized controlled trials. Overall, 17 devices (nine end-effector systems and eight exoskeletons) were investigated, among which only 4 (24%) were bore the CE mark. Studies differ on rehabilitation protocols duration, intensity, and outcome measures. Future research should improve both rehabilitation protocols’ and devices’ descriptions.

Devices for Gait and Balance Rehabilitation: General Classification and a Narrative Review of End Effector-Based Manipulators

“…Due to the aforementioned advantages and the importance of balance and gait in ADLs, a wide range of rehabilitation robots has been developed during the last few decades [36]. However, the current literature on rehabilitation robotics often provides limited information about the characteristics of available prototypes, and this lack of information makes the classification of robotic devices challenging [37].…”

“…Several research and review articles have collated information about end effectors already available for gait and balance rehabilitation [36,46]. However, most of these are part of a classification study that includes other type of rehabilitation devices (exoskeletons, treadmills, stationary trainers, etc.…”

Kinematic Analysis of Exoskeleton-Assisted Community Ambulation: An Observational Study in Outdoor Real-Life Scenarios

“…Although epidemiological studies have shown that sociodemographic and clinical characteristics of subacute stroke survivors can predict good participation in walking activities in the community 6 months after stroke [7,8], walking recovery must be promoted by targeted intensive rehabilitation programs. In this context, Wearable Powered Exoskeletons (WPEs) could be valuable complementary rehabilitation devices, as they emulate overground human neuromotor control of locomotion, allowing early, intensive, and specific gait training even in individuals unable to maintain the upright position [9]. The efficacy of WPE-assisted gait training to improve motor and functional outcomes in stroke patients is well established in the literature [10][11][12][13][14][15][16][17][18], although the neurophysiological effects have not yet been adequately studied [19][20][21][22].…”