Improvement of Gait after Robotic-Assisted Training in Children with Cerebral Palsy: Are We Heading in the Right Direction?

Abstract

Cerebral palsy (CP) is a non-progressive congenital neurological disorder that affects different physical and cognitive functions in children. In addition to standard rehabilitation, advanced robotic gait devices are novel tools that are becoming progressively more common as part of the treatment of CP. The aim of this study is to evaluate the effects of Lokomat training, in addition to conventional rehabilitation, on the motor function and quality of life of children with ataxic-spastic CP (ASCP). Ten children with ASCP who attended the Robotic Rehabilitation OutClinic of the IRCCS Centro Neurolesi “Bonino Pulejo”, from April to June 2019, were enrolled in this study. They received twenty-four robotic rehabilitation sessions, twice a week for three months, each session lasting about 45 min. They were also provided with conventional physical and occupational therapy. After the innovative training, we found significant changes in the children’s outcomes, i.e., in GMFM (p < 0.001), with significant improvements in sitting (p < 0.03) and walking (p < 0.03). Moreover, the quality of life of the young patients, evaluated by their parents, significantly improved (p < 0.005). The use of robotic systems could be considered to be an effective complementary treatment to improve gait, as well as quality of life, in children with CP.

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.…”

The Rehabilitation Interventions and Adaptive Technologies Used for Treating Patients With Cerebral Palsy

“…The main goal of robotic systems in treating these children is to achieve correct motor coordination of muscles. These devices can provide high-intensity and task-specific training, strengthening the muscles [ 21 ]. Hybrid robot-assisted limb gait training has a positive effect in improving the walking and posture of the children.…”

Rehabilitation of Gait and Balance in Cerebral Palsy: A Scoping Review on the Use of Robotics with Biomechanical Implications

“…To overcome these concerns, robotic systems have been employed as emerging rehabilitative tools that can provide an early rehabilitation program [12] with high-intensity, repetitive, task-specific and interactive training. It is noteworthy that rehabilitation robots have been used as an effective therapy to improve GMFs, such as trunk control, balance and gait in patients affected by CP [13].…”