Is robotic gait training effective for individuals with cerebral palsy? A systematic review and meta-analysis of randomized controlled trials

Abstract

Aim To determine if robotic gait training for individuals with cerebral palsy is more effective than the standard of care for improving function. Method PubMed, Embase, Scopus, and Cochrane databases were searched from 1980–January, 2022 for articles that investigated robotic gait training versus standard of care (i.e. physical therapy or standard gait training) for individuals with cerebral palsy. Articles were included if a randomized controlled trial design was used, and excluded if robotic gait training was combined with another neuromuscular intervention, such as functional electrical stimulation. A meta-analysis of outcomes measured in at least four studies was conducted. Results Eight citations met all criteria for full-text review and inclusion in the meta-analysis. A total of 188 individuals with cerebral palsy, ages four to 35, and Gross Motor Function Classification System levels I–IV were studied. Level of evidence ranged from 2b–1b. All studies utilized a tethered, assistive device for robotic gait training. The overall effect was not significantly different between the robotic gait training and control interventions for six minute walk test performance (95% CI: −0.17, 0.73; P = 0.22), free walking speed (95% CI: −0.18, 0.57; P = 0.30), or Gross Motor Function Measures D (Standing) (95% CI: −0.29, 0.39; P = 0.77) and E (Walking, Running and Jumping) (95% CI: −0.11, 0.57; P = 0.19). Conclusion Tethered robotic devices that provide assistive gait training for individuals with cerebral palsy do not provide a greater benefit for improving mobility than the standard of care.

Efficacy of Robot-Assisted Gait Therapy Compared to Conventional Therapy or Treadmill Training in Children with Cerebral Palsy: A Systematic Review with Meta-Analysis

“…To date, four recent systematic reviews have assessed the effect of RAGT on gait, gross motor and functional disability in children with CP [56][57][58]98]. Carvalho and colleagues, in 2017, performed a meta-analysis with 10 studies (including observational and experimental designs) to assess the effect of RAGT vs. other therapies, without reporting statistically significant differences for gait speed, walking distance and gross motor function [98].…”

“…Finally, in 2022, Conner et al published a meta-analysis including eight studies assessing the effectiveness of RAGT on gross motor function, walking distance and gait speed. However, their results did not find a significant difference across therapies (RAGT vs. others) [58]. However, these three reviews have some limitations that must be considered: (1) The number of studies published to date and the number of contributing participants was small, which reduces the robustness of the results; and (2) additional gait parameters such as step and stride length, width step or cadence have not been assessed to date.…”

“…There is evidence from three previous published reviews showing that RAGT may be a safe and useful therapy to be used in the recovery of gait, balance and gross motor function disorders in these children. However, these reviews do not report substantial variation between RAGT and other therapies, such as CT or TT [56][57][58]. In 2021, Cumplido et al conducted a systematic review that included 21 articles (only five were CP, mixed with spinal muscular atrophy, and not all of them were designed to compare two groups) published until 2020, in which the year of publication filter was included as well as the age of the participants [56].…”

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

“…Although different robotic devices with a fixed or overground design exist, there is no consensus about their use and effectiveness in CP [ 15 , 16 ]. Nevertheless, it is evident that they could be a promising complement treatment to standard neurorehabilitation, even though there is poor evidence to obtain decisive results on the efficacy of these robotic tools [ 17 ].…”

Effectiveness of Mechanical Horse-Riding Simulator-Based Interventions in Patients with Cerebral Palsy—A Systematic Review and Meta-Analysis

“…All of these therapies have been shown to be effective in improving gross motor function, balance, gait and functional capability in children with CP. In addition, technological advances have allowed new ways of performing physiotherapy techniques that increase patient motivation, thanks to virtual reality [ 24 , 25 ] or robotic devices [ 26 ], although the latter has not been shown to be more effective than physiotherapy.…”