The Effects of Over-Ground Robot-Assisted Gait Training for Children with Ataxic Cerebral Palsy: A Case Report

Abstract

Poor balance and ataxic gait are major impediments to independent living in ataxic cerebral palsy (CP). Robot assisted-gait training (RAGT) has been shown to improve the postural balance and gait function in children with CP. However, there is no report on the application of RAGT for children with ataxic CP. Here, we report two cases of children with ataxic CP who underwent over-ground RAGT along with conventional therapy for 4 weeks. Outcome measures including the gross motor function measure (GMFM), pediatric balance scale, pediatric reach scale, one-minute walk test, and Timed Up and Go test were assessed before and after the 4-week intervention. Both cases were well adapted to the RAGT system without any significant adverse event. Improvements in the GMFM after RAGT, compared with that in the GMFM, after intensive conventional therapy have been reported previously. It is noteworthy that over-ground RAGT improved areas of the GMFM that did not improve with conventional therapy. In addition, over-ground RAGT with conventional therapy led to improvements in functional balance and walking capacity. These findings suggest that over-ground RAGT is feasible and may be a potential option for enhancing balance and functional walking capacity in children with ataxic CP.

The Care and Management of Children and Young People with Ataxia Telangiectasia Provided by Nurses and Allied Health Professionals: a Scoping Review

“…Core stability training improved strength and endurance of muscles, trunk control, corrective postural control mechanisms, and ability to use the vestibular, somatosensory, and visual systems to maintain balance and stability 9 Lee et al (2021) Republic of Korea [ 27 ] Single‐subject experimental study CYP; n = 1 Cerebellar ataxia Physiotherapy Exercise and function Problem-based task training consisting of four walking tasks- a 10‐step walk and return, walking while carrying an object, walking between parallel lines, and kicking a ball (10 min/task, 8 sessions each in baseline and intervention phase followed by 1-year follow-up. Total duration of intervention phase not reported) Repeated practice of functional tasks led to improvement in balance and physical performance thereby improving overall motor function in children with cerebellar ataxia 10 Yoo et al (2021) Republic of Korea [ 36 ] Case Report CYP; n = 2 Ataxic CP Physiotherapy Exercise and function Over-ground robot assisted gait training (Angel Legs M20) alongside conventional physical and occupational therapy (5 sessions/week for 1 month) Improvements reported in postural control, functional mobility, and balance in children with ataxic CP. Improvements observed after RAGT in areas of gross motor function that did not improve with conventional therapy alone 11 Maring et al (2013) USA [ 42 ] Descriptive mixed method study Parents; n = 30 Friedreich ataxia Physiotherapy Exercise and function Semi-structured interviews of parents of children with FA to understand perceived effectiveness and barriers to PT 67% of children received PT intervention, most commonly muscle strengthening and stretching (considered increasingly useful as the child gets older), following by balance training (minimally helpful) Hydrotherapy was the most frequently recommended intervention by parents Muscle stretching HEP considered challenging and burdensome (9% reported consistent use) External barriers: lack of expert providers Internal barriers: Limited time and energy, lack of awareness and children’s preference 12 Harris-Love et al (2004) USA [ ...…”

“…Conversely, RAGT in combination with conventional physical and occupational therapy led to improvements in postural control, functional mobility, and balance in children with ataxic cerebral palsy. Improvements observed after RAGT in areas of gross motor function that did not improve with conventional therapy alone support the potential benefits of over-ground RAGT on gross motor function in these children [36]. A conference proceeding from 2014 reported significant improvement from a dynamic movement orthosis suit and orthotic shoes in gait and stability for a 12-year-old girl with severe ataxia [23].…”

“…Three case reports investigated the effect of assistive devices on gait performance, with mixed results [22,23,36]. Although robotic-assisted gait training (RAGT) led to decreased gait speed of a 16-year-old boy with non-progressive but persistent ataxia due to traumatic brain injury, the authors postulate that this may have been due to improved gait symmetry, decreased variability, and increased control achieved with a wearable robotic exoskeleton [22].…”

Effect of Exercise on the Ability of Children with Cerebellar Ataxia to Perform Activities of Daily Living

“…(minimal assistance)] of children with severe cerebellar ataxia who had posterior fossa hemorrhage [3] . Yoo et al ( 2021) also reported that robot-assisted gait training improved balance, walking capacity, and GMFM of children with ataxic cerebral palsy who had cerebellar atrophy [27] . On the other hand, taskoriented reaching activities, stretching, strengthening, and gait training resulted in a decrease in the rate of falls, while a decline in the gait speed of children with Friedreich ataxia [28] .…”