Use of Robot-Assisted Gait Training in Pediatric Patients with Cerebral Palsy in an Inpatient Setting—A Randomized Controlled Trial

Abstract

Robot-assisted gait training (RAGT) provides a task-based support of walking using exoskeletons. Evidence shows moderate, but positive effects in the therapy of patients with cerebral palsy (CP). This study investigates the impact of RAGT on walking speed and gait parameters in pediatric CP patients. Thirty subjects (male = 23; female = 7), with a mean age of 13.0 ± 2.5 (9–17) years, and with spastic CP, were recruited. The intervention group (n = 15) underwent six 20-minute RAGT sessions with the Hybrid Assistive Limb (HAL) during an 11-day hospital stay. Additionally, a therapy concept including physiotherapy, physician-performed manual medicine, massage and exercise therapy was provided. The control group (n = 15) was treated with the therapy concept only. The outcome was based on a 10-Metre Walking Test (10MWT), 6-Minute Walking Test (6MWT), Gross Motor Function Measure (GMFM-88) and lower extremities passive range of motion. The intervention group achieved a mean increase in walking speed in the 10MWT (self-selected walking speed SSW) of 5.5 s (p = 0.378). There were no significant differences between the groups in the 10MWT (max) (p = 0.123) and the 6MWT (p = 0.8). Changes in the GMFM (total) and in the dimension standing and walking, running and jumping (D + E) showed clinically relevant significant results (p = 0.002 and p = 0.046). RAGT as a supplement to an inpatient therapy stay appears to have a positive, yet not significant impact on the gait parameters of pediatric CP patients as well as motivating them to practice walking. Further studies with adapted study designs are needed to evaluate different influencing factors.

Clinical study on the safety and feasibility of AiWalker-K for lower limbs exercise rehabilitation in children with cerebral palsy

“…The latest research shows that combining RAGT and routine rehabilitation treatment can significantly improve the 6MWT test scores of children with CP compared to routine rehabilitation treatment alone [ 38 ], which is consistent with the results of this study. However, some studies on RAGT have also indicated that the combination of RAGT and routine rehabilitation treatment does not have an advantage in improving the performance of 6MWT compared to routine rehabilitation treatment alone [ 39 ]. Nonetheless, the types of RAGT devices used in the 6MWT tests, including those in this study, vary.…”

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.…”

“…The meta-analyses included 17 studies. 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 Rehabilitation Interventions and Adaptive Technologies Used for Treating Patients With Cerebral Palsy

“…It increases the ROM in muscles and improves the fine movements of fingers to master the obstacles posed by daily activities. A hybrid robot-assisted limb is a rigid exoskeleton device that provides little action [ 22 ]. Robomorphism is the designed robotic equipment for developing an active lower limb.…”