Robot-driven downward pelvic pull to improve crouch gait in children with cerebral palsy

Robotic training of children with crouch gait improved posture and walking by enhancing muscle strength and coordination. Children with cerebral palsy commonly exhibit an abnormality called crouch gait, which is characterized by excessive flexion of the hips/knees and weak plantar flexor muscles during the stance phase. One of the major reasons for this pathological gait is weakness in soleus muscles. During the mid-stance phase of gait when the toe and heel are both on the ground, the soleus keeps the shank upright and facilitates extension of the knee angle. It also provides propulsive forces on the body during the late stance phase of the gait cycle. We hypothesized that walking with downward pelvic pull will (i) strengthen extensor muscles, especially the soleus, against the applied downward force and (ii) improve muscle coordination during walking. We then tested a robotic training paradigm to improve both posture and gait of children with crouch gait. In this paradigm, participants with crouch gait were subjected to downward pelvic force when walking on a treadmill, provided by a cable-driven robot called Tethered Pelvic Assist Device. Electromyography of soleus and gastrocnemius muscles and walking kinematics of the participants showed the feasibility of this training, enhanced upright posture of the participants, and improved muscle coordination. In addition, walking features of these participants, such as increased step length, range of motion of the lower limb angles, toe clearance, and heel-to-toe pattern, improved. This robotic training method can be a promising intervention for children with cerebral palsy who have a crouch gait.