Functional effects of robotic-assisted locomotor treadmill thearapy in children with cerebral palsy.

OBJECTIVE The aim of this study was to assess gait in children with spastic diplegic cerebral palsy rehabilitated with the use of Lokomat active orthosis. DESIGN A randomized controlled trial. SUBJECTS Fifty-two children with spastic diplegic cerebral palsy. METHODS Temporospatial parameters of gait and selected kinematic parameters were assessed. Children from the study group used active orthosis in addition to following a programme of individual exercises. Children in the control group participated only in individual exercises. RESULTS The difference between the initial and control examinations was statistically insignificant. After the programme was finished, there was a slight improvement in walking speed in both groups. Improvement in the mean walking speed was not significantly different between the groups (p = 0.5905). Range of motion decreased slightly in both groups, and the difference between mean amounts of change was not significant (p = 0.8676). There was significant improvement in maximal range of flexion in the hip joint (p = 0.0065) in the study. It was shown that with a decrease in the mean value of adduction in hip joint, the mean walking speed increased (r = -0.53, p = 0.0011). CONCLUSION There are several limitations to this study, therefore these results should be regarded as preliminary. Further research consistent with the above indications is needed to investigate the impact of this new treatment option in patients with cerebral palsy.

[1]  L. Cohen,et al.  Role of voluntary drive in encoding an elementary motor memory. , 2005, Journal of neurophysiology.

[2]  Kelly P Westlake,et al.  Pilot study of Lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke , 2009, Journal of NeuroEngineering and Rehabilitation.

[3]  J. Schouenborg.  Learning in sensorimotor circuits , 2004, Current Opinion in Neurobiology.

[4]  K. Krosschell,et al.  Treadmill training with partial body‐weight support in children with cerebral palsy: a systematic review , 2009, Developmental medicine and child neurology.

[5]  E. Nordmark,et al.  Cerebral palsy in a total population of 4–11 year olds in southern Sweden. Prevalence and distribution according to different CP classification systems , 2007, BMC pediatrics.

[6]  M. Jan,et al.  Cerebral Palsy: Comprehensive Review and Update , 2006, Annals of Saudi medicine.

[7]  C. Van den Broeck,et al.  Prevalence, type, distribution, and severity of cerebral palsy in relation to gestational age: a meta‐analytic review , 2008, Developmental medicine and child neurology.

[8]  Diane L Damiano,et al.  Activity, Activity, Activity: Rethinking Our Physical Therapy Approach to Cerebral Palsy , 2006, Physical Therapy.

[9]  R. Tallis,et al.  Conventional physiotherapy and treadmill re-training for higher-level gait disorders in cerebrovascular disease. , 2000, Age and ageing.

[10]  V. Dietz,et al.  Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: a multicenter trial. , 2005, Archives of physical medicine and rehabilitation.

[11]  Ingo Borggraefe,et al.  Safety of robotic-assisted treadmill therapy in children and adolescents with gait impairment: A bi-centre survey , 2010, Developmental neurorehabilitation.

[12]  K. Mattern-Baxter.  Effects of Partial Body Weight Supported Treadmill Training on Children with Cerebral Palsy , 2009, Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association.

[13]  M. Garvey,et al.  Cerebral palsy: New approaches to therapy , 2007, Current neurology and neuroscience reports.

[14]  V R Edgerton,et al.  Full weight-bearing hindlimb standing following stand training in the adult spinal cat. , 1998, Journal of neurophysiology.

[15]  Diane L. Damiano,et al.  A Systematic Review of the Effectiveness of Treadmill Training and Body Weight Support in Pediatric Rehabilitation , 2009, Journal of neurologic physical therapy : JNPT.

[16]  Francesco Lacquaniti,et al.  Review Article: Plasticity of Spinal Centers in Spinal Cord Injury Patients: New Concepts for Gait Evaluation and Training , 2007, Neurorehabilitation and neural repair.

[17]  T. Hornby,et al.  Robotic-assisted, body-weight-supported treadmill training in individuals following motor incomplete spinal cord injury. , 2005, Physical therapy.

[18]  B. Dan,et al.  A report: the definition and classification of cerebral palsy April 2006 , 2007, Developmental medicine and child neurology. Supplement.

[19]  V R Edgerton,et al.  Locomotor capacity attributable to step training versus spontaneous recovery after spinalization in adult cats. , 1998, Journal of neurophysiology.

[20]  H. Barbeau.  Locomotor Training in Neurorehabilitation: Emerging Rehabilitation Concepts , 2003, Neurorehabilitation and neural repair.

[21]  T. Hornby,et al.  Metabolic Costs and Muscle Activity Patterns During Robotic- and Therapist-Assisted Treadmill Walking in Individuals With Incomplete Spinal Cord Injury , 2006, Physical Therapy.

[22]  B. Dobkin.  Rehabilitation and Functional Neuroimaging Dose-Response Trajectories for Clinical Trials , 2005, Neurorehabilitation and neural repair.

[23]  D. Damiano.  Rehabilitative Therapies in Cerebral Palsy: The Good, the Not As Good, and the Possible , 2009, Journal of child neurology.

[24]  A. Meyer-Heim,et al.  Improvement of walking abilities after robotic-assisted locomotion training in children with cerebral palsy , 2009, Archives of Disease in Childhood.

[25]  R. Greenwood,et al.  Rehabilitation after severe Guillain-Barré syndrome: the use of partial body weight support. , 2004, Physiotherapy research international : the journal for researchers and clinicians in physical therapy.

[26]  Rolf Moe-Nilssen,et al.  Test-retest reliability of spatial and temporal gait parameters in children with cerebral palsy as measured by an electronic walkway. , 2008, Gait & posture.

[27]  J. Hidler,et al.  Alterations in muscle activation patterns during robotic-assisted walking. , 2005, Clinical biomechanics.

[28]  A. Wernig,et al.  Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI , 2006, Neurology.

[29]  J. Hidler,et al.  Multicenter Randomized Clinical Trial Evaluating the Effectiveness of the Lokomat in Subacute Stroke , 2009, Neurorehabilitation and neural repair.

[30]  Carmen Krewer,et al.  The influence of different Lokomat walking conditions on the energy expenditure of hemiparetic patients and healthy subjects. , 2007, Gait & posture.

[31]  I. Schwartz,et al.  The Effectiveness of Locomotor Therapy Using Robotic‐Assisted Gait Training in Subacute Stroke Patients: A Randomized Controlled Trial , 2009, PM & R : the journal of injury, function, and rehabilitation.

[32]  S Hesse,et al.  Locomotor therapy in neurorehabilitation. , 2001, NeuroRehabilitation.

[33]  Sarah Foley,et al.  Efficacy of partial body weight-supported treadmill training compared with overground walking practice for children with cerebral palsy: a randomized controlled trial. , 2010, Archives of physical medicine and rehabilitation.

[34]  F. Müller,et al.  Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke: A Randomized Controlled Pilot Study , 2007, Stroke.

[35]  B Hagberg,et al.  The changing panorama of cerebral palsy in Sweden. IX. Prevalence and origin in the birth‐year period 1995–1998 , 1996, Acta paediatrica.

[36]  R. Teasell,et al.  Gait Retraining Post Stroke , 2003, Topics in stroke rehabilitation.

[37]  H. Rietman,et al.  Gait in Children With Cerebral Palsy: Observer Reliability of Physician Rating Scale and Edinburgh Visual Gait Analysis Interval Testing Scale , 2005, Journal of pediatric orthopedics.

[38]  A. Mayr,et al.  Prospective, Blinded, Randomized Crossover Study of Gait Rehabilitation in Stroke Patients Using the Lokomat Gait Orthosis , 2007, Neurorehabilitation and neural repair.