Robot-assisted gait training might be beneficial for more severely affected children with cerebral palsy

Abstract Purpose: Robot-assisted gait training (RAGT) can complement conventional therapies in children with cerebral palsy. We investigated changes in walking-related outcomes between children with different Gross Motor Function Classification System (GMFCS) levels and the dose–response relationship. Methods: Data from 67 children (3.9–19.9 years) with GMFCS levels II–IV were evaluated retrospectively. Every child received RAGT with the Lokomat complementing a multidisciplinary rehabilitation program. Changes in various walking-related outcomes were assessed. Results: Walking-related outcomes did not improve differently between GMFCS level groups. Significant within-group improvements were mainly observed in children with GMFCS level IV. A dose–response relationship was present for children with GMFCS levels III and IV. Conclusions: Our results indicated that, although children with a GMFCS level IV walked less during an average Lokomat session, they experienced significant improvements in walking-related outcomes. Further, training dose correlated with changes in walking-related outcomes. However, between-group differences in changes in walking-related outcomes were not significant.

[1]  D. Cadman,et al.  THE GROSS MOTOR FUNCTION MEASURE: A MEANS TO EVALUATE THE EFFECTS OF PHYSICAL THERAPY , 1989, Developmental medicine and child neurology.

[2]  D. Mclellan,et al.  Effect Of Increased Exposure To Physiotherapy On Skill Acquisition Of Children With Cerebral Palsy , 1992, Developmental medicine and child neurology.

[3]  D. Wade,et al.  Measurement in neurological rehabilitation. , 1992, Current opinion in neurology and neurosurgery.

[4]  M. Msall,et al.  The Functional Independence Measure for Children (WeeFIM) , 1994, Clinical pediatrics.

[5]  R. Palisano,et al.  Development and reliability of a system to classify gross motor function in children with cerebral palsy , 1997, Developmental medicine and child neurology.

[6]  V. Dietz,et al.  Treadmill training of paraplegic patients using a robotic orthosis. , 2000, Journal of rehabilitation research and development.

[7]  P. Raina,et al.  Improved scaling of the gross motor function measure for children with cerebral palsy: evidence of reliability and validity. , 2000, Physical therapy.

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

[9]  D. Mclellan,et al.  Randomized controlled trial of physiotherapy in 56 children with cerebral palsy followed for 18 months , 2001, Developmental medicine and child neurology.

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

[11]  R. Baker,et al.  Walking Speed in Children and Young Adults With Neuromuscular Disease: Comparison Between Two Assessment Methods , 2003, Journal of pediatric orthopedics.

[12]  Ian D Cameron,et al.  Treadmill training and body weight support for walking after stroke. , 2005, The Cochrane database of systematic reviews.

[13]  Volker Dietz,et al.  Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests. , 2005, Archives of physical medicine and rehabilitation.

[14]  Ross Querry,et al.  Robotic orthoses for body weight-supported treadmill training. , 2006, Physical medicine and rehabilitation clinics of North America.

[15]  G. Colombo,et al.  Feasibility of robotic‐assisted locomotor training in children with central gait impairment , 2007, Developmental medicine and child neurology.

[16]  J. Phillips,et al.  Endurance and Gait in Children With Cerebral Palsy After Intensive Body Weight-Supported Treadmill Training , 2007, Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association.

[17]  R. Cherng,et al.  Effect of Treadmill Training with Body Weight Support on Gait and Gross Motor Function in Children with Spastic Cerebral Palsy , 2007, American journal of physical medicine & rehabilitation.

[18]  Sarah Foley,et al.  Partial body‐weight‐supported treadmill training can improve walking in children with cerebral palsy: a clinical controlled trial , 2007, Developmental medicine and child neurology.

[19]  K. Dodd,et al.  A systematic review of the effectiveness of treadmill training for children with cerebral palsy , 2009, Disability and rehabilitation.

[20]  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.

[21]  A. Meyer-Heim,et al.  Sustainability of motor performance after robotic-assisted treadmill therapy in children: an open, non-randomized baseline-treatment study. , 2010, European journal of physical and rehabilitation medicine.

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

[23]  A. Meyer-Heim,et al.  Robotic-assisted treadmill therapy improves walking and standing performance in children and adolescents with cerebral palsy. , 2010, European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society.

[24]  S. Hesse,et al.  Improved Gait After Repetitive Locomotor Training in Children with Cerebral Palsy , 2011, American journal of physical medicine & rehabilitation.

[25]  Andreas Meyer-Heim,et al.  Robot-assisted and computer-enhanced therapies for children with cerebral palsy: current state and clinical implementation. , 2013, Seminars in pediatric neurology.

[26]  Joanna Dudek,et al.  Functional effects of robotic-assisted locomotor treadmill thearapy in children with cerebral palsy. , 2013, Journal of rehabilitation medicine.

[27]  J. Mehrholz,et al.  Treadmill training and body weight support for walking after stroke. , 2017, The Cochrane database of systematic reviews.