Effect of an End-effector Type of Robotic Gait Training on Stand Capability, Locomotor Function, and Gait Speed in Individuals with Spastic Cerebral Palsy

AbstractBackgroundChildren with cerebral palsy (CP) have decreased gait speeds, which can negatively affect their community participation and quality of life. However, evidence for effective rehabilitation interventions to improve gait speed remains unclear.PurposeThe purpose of this study was to determine the effectiveness of interventions for improving gait speed in ambulatory children with CP.Data SourcesMEDLINE/PubMed, CINAHL, ERIC, and PEDro were searched from inception through April 2014.Study SelectionThe selected studies were randomized controlled trials or had experimental designs with a comparison group, included a physical therapy or rehabilitation intervention for children with CP, and reported gait speed as an outcome measure.Data ExtractionMethodological quality was assessed by PEDro scores. Means, standard deviations, and change scores for gait speed were extracted. General study information and dosing parameters (frequency, duration, intensity, and volume) of the intervention were recorded.Data SynthesisTwenty-four studies were included. Three categories of interventions were identified: gait training (n=8), resistance training (n=9), and miscellaneous (n=7). Meta-analysis showed that gait training was effective in increasing gait speed, with a standardized effect size of 0.92 (95% confidence interval=0.19, 1.66; P=.01), whereas resistance training was shown to have a negligible effect (effect size=0.06; 95% confidence interval=−0.12, 0.25; P=.51). Effect sizes from negative to large were reported for studies in the miscellaneous category.LimitationsGait speed was the only outcome measure analyzed.ConclusionsGait training was the most effective intervention in improving gait speed for ambulatory children with CP. Strength training, even if properly dosed, was not shown to be effective in improving gait speed. Velocity training, electromyographic biofeedback training, and whole-body vibration were effective in improving gait speed in individual studies and warrant further investigation.

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Effects of Robot-Assisted Therapy on Gait Parameters in Pediatric Patients With Spastic Cerebral Palsy

Frontiers in Neurology ◽

10.3389/fneur.2021.724009 ◽

2021 ◽

Vol 12 ◽

Author(s):

Faustyna Manikowska ◽

Sabina Brazevic ◽

Anna Krzyżańska ◽

Marek Jóźwiak

Keyword(s):

Cerebral Palsy ◽

Gait Training ◽

Spastic Cerebral Palsy ◽

Gait Symmetry ◽

Double Support ◽

Patient Profile ◽

Gait Parameters ◽

Gait Deviation Index ◽

Spatiotemporal Parameters

Background: Gait dysfunction is a crucial factor that restricts independence and quality of life in children with cerebral palsy (CP). Gait training based on robotic-assisted therapy (RAT) is widely used, but information about effectiveness and ideal patient profile is not sufficient. Aim of this study was to assess the effect of RAT on gait parameters in spastic children with CP, and to determine whether changes in gait parameters are different among patients on different ambulatory levels.Method: A total of 26 children with bilateral spastic CP were divided into two groups based on their functional ability: non-assisted ambulator (NAS) or assisted ambulator (AS); and underwent a RAT program (30 training sessions of RAT during 10 weeks). Gait analysis was performed: before the therapy (t1), right after (t2), and 6 weeks later (t3).Results: No significant changes in spatiotemporal parameters or gait deviation index at t2 or t3. Double support symmetry significantly improved (t1 vs. t3, p = 0.03) for the whole group (NAS + AS). Walking speed symmetry significantly improved (t2 vs. t3, p = 0.02) for group AS.Conclusion: RAT based on our protocol did not change spatiotemporal parameters and kinematics of walking except limited improvement in some aspects of gait symmetry. We did not find differences in changes in selected objective gait parameters among children with CP in different ambulatory levels.

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Effect of low dose robotic-gait training on walking capacity in children and adolescents with cerebral palsy

Neurophysiologie Clinique ◽

10.1016/j.neucli.2020.09.005 ◽

2020 ◽

Vol 50 (6) ◽

pp. 507-519

Author(s):

Yosra Cherni ◽

Laurent Ballaz ◽

Josiane Lemaire ◽

Fabien Dal Maso ◽

Mickael Begon

Keyword(s):

Cerebral Palsy ◽

Children And Adolescents ◽

Low Dose ◽

Gait Training ◽

Walking Capacity ◽

Robotic Gait

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The influence of gait speed on co-activation in unilateral spastic cerebral palsy children

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2013.01.002 ◽

2013 ◽

Vol 28 (3) ◽

pp. 312-317 ◽

Cited By ~ 22

Author(s):

Raphaël Gross ◽

Fabien Leboeuf ◽

Jean Benoit Hardouin ◽

Mathieu Lempereur ◽

Brigitte Perrouin-Verbe ◽

...

Keyword(s):

Cerebral Palsy ◽

Gait Speed ◽

Spastic Cerebral Palsy ◽

Co Activation

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Clinical effects of assisted robotic gait training in walking distance, speed, and functionality are maintained over the long term in individuals with cerebral palsy: a systematic review and meta-analysis

Disability and Rehabilitation ◽

10.1080/09638288.2021.1942242 ◽

2021 ◽

pp. 1-11

Author(s):

Mariana Volpini ◽

Mariana Aquino ◽

Ana Carolina Holanda ◽

Elizabeth Emygdio ◽

Janaine Polese

Keyword(s):

Systematic Review ◽

Cerebral Palsy ◽

Meta Analysis ◽

Gait Training ◽

Walking Distance ◽

Clinical Effects ◽

Robotic Gait

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The Ability to Run in Young People with Cerebral Palsy before and after Single Event Multi-Level Surgery

Journal of Personalized Medicine ◽

10.3390/jpm11070660 ◽

2021 ◽

Vol 11 (7) ◽

pp. 660

Author(s):

Roman Rethwilm ◽

Harald Böhm ◽

Leonhard Döderlein ◽

Peter A. Federolf ◽

Chakravarthy U. Dussa

Keyword(s):

Cerebral Palsy ◽

Young People ◽

Surgical Procedures ◽

Gait Speed ◽

Young Patients ◽

Spastic Cerebral Palsy ◽

Control Group ◽

Single Event ◽

Before And After ◽

Multi Level

The objective of the study is to identify and evaluate possible factors that influence the ability to run before and after single event multi-level surgery (SEMLS). Young patients (6–25 years) with spastic cerebral palsy (GMFCSI-II) were retrospectively included. Type and number of surgical procedures, time for recovery and 3D gait analysis variables were analyzed with respect to the ability to run. In total, 98 patients (38 females; 60 males) who received SEMLS (12 years, SD 3.4) were included and compared to a control group of 71 conservatively treated patients. Of 60 runners pre-surgery, 17 (28%) lost the ability, while gained in 8 of 38 (21%) non-runners. The number of surgical procedures was a significant predictor and those who lost their ability to run had significantly more (mean = 5.9, SD = 1.7), compared to the patients who gained the ability (mean = 3.5, SD = 0.9). Further, pre-surgical function (e.g., gait speed) was significantly different (p < 0.001). Pre-surgical function and the number of surgical procedures seem to play an important role for the gain or loss of the ability to run after surgery. Caution is warranted in patients with lower pre-surgical function and the ability to run, as they seem at a higher risk to lose the ability.

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Changes in surface EMG patterns in children with cerebral palsy during robotic gait training in comparison to treadmill training

Gait & Posture ◽

10.1016/j.gaitpost.2013.07.169 ◽

2013 ◽

Vol 38 ◽

pp. S79-S80

Author(s):

Marcin Bonikowski ◽

Patrycja Mrozek

Keyword(s):

Cerebral Palsy ◽

Gait Training ◽

Surface Emg ◽

Treadmill Training ◽

Children With Cerebral Palsy ◽

Emg Patterns ◽

Robotic Gait

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Association between Gait Deviation Index and Physical Function in Children with Bilateral Spastic Cerebral Palsy: A Cross-Sectional Study

Journal of Clinical Medicine ◽

10.3390/jcm9010028 ◽

2019 ◽

Vol 9 (1) ◽

pp. 28 ◽

Cited By ~ 2

Author(s):

Tadashi Ito ◽

Koji Noritake ◽

Hiroshi Sugiura ◽

Yasunari Kamiya ◽

Hidehito Tomita ◽

...

Keyword(s):

Cerebral Palsy ◽

Motor Function ◽

Gait Speed ◽

Spastic Cerebral Palsy ◽

Cross Sectional ◽

Gross Motor ◽

Gross Motor Function ◽

Gait Deviation Index ◽

Level I ◽

Gmfcs Level

This study examined the association between Gait Deviation Index (GDI) and the five-times-sit-to-stand test (FTSST) or gait speed results, which represent mobility and muscle strength of the lower extremities in ambulatory children with Gross Motor Function Classification System (GMFCS) level I and II spastic cerebral palsy. In this cross-sectional, observational study, three-dimensional gait analysis data were obtained during gait trials to evaluate the GDI in 35 children (age 5–16 years) with spastic palsy. Motor function was evaluated using FTSST and gait speed. Gross motor function was evaluated using GMFCS. Children with GMFCS level II spastic cerebral palsy demonstrated lower GDI (p < 0.001) and poorer FTSST (p = 0.031) than those with GMFCS level I spastic cerebral palsy. Correlation analysis showed that FTSST results were significantly correlated with GDI (r = −0.624; p < 0.001). Motor function may be important for the maintenance of gait quality in patients with GMFCS level I and II spastic cerebral palsy and should not be ignored. In conclusion, reduction in gait impairment may affect the values of FTSST and GDI in patients with spastic cerebral palsy who can ambulate without an assistive device.

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