Effect of robot-assisted gait training on motor functions in adolescent and young adult patients with bilateral spastic cerebral palsy: A randomized controlled trial

2020 ◽  
Vol 47 (4) ◽  
pp. 495-508
Author(s):  
Stanislava Klobucká ◽  
Robert Klobucký ◽  
Branislav Kollár
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Conventional Therapy ◽  
Gait Training ◽  
Adult Patients ◽  
Robot Assisted ◽  
Gross Motor ◽  
Motor Functions ◽  
Gross Motor Function ◽  
Significant Difference

BACKGROUND: Robot-assisted gait training (RAGT) allows an intensive gait training in patients with cerebral palsy (CP). There are few evidences on the effectiveness of RAGT in adults with CP. OBJECTIVE: To assess the effect of RAGT on gross motor function in adolescent and adult patients with bilateral spastic CP and to compare the effect of RAGT with conventional kinesiotherapy. METHODS: Forty-seven patients (mean age 21.2±5.33 years) with bilateral spastic CP were divided into two groups. Twenty-one patients underwent 20 therapeutic units of RAGT and 26 patients underwent 20 therapeutic units of conventional therapy/training (CON). The following parameters were evaluated before (V1) and after the therapy (V2): dimension A (lying and rolling), B (sitting), C (crawling and kneeling), D (standing), E (walking, running and jumping) of the Gross Motor Function Measure (GMFM-88). In patients in the experimental RAGT group, these parameters were also evaluated 3–4 months later (V3). RESULTS: Comparing the mean improvements in endpoints in both groups (RAGT vs. CON) after 20 TUs, we observed the statistically significant difference (p < 0.001) and large effect size in all GMFM dimensions and total GMFM improvement in favour of the RAGT group. In RAGT patients, the improvement persisted even 3–4 months after RAGT (p < 0.001). CONCLUSION: We demonstrated that the intensive RAGT regimen is more effective than conventional therapy in terms of improvements in gross motor functions in adolescent and adult patients with bilateral spastic CP.

The effect of patient-specific factors on responsiveness to robot-assisted gait training in patients with bilateral spastic cerebral palsy

2021 ◽  
pp. 1-15
Author(s):  
Stanislava Klobucká ◽  
Robert Klobucký ◽  
Branislav Kollár
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Gait Training ◽  
Patient Specific ◽  
Spastic Cerebral Palsy ◽  
Robot Assisted ◽  
Gross Motor ◽  
Motor Functions ◽  
Gross Motor Function ◽  
Severity Of Disability

BACKGROUND: No general recommendations are yet available for the application of robot-assisted treadmill therapy for children with cerebral palsy regarding the length and intensity of the intervention. OBJECTIVE: The aim of the study was to evaluate patient-specific determinants of responsiveness to robot-assisted gait training (RAGT) in patients with bilateral spastic cerebral palsy. METHOD: During 12 months, the patients underwent 1–4 blocks of RAGT, representing 16–82 TUs. The following parameters were evaluated before (V0) and after each therapeutic block (V1–V4): dimension A (lying and rolling), B (sitting), C (crawling and kneeling), D (standing), E (walking, running and jumping) of the Gross Motor Function Measure (GMFM-88). We evaluated the change in motor functions in relation to the severity of disability, age, gender and number of therapeutic units. RESULTS: Ninety-seven patients aged between 3.7 and 27 years (mean age 10.02 years (SD±5.29); Gross Motor Function Classification System level I [n = 5], II [n = 25], III [n = 48], IV [n = 19]) underwent 16–82 TUs (overall average number 34.06 TUs, SD±16.41) of RAGT. In the patient group, we recorded clinically meaningful improvement and statistically significant improvement (p <  0.001) in gross motor functions with gradual increase in the effect size after each therapeutic block. Using correlation and regression analysis, we found a statistically significant associations between the number of therapeutic units, severity of disability, and improvement in motor functions after RAGT. CONCLUSION: We have identified two determinants –the severity of disability and the number of therapeutic units –which could have a decisive and predictive character in setting rehabilitation/designing programmes. The duration of the applied RAGT period, frequency and intensity could be a crucial factor for the potential of improvement in children with BS-CP.

scholarly journals Short-Term and Long-Term Effects of Riding for Children with Cerebral Palsy Gross Motor Functions

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
L. Žalienė ◽  
D. Mockevičienė ◽  
B. Kreivinienė ◽  
A. Razbadauskas ◽  
Ž. Kleiva ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Long Term Effects ◽  
Short Term ◽  
Gross Motor ◽  
Motor Functions ◽  
Gross Motor Skills ◽  
Gross Motor Function ◽  
Group I

Aim. To evaluate the effects of riding for beginners (short-term) and advanced (long-term) riders with cerebral palsy on their whole mobility. The study involved 15 subjects (two girls and eleven boys). The subjects were aged from 3 to 19 years (8.73 years ± 5.85). All of the subjects had been diagnosed with a spastic form of cerebral palsy. The duration of the participation differed as follows: the advanced subjects had been riding for 1-4 years (2.66 years ± 1.16), while the beginners have been riding for two weeks (10 sessions). Group I (advanced riders) consisted of eight subjects (7 boys and 1 girl) who had therapy sessions regularly once a week and differed only in terms of the duration of their participation in the experiment. Group II (beginners) consisted of seven children (1 girl and 6 boys) who participated in only 10 riding sessions. All of the subjects were assessed according to the Gross Motor Function Measure (GMFM) and Gross Motor Function Classification System for CP (GMFCS) both before the investigation and after it. Conclusions. Ten riding lessons did not have an influence on the beginner riders with cerebral palsy gross motor functions and their gross motor function level did not change. However, in half of the advanced riders with cerebral palsy, the gross motor functions significantly improved. Meanwhile, the level of the performance of the gross motor skills in the four advanced riders increased, but this difference was not statistically significant.

scholarly journals Ataxic-hypotonic cerebral palsy in a cerebral palsy registry

2019 ◽  
Vol 10 (2) ◽  
pp. 131-139
Author(s):  
Jake P. Levy ◽  
Maryam Oskoui ◽  
Pamela Ng ◽  
John Andersen ◽  
David Buckley ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Cerebral Malformation ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Significant Difference ◽  
Nosologic Entity ◽  
Gestational Age At Birth ◽  
Age At Birth ◽  
Worse Prognosis

ObjectiveTo specifically report on ataxic-hypotonic cerebral palsy (CP) using registry data and to directly compare its features with other CP subtypes.MethodsData on prenatal, perinatal, and neonatal characteristics and gross motor function (Gross Motor Function Classification System [GMFCS]) and comorbidities in 35 children with ataxic-hypotonic CP were extracted from the Canadian Cerebral Palsy Registry and compared with 1,804 patients with other subtypes of CP.ResultsPerinatal adversity was detected significantly more frequently in other subtypes of CP (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.5–11.7). The gestational age at birth was higher in ataxic-hypotonic CP (median 39.0 weeks vs 37.0 weeks, p = 0.027). Children with ataxic-hypotonic CP displayed more intrauterine growth restriction (OR 2.6, 95% CI 1.0–6.8) and congenital malformation (OR 2.4, 95% CI 1.2–4.8). MRI was more likely to be either normal (OR 3.8, 95% CI 1.4–10.5) or to show a cerebral malformation (OR 4.2, 95% CI 1.5–11.9) in ataxic-hypotonic CP. There was no significant difference in terms of GMFCS or the presence of comorbidities, except for more frequent communication impairment in ataxic-hypotonic CP (OR 4.2, 95% CI 1.5–11.6).ConclusionsOur results suggest a predominantly genetic or prenatal etiology for ataxic-hypotonic CP and imply that a diagnosis of ataxic-hypotonic CP does not impart a worse prognosis with respect to comorbidities or functional impairment. This study contributes toward a better understanding of ataxic-hypotonic CP as a distinct nosologic entity within the spectrum of CP with its own pathogenesis, risk factors, clinical profile, and prognosis compared with other CP subtypes.

scholarly journals The Effect of Robot-Assisted Gait Training on Locomotor Function and Functional Capability for Daily Activities in Children with Cerebral Palsy: A Single-Blinded, Randomized Cross-Over Trial

2020 ◽  
Vol 10 (11) ◽  
pp. 801
Author(s):  
Li Hua Jin ◽  
Shin-seung Yang ◽  
Ja Young Choi ◽  
Min Kyun Sohn
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Gait Training ◽  
Daily Activities ◽  
Robot Assisted ◽  
Functional Capability ◽  
Gross Motor ◽  
Children With Cerebral Palsy ◽  
Carry Over

Purpose: The effectiveness of robot-assisted gait training (RAGT) in children with cerebral palsy (CP), especially in terms of improving the performance of daily activities, remains unclear. Therefore, we aimed to investigate the effectiveness of RAGT in children with CP. Methods: In this single-center, single-blinded, randomized cross-over trial, we enrolled 20 children with CP with Gross Motor Function Classification System (GMFCS) levels II–IV (13 males; age range, 6.75 ± 2.15 years). The participants were randomized into the RAGT/standard care (SC) (n = 10) and SC/RAGT/SC sequence groups (n = 10). Using a Walkbot-K system, the RAGT program comprised 3 × 30-min sessions/week for 6 weeks with a continued SC program. The SC program comprised 2–4 conventional physiotherapy sessions/week for 6 weeks. The Gross Motor Function Measure-88 (GMFM-88), the pediatric functional independence measure (WeeFIM), and the Canadian occupational performance measure (COPM) scores were assessed pre- and post-RAGT or SC periods and treatment, period, follow-up, and carry-over effects were analyzed. Energy expenditure and body composition were measured pre- and post-RAGT. Results: Significant treatment effects were observed in dimensions D and E of the GMFM (D: p = 0.018; E: p = 0.021) scores, WeeFIM mobility subtotal (p = 0.007), and COPM performance (p < 0.001) and satisfaction (p = 0.001) measure scores. The period, follow-up, and carry-over effects were not statistically significant. The gross energy cost significantly decreased (p = 0.041) and the skeletal muscle mass increased (p = 0.014) at post-RAGT assessment. The factors associated with functional outcomes showed significant improvements in the GMFM D scores and were mainly observed in children with GMFCS levels II–III compared to those classified at level IV (p = 0.038). Conclusion: RAGT had training benefits for children with CP. Specifically, it improved locomotor function and functional capability for daily activities. These effects were better in ambulatory children with CP. However, as SC interventions continued during the RAGT period, these improvements may be also related to multiple treatment effects.

The effect of interactive computer play on balance and functional abilities in children with moderate cerebral palsy: a pilot randomized study

2019 ◽  
Vol 33 (4) ◽  
pp. 704-710 ◽  
Author(s):  
Tamis W Pin ◽  
Penelope B Butler
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Intervention Group ◽  
Controlled Study ◽  
Control Group ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Gross Motor Function Measure ◽  
Significant Difference ◽  
Function Measure

Objectives: To investigate the feasibility and potential efficacy of a six-week interactive computer play training on balance and gross motor function in children with moderate cerebral palsy. Design: A pilot single-blinded matched randomized controlled study. Setting: Community. Participants: In total, 18 children with moderate cerebral palsy were recruited, paired according to age and severity of cerebral palsy and randomized into intervention group or control group. Intervention: The intervention group received additional trunk control training using the interactive computer play in sitting four times per week, 20 minutes per session for six weeks. All study children continued their usual physiotherapy programme. Measurements: All study children were assessed at baseline, week 3, week 6 (completion of intervention) and week 12 using the Pediatric Reach Test, Gross Motor Function Measure–66-Item Set and 2-Minute Walk Test. Results: All intervention children completed and enjoyed the training with no reported adverse event. All children were assessed at all time points. No significant difference was found between the two groups in all assessments. In both groups of children, significant improvements were found in the Gross Motor Function Measure–66-Item Set between week 3 (intervention group: mean 53.41, SD 5.34; control group: mean 52.86, SD 8.33) and week 6 (intervention group: mean 55.00, SD 6.32; control group: mean 54.20, SD 8.35). Conclusion: The intervention protocol of a six-week interactive computer play training was feasible and safe for children with moderate cerebral palsy in special school settings. Future studies with larger sample sizes or using single-subject designs are recommended.

Correlation of Gross Motor Function with Topographical Diagnosis in Children with Cerebral Palsy

2012 ◽  
Vol 23 (1) ◽  
pp. 10-14
Author(s):  
Nonica Laisram ◽  
Tufail Muzaffar ◽  
S Y Kothari
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Care Hospital ◽  
Weak Correlation ◽  
Chi Square ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Topographical Distribution ◽  
Significant Difference ◽  
Gmfcs Level

Abstract There is a need for appropriate classification to describe gross motor function status in a child with cerebral palsy (CP). It was hypothesised that: greater the number of limbs involved, higher would be the Gross Motor Function Classification System (GMFCS) level; and, there would be spectrum of GMFCS level for each of the topographical types of the cerebral palsy. A cross-sectional study of 182 children of both sexes in the age group of 7 months to 30 years having spastic CP who attended CP clinic from 2008 to 2009 in tertiary care hospital were assessed for topographical diagnosis and GMFCS levels. Topographical distribution showed diplegia (42%), quadriplegia (30%), hemiplegia (23%), triplegia (4%) and monoplegia (1%). GMFCS levels were almost evenly distributed, level II (26%) was most common followed by level V (23%). Statistical analysis was done using Cramer's ratio and Pearson's Chi-square test. Cramer's ratio of 0.277 showed fairly weak correlation between GMFCS levels and topographical CP types. Pearson's Chi-square (12) =41.7, p=0.000 indicates that there is significant difference between expected and observed values of number of limbs involved in GMFCS levels, further substantiating the weak correlation. These results mean that GMFCS in different topographical groups have different distributions. It was also observed that GMFCS had weak correlation with the number of limbs involved, thus reflecting that the GMFCS is a better indicator of gross motor function impairment than the traditional topographical categorisation of CP that specifies the number of limbs involved.

scholarly journals Overground Robot-Assisted Gait Training for Pediatric Cerebral Palsy

Sensors ◽  
2021 ◽  
Vol 21 (6) ◽  
pp. 2087
Author(s):  
Seung Ki Kim ◽  
Dongho Park ◽  
Beomki Yoo ◽  
Dain Shim ◽  
Joong-On Choi ◽  
...  
Keyword(s):  
Oxygen Consumption ◽  
Motor Function ◽  
Gait Training ◽  
Walk Test ◽  
Wearable Robot ◽  
Robot Assisted ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Gross Motor Function Measure ◽  
Function Measure

The untethered exoskeletal robot provides patients with the freest and realistic walking experience by assisting them based on their intended movement. However, few previous studies have reported the effect of robot-assisted gait training (RAGT) using wearable exoskeleton in children with cerebral palsy (CP). This pilot study evaluated the effect of overground RAGT using an untethered torque-assisted exoskeletal wearable robot for children with CP. Three children with bilateral spastic CP were recruited. The robot generates assistive torques according to gait phases automatically detected by force sensors: flexion torque during the swing phase and extension torque during the stance phase at hip and knee joints. The overground RAGT was conducted for 17~20 sessions (60 min per session) in each child. The evaluation was performed without wearing a robot before and after the training to measure (1) the motor functions using the gross motor function measure and the pediatric balance scale and (2) the gait performance using instrumented gait analysis, the 6-min walk test, and oxygen consumption measurement. All three participants showed improvement in gross motor function measure after training. Spatiotemporal parameters of gait analysis improved in participant P1 (9-year-old girl, GMFCS II) and participant P2 (13-year-old boy, GMFCS III). In addition, they walked faster and farther with lower oxygen consumption during the 6-min walk test after the training. Although participant P3 (16-year-old girl, GMFCS IV) needed the continuous help of a therapist for stepping at baseline, she was able to walk with the platform walker independently after the training. Overground RAGT using a torque-assisted exoskeletal wearable robot seems to be promising for improving gross motor function, walking speed, gait endurance, and gait efficiency in children with CP. In addition, it was safe and feasible even for children with severe motor impairment (GMFCS IV).

scholarly journals Cerebral palsy in preterm infants

2016 ◽  
Vol 73 (4) ◽  
pp. 343-348 ◽  
Author(s):  
Cila Demesi-Drljan ◽  
Aleksandra Mikov ◽  
Karmela Filipovic ◽  
Snezana Tomasevic-Todorovic ◽  
Aleksandar Knezevic ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Preterm Birth ◽  
Motor Function ◽  
Gestational Age ◽  
Significant Risk ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Extremely Preterm ◽  
Significant Difference ◽  
Associated Conditions

Background/Aim. Cerebral palsy (CP) is one of the leading causes of neurological impairment in childhood. Preterm birth is a significant risk factor in the occurrence of CP. Clinical outcomes may include impairment of gross motor function and intellectual abilities, visual impairment and epilepsy. The aim of this study was to examine the relationships among gestational age, type of CP, functional ability and associated conditions. Methods. The sample size was 206 children with CP. The data were obtained from medical records and included gestational age at birth, clinical characteristics of CP and associated conditions. Clinical CP type was determined according to Surveillance of Cerebral Palsy in Europe (SCPE) and topographically. Gross motor function abilities were evaluated according to the Gross Motor Function Classification System (GMFCS). Results. More than half of the children with CP were born prematurely (54.4%). Statistically significant difference was noted with respect to the distribution of various clinical types of CP in relation to gestational age (p < 0.001). In the group with spastic bilateral CP type, there is a greater proportion of children born preterm. Statistically significant difference was noted in the functional classification based on GMFCS in terms of gestational age (p = 0.049), children born at earlier gestational age are classified at a higher GMFCS level of functional limitation. The greatest percentage of children (70.0%) affected by two or more associated conditions was found in the group that had extremely preterm birth, and that number declined with increasing maturity at birth. Epilepsy was more prevalent in children born at greater gestational age, and this difference in distribution was statistically significant (p = 0.032). Conclusion. The application of antenatal and postnatal protection of preterm children should be a significant component of the CP prevention strategy.

Effectiveness of Robot-Assisted Gait Training on Functional Skills in Children with Cerebral Palsy

2021 ◽  
Author(s):  
Burak Yaşar ◽  
Emine Atıcı ◽  
Derya Azim Razaei ◽  
Tülay Çevik Saldıran
Keyword(s):  
Cerebral Palsy ◽  
Functional Independence Measure ◽  
Gait Training ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Robot Assisted ◽  
Timed Up And Go ◽  
Motor Functions ◽  
Significant Difference ◽  
Children With Cerebral Palsy

AbstractThis study was aimed to investigate the effects of robot-assisted gait training (RAGT) on motor functions, spasticity status, balance, and functionality in children with cerebral palsy (CP). A total of 26 patients who were diagnosed with CP (diplegic, with gross motor function classification system [GMFCS] levels of 2–5) and who regularly participated in a rehabilitation program were recruited in the study after obtaining approval from their parents. The patients were randomly assigned to two groups. Group 1 (n = 13) received conventional physical therapy (65 minutes, 2 days/week × 8) and group 2 (n = 13) received 25 minutes of RAGT (RoboGait) in addition to conventional therapy (CT; 40 minutes, 2 days/week × 8). GMFCS was used to evaluate motor functions and the Modified Ashworth Scale was used to evaluate spasticity. The pediatric Berg balance scale, pediatric functional independence measure, and timed up and go tests were employed to assess balance and functional status. The evaluations were performed at baseline and after 8 weeks of therapy. Both rehabilitation methods led to a statistically significant decrease in spasticity (p < 0.05); however, there was no difference in this improvement of spasticity between the groups (p > 0.05). Both groups exhibited significant improvements in functional independence, balance, and performance at the end of therapy (p < 0.05), and there was no significant difference between the groups (p > 0.05). The results of this study show that addition of RAGT to CT for 8 weeks is not superior to CT alone in children with CP.

Profile of children with cerebral palsy spectrum disorder and a normal MRI study

Neurology ◽  
2019 ◽  
Vol 93 (1) ◽  
pp. e88-e96 ◽  
Author(s):  
Arielle Springer ◽  
Sasha Dyck Holzinger ◽  
John Andersen ◽  
David Buckley ◽  
Darcy Fehlings ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Classification System ◽  
Spectrum Disorder ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Causal Pathways ◽  
Significant Difference ◽  
Children With Cerebral Palsy ◽  
Mri Study

ObjectiveThis study looks at what profile can be expected in children with cerebral palsy spectrum disorder (CP) and a normal MRI.MethodsThe data were excerpted from the Canadian Cerebral Palsy Registry database. Only patients who had undergone MRI were included in the analysis. Neuroimaging classification was ascertained by university-based pediatric neuroradiologists and split into 2 categories: normal and abnormal MRIs. Six factors were then compared between those 2 groups: prematurity, perinatal adversity, presence of more than 1 comorbidity, CP subtype, bimanual dexterity (Manual Ability Classification System [MACS]), and gross motor function (Gross Motor Function Classification System [GMFCS]).ResultsParticipants with no perinatal adversity were 5.518 times more likely to have a normal MRI (p < 0.0001, 95% confidence interval [CI] 4.153–7.330). Furthermore, participants with dyskinetic, ataxic/hypotonic, and spastic diplegic forms of CP were 2.045 times more likely to have a normal MRI than those with hemiplegia, triplegia, and quadriplegia (p < 0.0001, 95% CI 1.506–2.778). No significant difference was found in prematurity, GMFCS levels, MACS levels, and the number of comorbidities.ConclusionsNormal MRIs were associated with lack of perinatal adversity as well as with the dyskinetic, ataxic/hypotonic, and spastic diplegic CP subtypes. As MRI normality is not strongly associated with the severity of CP, continuous follow-up in children with normal imaging appears warranted. Further advanced imaging modalities, as well as strong consideration for metabolic and genetic testing, may provide additional insights into causal pathways in this population.

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