Abstract
Objective
To evaluate retrospectively the effect of robotic rehabilitation in a large group
of children with motor impairment; an additional goal was to identify the effects
in children with cerebral palsy (CP) and acquired brain injury (ABI) and with different
levels of motor impairment according to the Gross Motor Function Classification System.
Finally, we examined the effect of time elapsed from injury on children’s functions.
Design
A cohort, pretest-posttest retrospective study was conducted.
Setting
Hospitalized care.
Participants
A total of 182 children, 110 with ABI and 72 with CP and with Gross Motor Function
Classification System (GMFCS) levels I-IV, were evaluated retrospectively.
Interventions
Patients underwent a combined treatment of robot-assisted gait training and physical
therapy.
Main Outcome Measures
All the patients were evaluated before and after the training using the 6-minute walk
test and the Gross Motor Function Measure. A linear mixed model with 3 fixed factors
and 1 random factor was used to evaluate improvements.
Results
The 6-minute walk test showed improvement in the whole group and in both ABI and CP.
The Gross Motor Function Measure showed improvement in the whole group and in the
patients with ABI but not in children with CP. The GMFCS analysis showed that all
outcomes improved significantly in all classes within the ABI subgroup, whereas improvements
were significant only for GMFCS III in children with CP.
Conclusions
Children with motor impairment can benefit from a combination of robotic rehabilitation
and physical therapy. Our data suggest positive results for the whole group and substantial
differences between ABI and CP subgroups, with better results for children with ABI,
that seem to be consistently related to time elapsed from injury.
Keywords
List of abbreviations:
ABI (acquired brain injury), CP (cerebral palsy), GMFCS (Gross Motor Function Classification System), GMFM (Gross Motor Function Measure), MCID (minimum clinically important difference), PT (physical therapy), RAGT (robot-assisted gait training), 6MWT (6-minute walk test)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A report: the definition and classification of cerebral palsy April 2006.Dev Med Child Neurol. 2007; 109: 8-14
- Children with cerebral palsy: severity and trends over time.Paediatr Perinat Epidemiol. 2009; 23: 513-521
- Incidence, aetiology, and outcome of non-traumatic coma: a population based study.Arch Dis Child. 2001; 84: 193-199
- Pediatric rehabilitation of severe acquired brain injury: a multicenter survey.Eur J Phys Rehabil Med. 2012; 48: 423-431
- Functional recovery ten years after pediatric traumatic brain injury: outcomes and predictors.J Neurotrauma. 2012; 29: 2539-2547
- A systematic review of interventions for children with cerebral palsy: state of the evidence.Dev Med Child Neurol. 2013; 55: 885-910
- Systematic review of physiotherapy interventions to improve gross motor capacity and performance in children and adolescents with an acquired brain injury.Brain Inj. 2016; 30: 948-959
- Robotic movement therapy in cerebral palsy.Dev Med Child Neurol. 2011; 53: 481
- Changes in supraspinal activation patterns following robotic locomotor therapy in motor-incomplete spinal cord injury.Neurorehabil Neural Repair. 2005; 19: 313-324
- Treadmill exercise activates subcortical neural networks and improves walking after stroke: a randomized controlled trial.Stroke. 2008; 39: 3341-3350
- Requirements for and impact of a serious game for neuro-pediatric robot-assisted gait training.Res Dev Disabil. 2013; 34: 3906-3915
- Virtual gait training for children with cerebral palsy using the Lokomat gait orthosis.Stud Health Technol Inform. 2008; 132: 204-209
- Can Lokomat therapy with children and adolescents be improved? An adaptive clinical pilot trial comparing Guidance Force, Path Control, and FreeD.J Neuroeng Rehabil. 2017; 14: 76
- Prospective controlled cohort study to evaluate changes of function, activity and participation in patients with bilateral spastic cerebral palsy after robot-enhanced repetitive treadmill therapy.Eur J Paediatr Neurol. 2014; 18: 502-510
- Electromechanical-assisted training for walking after stroke.Cochrane Database Syst Rev. 2017; 5CD006185
- The effectiveness of robotic-assisted gait training for paediatric gait disorders: systematic review.J Neuroeng Rehabil. 2017; 14: 1
- Robotic gait training for individuals with cerebral palsy: a systematic review and meta-analysis.Arch Phys Med Rehabil. 2017; 98: 2332-2344
- Robotic-assisted gait training improves walking abilities in diplegic children with cerebral palsy.Eur J Paediatr Neurol. 2017; 21: 557-564
- Improved gait parameters after robotic-assisted locomotor treadmill therapy in a 6-year-old child with cerebral palsy.Mov Disord. 2008; 23: 280-283
- Improvement of walking abilities after robotic-assisted locomotion training in children with cerebral palsy.Arch Dis Child. 2009; 94: 615-620
- Effect of robotic-assisted gait rehabilitation on dynamic equilibrium control in the gait of children with cerebral palsy.Gait Posture. 2018; 60: 55-60
- Robotically-driven orthoses exert proximal-to-distal differential recovery on the lower limbs in children with hemiplegia, early after acquired brain injury.Eur J Paediatr Neurol. 2018; 22: 1-10
- Functional effects of robotic-assisted locomotor treadmill therapy in children with cerebral palsy.J Rehabil Med. 2013; 45: 358-363
- Effectiveness of functional hand splinting and the cognitive orientation to occupational performance (CO-OP) approach in children with cerebral palsy and brain injury: two randomised controlled trial protocols.BMC Neurol. 2014; 14: 144
- Development and reliability of a system to classify gross motor function in children with cerebral palsy.Dev Med Child Neurol. 1997; 39: 214-223
- WAIS-R Manual: Wechsler Adult Intelligence Scale - Revised.1981
- The Gross Motor Function Measure: a means to evaluate the effects of physical therapy.Dev Med Child Neurol. 1989; 31: 341-352
- Validation of the gross motor function measure for use in children and adolescents with traumatic brain injuries.Pediatrics. 2007; 120: e880-e886
- Six-minute walk test in adults with cerebral palsy. A study of reliability.Clin Rehabil. 2006; 20: 488-495
- The efficacy of functional gait training in children and young adults with cerebral palsy: a systematic review and meta-analysis.Dev Med Child Neurol. 2018; 60: 866-883
- Minimal clinically important difference for the 6-min walk test: literature review and application to Morquio A syndrome.Orphanet J Rare Dis. 2017; 12: 78
- Feasibility of robotic-assisted locomotor training in children with central gait impairment.Dev Med Child Neurol. 2007; 49: 900-906
- Sustainability of motor performance after robotic-assisted treadmill therapy in children: an open, non-randomized baseline-treatment study.Eur J Phys Rehabil Med. 2010; 46: 125-131
- Outcome tools used for ambulatory children with cerebral palsy: responsiveness and minimum clinically important differences.Dev Med Child Neurol. 2008; 50: 918-925
- Practical recommendations for robot-assisted treadmill therapy (Lokomat) in children with cerebral palsy: indications, goal setting, and clinical implementation within the WHO-ICF framework.Neuropediatrics. 2015; 46: 248-260
- Robotic-assisted treadmill therapy improves walking and standing performance in children and adolescents with cerebral palsy.Eur J Paediatr Neurol. 2010; 14: 496-502
- Robot-assisted gait training might be beneficial for more severely affected children with cerebral palsy.Dev Neurorehabil. 2016; 19: 410-415
Article info
Publication history
Published online: September 25, 2019
Footnotes
Supported by a private donation through “Associazione La Nostra Famiglia” and by the Italian Ministry of Health (Ricerca Corrente 2017/2018/2019 to Eng G. Reni). Bambino Gesù Children's Hospital thanks “Fondazione Roma” for the generous contribution to the purchase of the Lokomat robotic system.
Clinical Trial Registration No.: NCT03828110.
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
