open access
Effect of robot-assisted gait training on functional capabilities in individuals with cerebral palsy: a systematic review and meta-analysis
, 1, 1, 2, 1
Affiliations- Department of Pediatric Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
open access
Abstract
The present study evaluates the effectiveness of robot-assisted gait training (RAGT). Lower limb function treatment in patients with cerebral palsy (CP) includes functional testing: UP&GO, 6-Minute Walking Test (6MWT), and the Gross Motor Function Measure (GMFM).
PubMed, Web of Science, Cochrane Library, Embase, Scopus, and EBSCO databases were searched to collect RAGT studies on lower limb dysfunction in CP patients. The GMFM, GMFM D, and GMFM E scales assessed motor function, and the UP & GO test assessed balance function and walking speed. 6MWT assessed endurance and walking speed. Due to the occurrence of only one publication with the UP&GO test, it was impossible to analyze this element.
The review included a total of 17 studies. The meta-analysis showed that RAGT significantly improved GMFM, GMFM D and E and 6MWT scores in patients with CP. Results are a compilation of all publications combined, as well as by group for randomized and non-randomized trials, and for RAGT alone or combined with conventional physiotherapy. The results regarding the assessment of functional status using the GMFM scale present the lowest heterogeneity.
RAGT positively affects gait and balance functions in CP patients. Future high-quality, long-term follow-up studies are needed to investigate the clinical efficacy of RAGT thoroughly.
Abstract
The present study evaluates the effectiveness of robot-assisted gait training (RAGT). Lower limb function treatment in patients with cerebral palsy (CP) includes functional testing: UP&GO, 6-Minute Walking Test (6MWT), and the Gross Motor Function Measure (GMFM).
PubMed, Web of Science, Cochrane Library, Embase, Scopus, and EBSCO databases were searched to collect RAGT studies on lower limb dysfunction in CP patients. The GMFM, GMFM D, and GMFM E scales assessed motor function, and the UP & GO test assessed balance function and walking speed. 6MWT assessed endurance and walking speed. Due to the occurrence of only one publication with the UP&GO test, it was impossible to analyze this element.
The review included a total of 17 studies. The meta-analysis showed that RAGT significantly improved GMFM, GMFM D and E and 6MWT scores in patients with CP. Results are a compilation of all publications combined, as well as by group for randomized and non-randomized trials, and for RAGT alone or combined with conventional physiotherapy. The results regarding the assessment of functional status using the GMFM scale present the lowest heterogeneity.
RAGT positively affects gait and balance functions in CP patients. Future high-quality, long-term follow-up studies are needed to investigate the clinical efficacy of RAGT thoroughly.
Keywords
neurological disorders of gait; rehabilitation; nervous system disorders
About this articleTitle
Effect of robot-assisted gait training on functional capabilities in individuals with cerebral palsy: a systematic review and meta-analysis
Journal
Issue
Article type
Review paper
Published online
2024-01-09
Page views
134
Article views/downloads
80
DOI
Keywords
neurological disorders of gait
rehabilitation
nervous system disorders
Authors
Anna Krzyżańska
Magdalena Dziurda
Mateusz Maćkowiak
Michał Michalak
Marek Jóźwiak
References (30)- Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007; 109: 8–14.
- Rodda J, Graham HK. Classification of gait patterns in spastic hemiplegia and spastic diplegia: a basis for a management algorithm. Eur J Neurol. 2001; 8 Suppl 5: 98–108.
- Oudenhoven LM, van Vulpen LF, Dallmeijer AJ, et al. Improved Walking Capacity and Muscle Strength After Functional Power-Training in Young Children With Cerebral Palsy. Neurorehabil Neural Repair. 2017; 31(9): 827–841.
- Lerner ZF, Damiano DL, Bulea TC. Relationship between assistive torque and knee biomechanics during exoskeleton walking in individuals with crouch gait. IEEE Int Conf Rehabil Robot. 2017; 2017: 491–497.
- Aurich-Schuler T, Grob F, van Hedel HJA, et al. 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(1): 76.
- Volpini M, Aquino M, Holanda AC, et al. 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. Disabil Rehabil. 2022; 44(19): 5418–5428.
- Sterne JAc, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016; 355: i4919.
- Flemyng E, Moore TH, Boutron I, et al. Using Risk of Bias 2 to assess results from randomised controlled trials: guidance from Cochrane. BMJ Evid Based Med. 2023; 28(4): 260–266.
- Klobucká S, Klobucký R, Kollár B. Effect of robot-assisted gait training on motor functions in adolescent and young adult patients with bilateral spastic cerebral palsy: A randomized controlled trial. NeuroRehabilitation. 2020; 47(4): 495–508.
- Wu M, Kim J, Arora P, et al. Effects of the Integration of Dynamic Weight Shifting Training Into Treadmill Training on Walking Function of Children with Cerebral Palsy: A Randomized Controlled Study. Am J Phys Med Rehabil. 2017; 96(11): 765–772.
- Moll F, Kessel A, Bonetto A, et al. Use of Robot-Assisted Gait Training in Pediatric Patients with Cerebral Palsy in an Inpatient Setting-A Randomized Controlled Trial. Sensors (Basel). 2022; 22(24).
- Wu M, Kim J, Gaebler-Spira DJ, et al. Robotic Resistance Treadmill Training Improves Locomotor Function in Children With Cerebral Palsy: A Randomized Controlled Pilot Study. Arch Phys Med Rehabil. 2017; 98(11): 2126–2133.
- Fu WS, Song YC, Wu BA, et al. Virtual reality combined with robot-assisted gait training to improve walking ability of children with cerebral palsy: A randomized controlled trial. Technol Health Care. 2022; 30(6): 1525–1533.
- Yaşar B, Atıcı E, Razaei D, et al. Effectiveness of Robot-Assisted Gait Training on Functional Skills in Children with Cerebral Palsy. J Pediatr Neurol. 2021; 20(03): 164–170.
- Peri E, Turconi AC, Biffi E, et al. Effects of dose and duration of Robot-Assisted Gait Training on walking ability of children affected by cerebral palsy. Technol Health Care. 2017; 25(4): 671–681.
- Conner BC, Remec NM, Orum EK, et al. Wearable Adaptive Resistance Training Improves Ankle Strength, Walking Efficiency and Mobility in Cerebral Palsy: A Pilot Clinical Trial. IEEE Open J Eng Med Biol. 2020; 1: 282–289.
- Manikowska F, Krzyżańska A, Chmara P, et al. Baseline Gross Motor Function Affects the Outcome of Robot-Assisted Therapy in Ambulatory Individuals with Spastic Cerebral Palsy. Brain Sci. 2021; 11(12).
- Maira B, Sholpan B. Effectiveness of the combined use of robotic kinesiotherapy and botulinum therapy in the complex rehabilitation of children with cerebral palsy. Asian J Pharmaceut Clin Res. 2018; 11(9): 360.
- van Hedel HJA, Meyer-Heim A, Rüsch-Bohtz C. Robot-assisted gait training might be beneficial for more severely affected children with cerebral palsy. Dev Neurorehabil. 2016; 19(6): 410–415.
- Pajaro-Blazquez M, Shetye R, Gallegos-Salazar J, et al. Robotic-Assisted Gait Training in Children with Cerebral Palsy in Clinical Practice. Biosystems Biorobot. 2013: 29–33.
- Moll F, Kessel A, Bonetto A, et al. Safety and Feasibility of Robot-assisted Gait Training in Adults with Cerebral Palsy in an Inpatient Setting - an Observational Study. J Dev Phys Disabil. 2023 [Epub ahead of print]: 1–16.
- Beretta E, Storm FA, Strazzer S, et al. Effect of Robot-Assisted Gait Training in a Large Population of Children With Motor Impairment Due to Cerebral Palsy or Acquired Brain Injury. Arch Phys Med Rehabil. 2020; 101(1): 106–112.
- De Luca R, Bonanno M, Settimo C, et al. Improvement of Gait after Robotic-Assisted Training in Children with Cerebral Palsy: Are We Heading in the Right Direction? Med Sci (Basel). 2022; 10(4).
- Bonato P. Unraveling Mechanisms Underlying the Effectiveness of Robot-Assisted Gait Training in Children with Cerebral Palsy. Biosystems Biorobot. 2013: 1139–1142.
- Kuroda MM, Mutsuzaki H, Nakagawa S, et al. Short-Term Outcome of Rehabilitation Program with Hybrid Assistive Limb after Tendon Lengthening in Patients with Cerebral Palsy. Pediatr Rep. 2022; 14(4): 505–518.
- Matsuda M, Iwasaki N, Mataki Y, et al. Immediate effects of a single session of robot-assisted gait training using Hybrid Assistive Limb (HAL) for cerebral palsy. J Phys Ther Sci. 2018; 30(2): 207–212.
- Beretta E, Storm FA, Strazzer S, et al. Effect of Robot-Assisted Gait Training in a Large Population of Children With Motor Impairment Due to Cerebral Palsy or Acquired Brain Injury. Arch Phys Med Rehabil. 2020; 101(1): 106–112.
- Wallard L, Dietrich G, Kerlirzin Y, et al. Robotic-assisted gait training improves walking abilities in diplegic children with cerebral palsy. Eur J Paediatr Neurol. 2017; 21(3): 557–564.
- Wallard L, Dietrich G, Kerlirzin Y, et al. Robotic-assisted gait training improves walking abilities in diplegic children with cerebral palsy. Eur J Paediatr Neurol. 2017; 21(3): 557–564.
- Gardner AW, Montgomery PS, Wang M. Minimal clinically important differences in treadmill, 6-minute walk, and patient-based outcomes following supervised and home-based exercise in peripheral artery disease. Vasc Med. 2018; 23(4): 349–357.
