A Narrative Review on Robotic-Assisted Gait Training in Children and Adolescents with Cerebral Palsy: Training Parameters, Choice of Settings, and Perspectives
Abstract
:1. Introduction: A Summary of Pertinent Research
2. Evidence of the Effectiveness of Robotic Gait Training in Children and Adolescents with Cerebral Palsy
3. Training Parameters and Settings
4. Discussion and Recommendations for Clinical Practice
4.1. Training Parameters
4.2. Choice of Settings
4.3. Effectiveness of RAGT Training
4.4. Patient-Specific Determinants of Responsiveness
4.5. Perspectives
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Authors | Design | N of Subjects | Intervention | ICF Domains | Main Results |
---|---|---|---|---|---|
Borggraefe et al. [23] | Pre/post with follow-up | 20 patients with CP; age = 5–20 yrs; GMFCS = I–VI | Lokomat trianing | Activity | Improved GMFM-66 score, walking endurance (6-MWT), and comfortable walking speed. Improvements were maintained at follow-up. |
Schroeder et al. [24] | Prospective controlled cohort | 18 patients with CP; age = 5–21 yrs; GMFCS = I–VI | Lokomat training | Activity and participation | Significant improvement in GMFM-66 score and COPM (participation). Improvements were maintained after 8 weeks of follow-up. |
Van Hedel et al. [25] | Retrospective | 67 patients with CP; age = 4–20 yrs; GMFCS II–IV | Lokomat training combined to conventional therapy | Activity | Improved function (as measured by the WeeFIM test) and walking speed. |
Klobucká et al. [26] | Pre/post | 51 patients with CP; age = 4–27 yrs; GMFCS = I–IV | Lokomat training | Activity | Improvement in GMFM A, B, C, D, and E scores, maximum walking speed, and walking endurance (6-MWT). |
Meyer-Heim et al. [27] | Pre/post | 22 patients with CP; age = 5–12 yrs; GMFCS = II–IV | Lokomat training | Activity | Improvements in GMFM D and E scores, walking endurance (6-MWT), and walking speed. |
Cherni et al. [28] | Pre/post with follow-up | 24 patients with CP; age = 7–20 yrs; GMFCS = II–IV | Lokomat training | Body function and activity | Increased hip and knee flexors and extensors’ strength, comfortable walking speed (+20%), and step length (+14%). Increase in walking endurance (6-MWT) was maintained at follow-up. No change in gait pattern. |
Beretta et al. [29] | Retrospective | 72 patients with CP; age = 4–18 yrs; GMFCS = I–IV | Lokomat training combined to conventional therapy | Activity | Improvement in walking endurance (6-MWT). No improvement in GMFM-88 scores. |
Aras et al. [30] | RCT | 30 patients with CP; age = 6–4 yrs; GMFCS = II–III | Lokomat training (n = 10) vs. anti-gravity training (n = 10), and BWSTT (n = 10) | Activity | Increased cadence, stride length, and stride time after anti-gravity training. Decreased double-support time was significant in the anti-gravity and Lokomat training. Increased GMFM-D, GMFM-E, and walking endurance (6-MWT) in all the groups. |
Petrarca et al. [31] | Pre/post | 24 participants with CP; age = 4–13 yrs; GMFCS = I–IV | Lokomat training combined with conventional therapy | Activity | All improved GMFM D, while dimension E improved only for younger and more severely affected patients. No change in gait pattern. |
Wallard et al. [32,33] | RCT | 14 patients with CP (jump gait) age = 8–10 yrs; GMFCS II–III | Lokomat training combined to virtual reality | Activity | Improvement of knee and ankle sagittal kinematics as well as dynamic balance control after Lokomat training combined with virtual reality. |
Druzbicki et al. [34] | RCT | 35 patients with CP; age = 6–13 yrs; GMFCS = II–III | Lokomat training (n = 10) vs. control group (n = 9) | Activity | Improvement in balance, step length, and maximum hip flexion amplitude. |
Ammann-Reiffer et al. [35] | RCT | 16 patients with CP; age = 6.0–15.3 years; GMFCS = II–IV | Lokomat training (n = 8) vs. control group (n = 8) | Activity domain | Neither GMFM nor walking speed and endurance (6-MWT) changed significantly after Lokomat training. |
Studies | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | Total (/10) |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Borggraefe et al. [23] | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | 1 | 3/10 (low) |
Schroeder et al. [24] | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 4/10 (fair) |
Van Hedel et al. [25] | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 1 | 2/10 (low) |
Klobucká et al. [26] | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | 1 | 3/10 (low) |
Meyer-Heim et al. [27] | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | 1 | 3/10 (low) |
Cherni et al. [28] | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | 1 | 3/10 (low) |
Beretta et al. [29] | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 (good) |
Aras et al. [30] | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 0 | 1 | 1 | 7/10 (good) |
Petrarca et al. [31] | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | 1 | 3/10 (low) |
Wallard et al. [32,33] | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 0 | 1 | 1 | 7/10 (good) |
Druzbicki et al. [34] | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 0 | 0 | 1 | 1 | 6/10 (good) |
Ammann-Reiffer et al. [35] | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 (good) |
Studies | Training Parameters | Lokomat Settings |
---|---|---|
Borggraefe et al. [23] | 50 min per session, 4 sessions per week for 3 weeks | Speed was set at 1.1 km/h and gradually increased to 1.8 km/h. BWS started at 100% and then decreased as much as possible. Guidance was adjusted according to clinical judgement. Progression of settings not described except for speed. |
Schroeder et al. [24] | 30–39 min per session, 4 sessions per week for 3 weeks | No information about Lokomat settings. |
Van Hedel et al. [25] | At least one session | No information about Lokomat settings. |
Klobucká et al. [26] | 20–25 min per session, 3–5 sessions per week for 5–6 weeks | Training speed ranged from 1.1 m/s for severely impaired patients to 1.8 m/s for the mildly impaired group. |
Meyer-Heim et al. [27] | 45–60 min per session, 3–5 sessions per week for 3–5 weeks | No information about Lokomat settings. |
Cherni et al. [28] | 30–45 min per session, 2 sessions per week for 12 weeks | Speed was set at 1.2 km/h and gradually increased to 1.8 km/h. BWS started at 47% and then decreased to 22%. Guidance was initially set at 100% and gradually decreased to 65%. |
Beretta et al. [29] | 45 min per session, 5 sessions per week for 4 weeks | For all patients, the same exercises were offered with a set duration, speed, and difficulty. BWS started at 50% and gradually decreased according to the patient’s functional capacity. Guidance was initially set to 100% and gradually decreased. Progression of settings not described. |
Aras et al. [30] | 45 min per session, 5 sessions per week for 4 weeks | Speed was set to the child’s average walking speed. BWS started at 60% and gradually decreased to a level which prevented the collapse of the knee in flexion during the stance phase. No information about guidance. Progression of settings not described. |
Petrarca et al. [31] | 30 min per session, 5 sessions per week for 4 weeks | No information about Lokomat settings. |
Wallard et al. [32,33] | 40 min per session, 5 sessions per week for 4 weeks | Speed was set at 0.7 km/h and gradually increased to 1.4 km/h. BWS started at 70% and then decreased to 40%. No information about guidance. |
Druzbicki et al. [34] | 45 min per session, 4 sessions per week for 5 weeks | No information about Lokomat settings. |
Ammann-Reiffer et al. [35] | 30–45 min per session, 3 sessions per week for 5 weeks | No information about Lokomat settings. |
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Cherni, Y.; Ziane, C. A Narrative Review on Robotic-Assisted Gait Training in Children and Adolescents with Cerebral Palsy: Training Parameters, Choice of Settings, and Perspectives. Disabilities 2022, 2, 293-303. https://doi.org/10.3390/disabilities2020021
Cherni Y, Ziane C. A Narrative Review on Robotic-Assisted Gait Training in Children and Adolescents with Cerebral Palsy: Training Parameters, Choice of Settings, and Perspectives. Disabilities. 2022; 2(2):293-303. https://doi.org/10.3390/disabilities2020021
Chicago/Turabian StyleCherni, Yosra, and Clara Ziane. 2022. "A Narrative Review on Robotic-Assisted Gait Training in Children and Adolescents with Cerebral Palsy: Training Parameters, Choice of Settings, and Perspectives" Disabilities 2, no. 2: 293-303. https://doi.org/10.3390/disabilities2020021