Effects of robot-assisted gait training on walking abilities of children with cerebral palsy

Cerebral palsy (CP) is the most common cause of movement disorders in childhood and is associated with abnormal muscle tone, low range of motion, and muscle weakness. These impairments reduce walking ability. Robotic-assisted gait training (RAGT; e.g. Lokomat) are considered as a promising approach for gait rehabilitation in patients with neurologic impairment. However, the evidence on its effectiveness in pediatric rehabilitation is still scarce. This study aimed to evaluate whether gait training using the RAGT can improve walking abilities in children with CP. Twenty-three children (age: 10±3 yrs, GMFCS: II-IV) with CP completed a RAGT program (2 sessions/week of 30–45min for 12 weeks). RAGT sessions included oriented task exercises (e.g., pass an obstacle). Lokomat settings were individually set according to each participant's functional level. Outcome measures were spatiotemporal parameters, lower limb isometric strength (i.e., hip flexors, extensors and abductors and knee flexors and extensors) and the distance traveled during a 6-min walking exercise (6mwe). GLM repeated measures and Tukey post-hoc tests were used to compare outcomes in pre-, post-training and 6-month follow-up. All outcomes (except single support duration and hip flexors strength) were improved in post-training and maintained after 6-months. Comfortable walking speed increased by +21.6% (+0.14m/s, P=0.012), mainly explained by step length (+0.06m, P≤0.01). Muscle strength increased by 27 to 68% in post-training. The endurance measured by 6mwe increased by +22.3% (P≤0.01). RAGT increases global walking capacities in children with CP. Lokomat training could be viewed as a valuable training modality for children with CP.