The effectiveness of robot assisted gait training in children with cerebral palsy: Randomized comparative trial

Aim: Cerebral Palsy (CP) is a group of permanent disorders of motor function, posture and movement development that develops because of a non-progressive lesion in the developing fetal or infant brain, but can change with age, leading to activity limitation. There is evidence that gait training therapy for regaining walking capacity using the principle of enhancing neuroplasticity by task-specific training is effective in the rehabilitation of patients with gait disorders. The use of robotic walking devices for this purpose helps to establish and maintain physiological walking pattern. The use of robotic devices is increasing day by day as an alternative treatment to improve walking function in children with CP. This study is designed to compare the effectiveness of conventional physical therapy (CPt) and robot assisted gait training (RAGT) on gait related gross motor functions of children with CP. Materials and Methods: This is a prospective, randomized comparative trial. Children aged 5 to 18 years with GMFCS Level II-IV, bilateral or unilateral spastic CP are included in this study. Children are randomly assigned to receive CPt or CPt+RAGT. All two intervention groups will receive 2-3 sessions of CPt per week. The CPt+RAGT group also receive 15 sessions of RAGT (2-3 times per week). Gross Motor Function Measure-88 (GMFM-88), Six-minute walk test (6MWT), Ten-meter walk test (10MWT), Modified Ashworth Scale (MAS), Goal Attainment Scale, Pediatric Quality of Life Inventory 3.0 SP Module were used as evaluation parameters. All patients were evaluated before treatment (T1), after treatment (T2), 6 weeks after the end of treatment (T3) and 12 weeks after the end of treatment (T4). Results: As a result of this study, statistically significant improvement was found in GMFM total score (p = 0.044) and GMFM-D (p=0.028) in CPt+RAGT group compared to the CPt group. In the CPt+RAGT group; the difference of GMFM-88 total score between T1-T2 (p=0.014); T1-T3 (p=0.003) and T1-T4 (p<0.001) was statistically significant; in the CPt group, no statistically significant difference was found in terms of GMFM-88 total score (p=0.494) and GMFM-D (p=0.534). While there was no significant difference between the groups in GMFM-E (p=0.067), the improvement with treatment was statistically significant regardless of group (p=0.001). The difference between T1-T2 (p=0.025); T1-T3 (p=0.001) and T1-T4 (p=0.001) in GMFM-E was statistically significant. No significant improvements were found in 6MWT (p=0.997) and 10MWT (p=0.810) with treatment in both groups. No significant difference was found for the change of lower extremity spasticity with treatment in both groups. Significant difference was found in Goal Attainment Scale, between T1-T2 (p=0.035) and T1-T4 (p=0.035) in the CPt+RAGT group for the first goal; no significant difference was found for the second goal in the CPt+RAGT group and for both goals in the CPt group. The change in Paediatric Quality of Life Inventory results over time does not differ significantly according to the treatment method received (p = 0.767). Conclusions: As a result of this study, there was improvement in gross motor functions of children with CP, with RAGT in addition to CPt, while no significant changes were found in walking distance, walking speed, lower extremity spasticity and quality of life. RAGT in addition to CPt is an effective, applicable, and reliable method to improve the gross motor functions of children with CP. Key Words: cerebral palsy, robotics, physical therapy, functional status, spasticity, quality of life