Evidence for gait improvement with robotic-assisted gait training of children with cerebral palsy remains uncertain

Mátyás Vezér; Orsolya Gresits; Marie Anne Engh; Laszlo Szabó; Zsolt Molnar; Peter Hegyi; Tamás Terebessy

doi:10.1016/j.gaitpost.2023.08.016

Evidence for gait improvement with robotic-assisted gait training of children with cerebral palsy remains uncertain

Gait Posture. 2024 Jan:107:8-16. doi: 10.1016/j.gaitpost.2023.08.016. Epub 2023 Sep 1.

Authors

Mátyás Vezér¹, Orsolya Gresits¹, Marie Anne Engh², Laszlo Szabó², Zsolt Molnar³, Peter Hegyi⁴, Tamás Terebessy⁵

Affiliations

¹ Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary.
² Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary.
³ Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary; Department of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland.
⁴ Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Baross út 22-24, 1085 Budapest, Hungary.
⁵ Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary. Electronic address: terebessy.tamas@med.semmelweis-univ.hu.

PMID: 37703782
DOI: 10.1016/j.gaitpost.2023.08.016

Abstract

Background: Cerebral palsy (CP) is a group of neuromotor diseases that develops as a result of damage to the developing central nervous system during the perinatal period. The condition is usually accompanied by musculoskeletal problems resulting in movement disorders. Gait improvement therefore, is an important part of its treatment. Roboticassisted gait training (RAGT) is a new potential rehabilitation tool for CP patients, however there is no clear evidence for the effectiveness of this method.

Research question: Can robotic-assisted gait training improve walking function in children with CP?

Methods: A systematic search was performed in five databases: MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Scopus, and Web of Science. Eligible studies were randomized controlled trials (RCT) with CP patients under the age of 18. Gross motor function and kinematic gait parameters of patients were the main outcomes. Two authors determined the risk of bias of the RCTs independently using the revised Risk of Bias 2 (ROB 2) tool. Mean Differences (MDs) along with their 95% Confidence Interval (CI) were calculated when at least three studies were present for an outcome, subgroup analysis was performed based on the treatment of the control group.

Results: Of the 7363 screened articles, 13 papers met our inclusion criteria and among them, 7 studies could be used in our meta-analyses. The results related to RAGT suggest nonsignificant improvement in standing and walking function (Gross Motor Function Measure D, E), moreover changes in gait speed, step length, and in cadence were also only comparable to controls.

Significance: The results indicate that there is a trend in some gait parameters where the improvement was higher in the intervention group than in control group. The therapeutic effect of RAGT was probably not superior to physiotherapy combined with treadmill training.

Keywords: Cadence; E; Gait speed; Gross motor function measurement D; Step length.

Publication types

Review

MeSH terms

Cerebral Palsy*
Child
Exercise Therapy / methods
Gait
Humans
Randomized Controlled Trials as Topic
Robotic Surgical Procedures*
Walking