Training intensity of robot-assisted gait training in children with cerebral palsy

Abstract

To enhance active participation and independence in daily living, a key therapeutic goal for patients with cerebral palsy (CP) is to improve walking ability. Recent advances in technology suggested that robot-assisted gait training (RAGT) may be an alternative method of treatment. The authors compared three different intensities of RAGT for achieving favourable outcomes in children with CP. This study was conducted using a randomized controlled, single-blind design, which is set up so that the treatment each participant receives is not known by the participants but is known by the researchers.

Thirty children with CP classified in Gross Motor Function Classification System levels II and III were assigned to three different RAGT intensity groups: (1) high-intensity (fastest walking speed and lowest body weight support [BWS]); (2) low-intensity (slowest speed and highest BWS); and (3) comfortable intensity (intermediate speed and intermediate BWS).

The RAGT intervention was performed three times a week for 6 weeks with each group using the Walkbot-K system. The Walkbot-K is a trajectory-controlled, treadmill-tethered, robot-assisted locomotor training device with a built-in ankle actuator to assist ankle motion.

The Gross Motor Function Measure (GMFM) is an observational clinical tool designed to evaluate change in gross motor function in children with CP. The 88-item GMFM was significantly improved after training in the high-intensity and comfortable intensity groups, whereas gait speed was improved in the comfortable intensity group, without statistically significant group differences. Only the low-intensity group showed improvement on the stability index. Everyday functional performance significantly improved in all three groups, with the comfortable intensity group showing the greatest improvement.