Effect of robot assisted gait training on motor performance in cerebral palsy: a pilot study

Abstract

Purpose: Children with Cerebral Palsy (CP) have significantly impaired motor performance. There are various rehabilitation methods in rehabilitation in CP. Robot Assisted Gait Training (RAGT) is an alternative rehabilitation system in addition to ether therapies. This study aims to investigate effects of RAGT in children with CP.

Methods: 17 patients with spastic type CP, mean age 12.83±5.41 years, participated in this study. Muscles’ tone were assessed with “Modified Ashworth Scale”, motor developmental level was analysed by “Gross Motor Function Scale (GMFM)”, motor performance was assessed by “Gross Motor Performance Measure (GMPM)” balance and coordination was assessed with “Paediatric Balance Scale (PBS)”. GEO robotic systems designed by Reha- Technology was used in treatment for 10 weeks (45 minutes-3 days a week), which was composed of treadmill and stair training.

Results: The level of motor development, motor performance and balance has been detected to chance positively at the end of RAGT (p<0.05)

Discussion: Robotic rehabilitation method such as walking, climbing stairs has a positive effect on the motor performance and the balance parameters in patients with CP. However, there is not a certain protocol in which to define the level and duration of application of RAGT for these patients.

Keywords

• Cerebral palsy,Robotics,Motor Performance,Gait

Robot yardımlı yürüme eğitiminin serebral palside motor performans üzerine etkisi: pilot çalışma

Abstract

Amaç: Serebral palsili (SP) çocukların motor performansları ciddi derecede bozulmuştur. Sp rehabilitasyonunda pek çok rehabilitasyon metodu kullanılmaktadır. Robot yardımlı yürüyüş eğitimi konvansiyonel rehabilitasyonlara ek olarak uygulanan alternatif bir rehabilitasyon sistemidir. Çalışmanın amacı Robot Yardımlı Yürüyüş Eğitiminin (RYYE) SP’li çocuklarda motor performans üzerine etkisini araştırmaktır.

Yöntem: Spastik tip tanılı, 12.83±5.41 yıl yaş ortalamasında olan 17 hasta çalışmaya dahil edildi. Kas tonusu “Modifiye Ashworth Skalası” ile, motor gelişim seviyesi “Kaba Motor Fonksiyon Ölçütü” ile değerlendirildi, Motor performansı değerlendirmek için “Kaba Motor Performans Ölçütü”, denge ve koordinasyonu değerlendirmek amacıyla “Pediatrik Denge Skalası” kullanıldı. Düz zeminde yürüme ve merdiven çıkma olarak iki ayrı modda 10 hafta süreyle haftada 3 gün 45 dk olarak tedavi protokolü uygulandı. Eğitimlerde GEO robotik sistemi (Reha-Technology) kullanıldı.

Bulgular: RYYE sonunda motor gelişim seviyesi, motor performans ve denge parametrelerinde anlamlı pozitif değişimler görüldü (p<0.05).

Sonuç: Yürüme ve merdiven çıkma gibi aktiviteleri içeren robot destekli rehabilitasyonun motor performans ve denge üzerine olumlu etkileri vardır. Bununla birlikte RYYE’nin serebral palside uygulanabilirliği açısından, uygulamanın seviyesi veya durasyonu ile ilgili olarak belirli bir protokol veya görüş birliği bulunmamaktadır.

Keywords

• serebral palsi,robotik,motor performans,yürüme

References

1. 1. Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109:8-14.
2. 2. O’Shea TM. Diagnosis, treatment, and prevention of cerebral palsy in near-term/term infants. Clin Obstet Gynaecol. 2008;51:816.
3. 3. Graham HK, Rosenbaum P, Paneth N, et al. Cerebral palsy. Nat Rev Dis Primers. 2016;2:15082.
4. 4. Van Zelst B, Miller MD, Russo RN, et al. Activities of daily living in children with hemiplegic cerebral palsy: a cross-sectional evaluation using the assessment of motor and process skills. Dev Med Child Neurol. 2006;48:723-727.
5. 5. Beretta E, Romei M, Molteni E, et al. Combined robotic-aided gait training and physical therapy improve functional abilities and hip kinematics during gait in children and adolescents with acquired brain injury. Brain Inj. 2015;29:955-962.
6. 6. Aurich-Schuler T, Grob F, van Hedel HJ, et al. Can Lokomat therapy with children and adolescents be improved? An adaptive clinical pilot trial comparing Guidance force, Path control, and FreeD. J Neuroeng Rehabil. 2017;14:76.
7. 7. Schwartz I, Meiner Z. Robotic-Assisted Gait Training in Neurological Patients: Who May Benefit? Ann Biomed Eng. 2015;43:1260-1269.
8. 8. Hidler J, Wisman W, Neckel N. Kinematic trajectories while walking within the Lokomat robotic gait-orthosis. Clin Biomech. 2008;23:1251-1259.

9. 9. Mazzoleni S, Focacci A, Franceschini M, et al. Robot-assisted end-effector-based gait training in chronic stroke patients: A multicentric uncontrolled observational retrospective clinical study. NeuroRehabil. 2017:1-10.10. Alwardat M, Etoom M, Al Dajah S, et al. Effectiveness of robot-assisted gait training on motor impairments in people with Parkinson's disease: a systematic review and meta-analysis. Int J Rehabil Res. 2018;41:287-296.
10. 11. Boyce W, Gowland C, Rosenbaum P, et al. Gross motor performance measure for children with cerebral palsy: study design and preliminary findings. Can J Public Health. 1991;83:S34-S40.
11. 12. Kembhavi G, Darrah J, Magill-Evans J, et al. Using the berg balance scale to distinguish balance abilities in children with cerebral palsy. Pediatr Phys Ther. 2002;14:92-99.
12. 13. Franjoine MR, Gunther JS, Taylor MJ. Pediatric balance scale: a modified version of the berg balance scale for the school-age child with mild to moderate motor impairment. Pediatr Phys Ther. 2003;15:114-128.
13. 14. Hayes SC, James Wilcox CR, Forbes White HS, et al. The effects of robot assisted gait training on temporal-spatial characteristics of people with spinal cord injuries: A systematic review. J Spinal Cord Med. 2018:1-15.
14. 15. Bergmann J, Krewer C, Bauer P, et al. Virtual reality to augment robot-assisted gait training in non-ambulatory patients with a subacute stroke: a pilot randomized controlled trial. Eur J Phys Rehabil Med. 2018;54:397-407.
15. 16. Han EY, Im SH, Kim BR, et al. Robot-assisted gait training improves brachial–ankle pulse wave velocity and peak aerobic capacity in subacute stroke patients with totally dependent ambulation: Randomized controlled trial. Medicine. 2016;95:e5078.
16. 17. Esquenazi A, Lee S, Wikoff A, et al. A Comparison of Locomotor Therapy Interventions: Partial Body Weight− Supported Treadmill, Lokomat, and G-EO Training in People With Traumatic Brain Injury. PM R. 2017;9:839-846.
17. 18. Carvalho I, Pinto SM, Chagas DD, et al. Robotic Gait Training for Individuals With Cerebral Palsy: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2017;98:2332-2344.
18. 19. Borggraefe I, Klaiber M, Schuler T, et al. Safety of robotic-assisted treadmill therapy in children and adolescents with gait impairment: a bicentre survey. Dev Neurorehab. 2010;13:114-119.
19. 20. Wu M, Kim J, Arora P, et al., editors. Locomotor training through a 3D cable-driven robotic system for walking function in children with cerebral palsy: A pilot study. 2014 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society; 2014: IEEE.
20. 21. Kurz MJ, Wilson TW, Corr B, et al. Neuromagnetic Activity of the Somatosensory Cortices Associated With Body Weight–Supported Treadmill Training in Children With Cerebral Palsy. J Neurol Phys Ther. 2012;36:166-172.
21. 22. Van Hedel HJ, Meyer-Heim A, Rüsch-Bohtz C. Robot-assisted gait training might be beneficial for more severely affected children with cerebral palsy: Brief report. Dev Neurorehab. 2015:1-6.
22. 23. Gibson BE, Teachman G. Critical approaches in physical therapy research: investigating the symbolic value of walking. Physiother Theory Pract. 2012;28:474-484.
23. 24. Wiart L, Darrah J. Changing philosophical perspectives on the management of children with physical disabilities--their effect on the use of powered mobility. Disabil Rehabil. 2002;24:492-498.
24. 25. Garth B, Aroni R. 'I value what you have to say'. Seeking the perspective of children with a disability, not just their parents. Disabil Soc. 2003;18:561-576.