EFFECT OF ROBOTIC-ASSISTED GAIT TRAINING ON RANGE OF MOTION, MUSCLE STRENGHT AND SPASTICITY IN CHILDREN WITH CEREBRAL PALSY

D. Djuric¹, D.L. Puerto², N.M. Ahmed², A. Al Saadi², A.I.M. Ibrahim²

¹Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates, ²Zayed Higher Organization for People of Determination, Abu Dhabi, United Arab Emirates

Background: Children with cerebral palsy have motor impairments affecting functional activities. Walking difficulties in cerebral palsy negatively impact on children’s participation and their quality of life. Overground gait training with or without body support is quite challenging for both therapists and children. Robotic-assisted gait treadmill training (Lokomat) reduces the effort of therapist and children to a greater extent. It is a type of intensive training which is individually tailored and suitable for children with mild to severe functional deficits and also for those with lower cognitive ability.

Purpose: The aim of the study was to assess the effectiveness of robotic-assisted gait treadmill training (Lokomat) as an adjunct to traditional physiotherapy in improving range of motion and muscle strength and decreasing spasticity in lower extremities in children with cerebral palsy.

Methods: Twenty-six participants (mean age 7.69±2.90 years), level I-IV on Gross Motor Function Classification System ( 38.5 % level I-II and 61.5% level III-IV) , with a bilateral and unilateral form of cerebral palsy went under intensive 20 Lokomat and 20 traditional physiotherapy sessions, each training session lasting 40 minutes. Pre and post-testing was done using goniometer measure, manual muscle testing and modified Ashworth scale (MAS).

Results: Positive effects were seen in participants who underwent a combination of Lokomat training and traditional therapy. Increase in range of motion was minimal (2 to 4 degree) in hip- flexion, extension, abduction. The significant improvement was in ankle dorsiflexion p= 0.003 on right and p=0.006 left while knee extension p=0.062 left and p= 0.075 right side. Increase of muscle strength in 30.8% – 80 % was seen in participants with the highest recorded on quadriceps 68%-80 %. Asymmetrical reduction of spasticity 7.7 % – 26.9 % with highest being in adductors, hamstrings, and gastrocnemius.

Conclusions: Lokomat training is an adjunct to conventional physiotherapy with negligible effect on range of motion, muscle strength and spasticity in lower limb in cerebral palsy children.

Implications: There are limited studies assessing the impact of robotic-assisted treadmill gait training on motor impairments and further research is required in cerebral palsy children according to their age and functional levels. The studies are needed to link their impairment to activity limitations.

Funding acknowledgements: None

Keywords:
robotic-assisted gait treadmill training
cerebral palsy
motor impairments

Topics:
Innovative technology: robotics
Paediatrics: cerebral palsy
Paediatrics

Did this work require ethics approval? Yes

Institution: Fatima College of Health Sciences

Committee: Dr. Ahmed Saifan Chair of FCHS Ethics Committee

Ethics number: INTSTF018PHY20