Existing evidence of SRE for preschool children with CP is limited and mainly use soft robotics ankle device. The purpose of this study is to investigate the effectiveness of SRE (knee device) on walking gait and functional mobility in single case with CP in routine training.
A Longitudinal single case study was designed. A 5 years old male child with CP functioning at Gross Motor Function Classification System (GMFCS) level 3 was recruited by convenient sampling in community special child care centres of Heep Hong Society in Hong Kong. Informed consent was obtained from parent. A phase of 6 weeks conventional routine treadmill walking training twice weekly was arranged at the beginning. Followed by two phases of 6 weeks SRE assisted routine treadmill training twice weekly. A break of summer vacation (around 6 weeks) was given afterwards. SRE knee device with actuators and force sensors (Flexiforce A401) were used in order to improve his crouch gait. The treadmill walking speed were set at 0.8 KPH and the child was walking with hands holding onto rails. SRE assisted routine treadmill training were conducted by centre physiotherapist with technical support by university biomedical engineering student volunteers experienced with the soft robotic device. Pre and post tests of 1) 6-meter walk using Kaye walker (time, average stride length and cadence), 2) Static standing balance, 3) Modified perceived competence scale for child and 4) Caregiver questionnaire were collected by blinded supporting physiotherapist. Percentage changes between pre and post assessment information were analyzed.
No obvious change in walking time, cadence or average stride length was noted after routine treadmill walking training period. After the SRE assisted routine treadmill training, significant improvement of walking time (87%), average stride length (150%), cadence (203%) and static standing balance (61%) were obtained. The child reported to feel walking was an easy task and became very competent to walk with a Kaye walker. His caregiver also agreed that his walking gait improved especially found that he stood with straight knees. After the summer holidays when no routine training was provided, objective measurements revealed same results while static standing balance continued to improve.
Application of SRE during routine training using treadmill can improve walking gait and functional mobility of preschool child with CP and (GMFCS) level 3.
Choice of soft robotic device is crucial depending on the aim of training. Physiotherapists take important role in making the decision and design routine training program for children with CP. SRE with user-friendly devices may further enhance the training effect in the future.
Cerebral Palsy
Gait Training
