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Matsuda T.1,2, Tagami M.1,2, Fukuhara I.2, Hanai T.2, Nitta O.3, Kusumoto Y.4, Koyama T.5, Nezu A.2
1Uekusa Gakuen University, Physical Therapy, Chiba, Japan, 2Yokohama Residential Care and Medical Centre for Developmentally Disabled Person, Rehabilitation, Yokohama, Japan, 3Tokyo Metropolitan University, Graduate School of Human Health Sciences, Tokyo, Japan, 4Tokyo University of Technology, Physical Therapy, Tokyo, Japan, 5Nihon University, Tokyo, Japan
Background: Although gait rehabilitation using robot suits has been reported somewhat effective in patients with stroke or spinal cord injuries, few reports included children with cerebral palsy (CP). Robot suits have been developed to enhance use of knees and elbows including hybrid assistive limbs single joint type (single joint type ; HAL-SJ).
Purpose: We studied the short and long term effects on gait speed and standing ability (increased equilibration function) in children with CP using HAL-SJ.
Methods: Four subjects, with CP (age, 9-16 yrs), showed spastic diplegia at gross motor function classification system (GMFCS) levels I to III requiring ankle-foot orthosis. HAL-SJ training included knee flexion and extension exercises during sitting and standing for 20-30 minutes, and gait and stepping, pedaling exercises for 20-30 minutes. Data from CWS (comfort walking speed) and MWS (maximum walking speed) trials of 10-meter walk test and postural balance was measured by Gravicorder GS-31P stabilometer (Anima Co.) during two trials of 30-s under condition of static upright posture with eyes open, before and after training, were compared. Walking speed and postural balance change was analyzed by Wilcoxon rank sum test with change in standing posture evaluated by a physical therapist. Written informed consent was obtained from participants and their parents.
Results: The mean pace in gait 61.2±13.8m/min (CWS), 79.2±9.2m/min (MWS) was improved to 68.8±10.9m/min (CWS), 87.4±15.4 m/min (MWS) after training (p 0.05). The mean stride 52.3±7.9 cm (CWS) was lengthened to 55.1±8.0 cm (CWS) after training (p 0.05). Static balance decreased ENV/AREA, before and after training (p 0.05). All subjects showed noticeably improved walking posture at all stages, especially in extension movement of knee, and these improvements continued for a short period after removing their HAL-SJ.
Conclusion(s): Just one trial of HAL-SJ training soon improved gait in CP, suggesting HAL-SJ modulates motor control in children with CP. Not only movement of the knee but hip joint control of the proximal joint was enhanced. In particular, the visual feedback for muscle activity on a HAL monitor seemed to be useful for correcting joint movement by oneself. Exercise therapy using HAL-SJ was effective to improve standing posture and gait function.
Implications: Further study is requested for confirming this effectiveness of a HAL and HAL-SJ on spastic gait in childhood CP.
Funding acknowledgements: The authors wish to acknowledge Dr Shigeyuki Imura for her help in interpreting the significance of this study.
Topic: Paediatrics
Ethics approval: This study conformed to the tenets of the Declaration of Helsinki. Our study protocol was approved by the ethics committee.
All authors, affiliations and abstracts have been published as submitted.
