1
|
Vezér M, Gresits O, Engh MA, Szabó L, Molnar Z, Hegyi P, Terebessy T. Evidence for gait improvement with robotic-assisted gait training of children with cerebral palsy remains uncertain. Gait Posture 2024; 107:8-16. [PMID: 37703782 DOI: 10.1016/j.gaitpost.2023.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Cerebral palsy (CP) is a group of neuromotor diseases that develops as a result of damage to the developing central nervous system during the perinatal period. The condition is usually accompanied by musculoskeletal problems resulting in movement disorders. Gait improvement therefore, is an important part of its treatment. Roboticassisted gait training (RAGT) is a new potential rehabilitation tool for CP patients, however there is no clear evidence for the effectiveness of this method. RESEARCH QUESTION Can robotic-assisted gait training improve walking function in children with CP? METHODS A systematic search was performed in five databases: MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Scopus, and Web of Science. Eligible studies were randomized controlled trials (RCT) with CP patients under the age of 18. Gross motor function and kinematic gait parameters of patients were the main outcomes. Two authors determined the risk of bias of the RCTs independently using the revised Risk of Bias 2 (ROB 2) tool. Mean Differences (MDs) along with their 95% Confidence Interval (CI) were calculated when at least three studies were present for an outcome, subgroup analysis was performed based on the treatment of the control group. RESULTS Of the 7363 screened articles, 13 papers met our inclusion criteria and among them, 7 studies could be used in our meta-analyses. The results related to RAGT suggest nonsignificant improvement in standing and walking function (Gross Motor Function Measure D, E), moreover changes in gait speed, step length, and in cadence were also only comparable to controls. SIGNIFICANCE The results indicate that there is a trend in some gait parameters where the improvement was higher in the intervention group than in control group. The therapeutic effect of RAGT was probably not superior to physiotherapy combined with treadmill training.
Collapse
Affiliation(s)
- Mátyás Vezér
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary
| | - Orsolya Gresits
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary
| | - Marie Anne Engh
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary
| | - Laszlo Szabó
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary
| | - Zsolt Molnar
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary; Department of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Peter Hegyi
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Baross út 22-24, 1085 Budapest, Hungary
| | - Tamás Terebessy
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary.
| |
Collapse
|
2
|
Bonanno M, Militi A, La Fauci Belponer F, De Luca R, Leonetti D, Quartarone A, Ciancarelli I, Morone G, Calabrò RS. Rehabilitation of Gait and Balance in Cerebral Palsy: A Scoping Review on the Use of Robotics with Biomechanical Implications. J Clin Med 2023; 12:jcm12093278. [PMID: 37176718 PMCID: PMC10179520 DOI: 10.3390/jcm12093278] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/22/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Cerebral palsy (CP) is a congenital and permanent neurological disorder due to non-progressive brain damage that affects gross motor functions, such as balance, trunk control and gait. CP gross motor impairments yield more challenging right foot placement during gait phases, as well as the correct direction of the whole-body center of mass with a stability reduction and an increase in falling and tripping. For these reasons, robotic devices, thanks to their biomechanical features, can adapt easily to CP children, allowing better motor recovery and enjoyment. In fact, physiotherapists should consider each pathological gait feature to provide the patient with the best possible rehabilitation strategy and reduce extra energy efforts and the risk of falling in children affected by CP.
Collapse
Affiliation(s)
- Mirjam Bonanno
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Palermo, SS 113, C. da Casazza, 98124 Messina, Italy
| | - Angela Militi
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98125 Messina, Italy
| | - Francesca La Fauci Belponer
- Neuropsichiatria Infantile, Azienda Ospedaliera Universitaria (AOU), Policlinico "Gaetano Martino", 98125 Messina, Italy
| | - Rosaria De Luca
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Palermo, SS 113, C. da Casazza, 98124 Messina, Italy
| | - Danilo Leonetti
- Department of Biomedical, Dental and Morphological and Functional Images, Section of Orthopaedic and Traumatology, University of Messina, 98125 Messina, Italy
| | - Angelo Quartarone
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Palermo, SS 113, C. da Casazza, 98124 Messina, Italy
| | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
- ASL 1 Abruzzo (Avezzano-Sulmona-L'Aquila), 67100 L'Aquila, Italy
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
- San Raffaele Institute of Sulmona, 67039 Sulmona, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Palermo, SS 113, C. da Casazza, 98124 Messina, Italy
| |
Collapse
|
3
|
Pouliot-Laforte A, Franco Carvalho M, Bonnefoy-Mazure A, Armand S. How many observations in the reference dataset are required to compute a consistent Gait Deviation Index & Gait Profile Score? Gait Posture 2023; 99:51-53. [PMID: 36327538 DOI: 10.1016/j.gaitpost.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The Gait Deviation Index (GDI) and the Gait Profile Score (GPS) are the most used scores to sum up gait deviations and are used as primary outcomes in many clinical studies. They are considered as equivalent scores. The computation of these scores is based on a reference dataset but often no description is provided. Among other characteristics, the number of observations needed and its possible influence on the computation of the scores remains unknown. RESEARCH QUESTION Define the number of observations needed in the reference dataset to compute consistent and reliable GDI and GPS. METHODS Fifty individuals with cerebral palsy (CP) were randomly selected from our laboratory database. Both scores were computed based on the reference dataset of Schwartz et al. (2008). A bootstrap analysis was performed, for every individual, to assess the effect of the number of observations on both scores. N number of observations were randomly selected, with replacement, from the reference dataset. This procedure was repeated 2000 times for every individual and every N and performed from N = 5 to N = 165 with an increment of 5. The 95 % of the absolute error distribution was considered for every individual and every N. The smallest detectable change (SDC) for both scores was considered as a threshold (GDI: 10.8; GPS:1.3°) to determine the minimum N required. RESULTS AND SIGNIFICANCE A minimum of 90 and 20 observations are required to compute consistent GDI and GPS, respectively. The number of observations has a higher impact on the GDI than the GPS, mainly because the GPS calculation does not rely on the standard deviation (SD). Furthermore, the GDI absolute error seems to be higher in individuals with greater gait deviations, i.e. lower GDI value. This effect was not observed on the GPS. In the case of a small reference dataset, the GPS should therefore be preferred.
Collapse
Affiliation(s)
- Annie Pouliot-Laforte
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Marys Franco Carvalho
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Alice Bonnefoy-Mazure
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| |
Collapse
|
4
|
Cortés-Pérez I, González-González N, Peinado-Rubia AB, Nieto-Escamez FA, Obrero-Gaitán E, García-López H. Efficacy of Robot-Assisted Gait Therapy Compared to Conventional Therapy or Treadmill Training in Children with Cerebral Palsy: A Systematic Review with Meta-Analysis. SENSORS (BASEL, SWITZERLAND) 2022; 22:9910. [PMID: 36560281 PMCID: PMC9785795 DOI: 10.3390/s22249910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Motor, gait and balance disorders reduce functional capabilities for activities of daily living in children with cerebral palsy (CP). Robot-assisted gait therapy (RAGT) is being used to complement conventional therapy (CT) or treadmill therapy (TT) in CP rehabilitation. The aim of this systematic review is to assess the effect of RAGT on gait, balance and functional independence in CP children, in comparison to CT or TT. METHODS We have conducted a systematic review with meta-analysis. A search in PubMed Medline, Web of Science, Scopus, CINAHL, PEDro and SciELO has been conducted for articles published until October 2022. Controlled clinical trials (CCT), in which RAGT was compared to TT or CT and assessed gait speed, step and stride length, width step, walking distance, cadence, standing ability, walking, running and jumping ability, gross motor function and functional independence in children with CP, have been included. Methodological quality was assessed with the PEDro scale and the pooled effect was calculated with Cohen's Standardized Mean Difference (SMD) and its 95% Confidence Interval (95% CI). RESULTS A total of 15 CCTs have been included, providing data from 413 participants, with an averaged methodological quality of 5.73 ± 1.1 points in PEDro. The main findings of this review are that RAGT shows better results than CT in the post-intervention assessment for gait speed (SMD 0.56; 95% CI 0.03 to 1.1), walking distance (SMD 2; 95% CI 0.36 to 3.65) and walking, running and jumping ability (SMD 0.63; 95% CI 0.12 to 1.14). CONCLUSIONS This study shows that the effect of RAGT is superior to CT on gait speed, walking distance and walking, running and jumping ability in post-intervention, although no differences were found between RAGT and TT or CT for the remaining variables.
Collapse
Affiliation(s)
- Irene Cortés-Pérez
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Road Sacramento s/n, 04120 Almería, Spain
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaén, Spain
| | | | | | - Francisco Antonio Nieto-Escamez
- Department of Psychology, University of Almería, Road Sacramento s/n, La Cañada, 04120 Almería, Spain
- Center for Neuropsychological Assessment and Neurorehabilitation (CERNEP), University of Almería, Road Sacramento s/n, La Cañada, 04120 Almería, Spain
| | - Esteban Obrero-Gaitán
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaén, Spain
| | - Héctor García-López
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Road Sacramento s/n, 04120 Almería, Spain
| |
Collapse
|
5
|
Feasibility of Overground Gait Training Using a Joint-Torque-Assisting Wearable Exoskeletal Robot in Children with Static Brain Injury. SENSORS 2022; 22:s22103870. [PMID: 35632279 PMCID: PMC9144762 DOI: 10.3390/s22103870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/08/2022] [Accepted: 05/17/2022] [Indexed: 02/04/2023]
Abstract
Pediatric gait disorders are often chronic and accompanied by various complications, which challenge rehabilitation efforts. Here, we retrospectively analyzed the feasibility of overground robot-assisted gait training (RAGT) using a joint-torque-assisting wearable exoskeletal robot. In this study, 17 children with spastic cerebral palsy, cerebellar ataxia, and chronic traumatic brain injury received RAGT sessions. The Gross Motor Function Measure (GMFM), 6-min walk test (6 MWT), and 10-m walk test (10 MWT) were performed before and after intervention. The oxygen rate difference between resting and training was performed to evaluate the intensity of training in randomly selected sessions, while the Quebec User Evaluation of Satisfaction with assistive Technology 2.0 assessment was performed to evaluate its acceptability. A total of four of five items in the GMFM, gait speed on the 10 MWT, and total distance on the 6 MWT showed statistically significant improvement (p < 0.05). The oxygen rate was significantly higher during the training versus resting state. Altogether, six out of eight domains showed satisfaction scores more than four out of five points. In conclusion, overground training using a joint-torque-assisting wearable exoskeletal robot showed improvement in gross motor and gait functions after the intervention, induced intensive gait training, and achieved high satisfaction scores in children with static brain injury.
Collapse
|
6
|
Jiang W, Jiang S, Yu Y, Zhan Q, Wei M, Mei R, Chen F, Guo Y, Xiao B. Improvement of the gait pattern after selective dorsal rhizotomy derives from changes of kinematic parameters in the sagittal plane. Front Pediatr 2022; 10:1047227. [PMID: 36619509 PMCID: PMC9822718 DOI: 10.3389/fped.2022.1047227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Selective dorsal rhizotomy (SDR) can decrease spasticity in children suffering from spastic cerebral palsy (SCP) and thus improve their moving ability when supplemented with the post-operational rehabilitation program. In this case, the study aims to investigate the gait changes in children with mild SCP after SDR in short-term follow-up. METHODS The information of ambulatory SCP cases who underwent SDR in our center was retrospectively reviewed, and comparisons of changes in spasticity, motor function and data of gait analysis before and after SDR were analyzed. RESULTS In total, 32 cases were included in this study, with a mean age of 5.9 ± 2.1 years old. Noticeable decrease was found in the median value of the pre-operational MAS score after SDR at last follow-up in both sides of adductors, gastrocnemius, soleus, and left hamstrings. The Gross Motor Function Measure-66 score increased from 70.6 ± 9.2 to 73.4 ± 8.2, and the gait deviation index increased after SDR compared with the pre-operational data (right side: 65.8 ± 8.8 vs. 60.1 ± 10.7; left side: 63.5 ± 10.1 vs. 57.0 ± 9.9). Noticeable changes were found that the maximum angle of affected ankles in the sagittal plane (the dorsal-flexion angle) increased from 2.5° to 8.2°, the angles at initial contact (1% gait cycle) of affected knees in the sagittal plane decreased from 34.0° to 27.8°, and the angles at the end of swing phase (100% gait cycle) of affected knees in the sagittal plane decreased from 35.8° to 28.3°. CONCLUSION In short-term follow-up, SDR can lower spasticity in children with SCP. Post-operational gait analysis showed improvements in gross motor function and gait, which derived from the changes in the sagittal plane (ankle and knee). A longer follow-up duration is thus needed to clarify the long-term outcome.
Collapse
Affiliation(s)
- Wenbin Jiang
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuyun Jiang
- Department of Gait Analysis, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Yu
- Department of Gait Analysis, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qijia Zhan
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Min Wei
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Mei
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fang Chen
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yao Guo
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Xiao
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|