Robotic gait training doesn’t wow young patients with CP

Kids, parents differ on ‘normal’ gait.

Although physical therapists and parents often strive for attaining normal gait in children with neuromotor disorders, a new study from researchers at the University of Alberta in Edmonton, Canada, indicates that children undergoing robotic gait training therapy may not share the same enthusiasm for this goal.

carson-gait-training

When Carson was born he was a very healthy infant. With around 15 months Cerebral Palsy was diagnosed based on an inverted right foot and leg. Today, Carson is a patient at the Cincinnati Children’s Hospital where he improves his mobility with the Lokomat therapy.

By Brigid Galloway, Lower Extremity Review August 2015

The qualitative study assessed the expectations and experiences of five children aged 8 to 11 years with cerebral palsy (CP, gross motor function classification system levels II or III), who underwent robotic gait training with a treadmill-based gait trainer, and their parents. The trainer provides upright support while using robotic orthoses to move the patient’s legs. Its adjustable body-weight support allows children to use a more vertical, physiologically typical gait pattern.

Over about 10 weeks, the children underwent 16 sessions of robotic gait training, which involved stepping over blocks, active hip extension against resistance, and playing with a ball while walking. The sessions also included video games in which children had to do specific movements to advance in play.

Photo William Suarez, Holland Bloorview Kids Rehabilitation Hospital, Toronto.

Researchers interviewed children and parents after the child’s last robotic training session. They asked parents about their expectations, experiences, and perceived outcomes with regard to the robotic trainer and walking goals for their child. Questions for children were designed to get their perspective on walking, as well as how they felt about using the trainer.

Parents generally expressed interest in continuing robotic gait training, felt it made their children more confident, and assumed their children found the games engaging and that they valued being able to walk like a typically developing child.

The children had more mixed impressions of the robotic trainer, finding it alternately “fun,” “boring,” and even “uncomfor­table/painful.” Young respondents also did not echo their parents’ point of view on “normal” gait, said lead author Shanon Phelan, PhD, assistant professor of occupational therapy at the University of Alberta. “They often equated normal walking with their typical gait, weren’t always sure whether the robot was helping them, and didn’t universally find it fun or engaging.”

Parents thought robotic training, which took place at Holland Bloorview Kids Rehabilitation Hospital in Toronto, boosted children’s confidence, but the children didn’t express this, and some felt anxiety about engaging the technology. Also a prominent problem for children was skin irritation caused by the trainer’s straps.

Both children and parents, however, said they valued the interactions with their therapists regardless of the technology.

Continue reading in Lower Extremity Review

G-EO System pediatric application from Reha Technology is an end effect robotic gait trainer, capable of assisted therapy and stairwalking. Developed for the rehabilitation of Stroke and Head Injury survivors. Reha Technology. Youtube Jun 27, 2017

Also see
Children’s Perspectives on Robotic Gait Training, Elena Noble MPT, Rifton

Gait training is a fundamental intervention in pediatric rehabilitation. At present, over-ground assistive devices and treadmills dominate the field, but we’re now seeing emerging robotic technologies that offer solutions to normalize and enhance the quality of gait mainly through the application of motor learning principles and the use of dynamic weight-bearing systems. We need to learn more about these technologies, what they offer and what their limitations might be.

One new qualitative study on robotics has just been published and it carries an important message: the goals and aims of clinicians need to remain sensitive to the goals and needs of the children being treated. Shanon Phelan and her colleagues at the University of Alberta in Canada have just published What is it like to walk with the help of a robot? Children’s perspectives on robotic gait training technology in the journal Disability and Rehabilitation, and it’s an important contribution.

Continue reading in Rifton, Evidence Based Practice

Improved Gait After Repetitive Locomotor Training in Children with Cerebral Palsy, Smania N, Bonetti P, Gandolfi M, Cosentino A, Waldner A, Hesse S, Werner C, Bisoffi G, Geroin C, Munari D. Am J Phys Med Rehabil. 2011 Feb;90(2):137-49. doi: 10.1097/PHM.0b013e318201741e.

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