Robotic gait training for kids with CP: Is it really effective?

UAlberta study recruiting children to evaluate Lokomat gait training program.

Researchers at Canada’s University of Alberta Faculty of Rehabilitation Medicine are investigating the effectiveness of a gait training program on a robotic device called Lokomat compared to regular physical therapy for enhancing walking abilities in pediatric cerebral palsy (CP) patients.

Maggie Slessor practises walking on the Lokomat while tossing a balloon back and forth with a physical therapist at the Glenrose Rehabilitation Hospital.

Charles Moore, Cerebral Palsy News Today August 12, 2016

The research is being conducted at the Glenrose Rehabilitation Hospital in Edmonton, Alberta, the largest free-standing, comprehensive rehabilitation hospital in Canada addressing the needs of patients of all ages who require complex rehabilitation.

The Canadian Institutes of Health Research (CIHR) funded randomized control trial is being led by Lesley Wiart, assistant professor of physical therapy at the Faculty of Rehabilitation Medicine and a research associate at the Glenrose Rehabilitation Hospital. Wiart and her team are currently recruiting children and teens with cerebral palsy ages 5 to 18 who walk with or without handheld walkers. Interested families are invited to  email or call  780-492-9098.

The Lokomat robotic gait device is a product of Hocoma, headquartered in Volketswil, near Zürich, Switzerland, with subsidiaries in the U.S., Singapore, and Slovenia. Hocoma says Lokomat supports an optimized physiological gait pattern, providing constant feedback and therapy assessments, and improving patient outcomes by increasing therapy volume and intensity over time, providing task-specific training and increasing patient engagement.

In 2010, Hocoma launched a version of the Lokomat system more compact than the original LokomatPro device called the LokomatNanos. Like the LokomatPro, it is designed to improve training efficiency compared with conventional, manually assisted therapy. The device is equipped with all the features needed to provide effective robotic gait training

The Lokomat’s driven robotic gait orthosis legs guide the child through walking movements on a treadmill, supporting the body weight so they move their legs more freely. Body weight support and the amount of guidance is decreased over time to more closely replicate regular unassisted walking. A video game connected to the Lokomat provides feedback on the amount of force the child is generating.

The robotic device is designed to promote faster progress through longer and more intensive training sessions compared to manually assisted therapy, with less physical strain on therapists. The device’s basic walking indicator supports monitoring and improved motivation through visualized performance feedback.

“Research evidence for robotic gait training for children with cerebral palsy is limited,” Wiart said in a University of Alberta news release. “We are doing this study so that families and clinicians have information about effectiveness and they can make informed decisions about physical therapy treatment.”

Maggie Slessor with (left to right) researcher Shanon Phelan, mom Doreen, researcher Lesley Wiart, and physical therapist Kelsey Switzer. University of Alberta

The release cites Doreen Slessor, mother of 12-year-old study participant Maggie Slessor, saying, “I’ve seen how the Lokomat has motivated Maggie and given her confidence. It’s also helped her have more confidence walking with a cane. She’ll probably give me a hard time for saying this, but it’s also helped with her gut motility!”

Wiart, who has also teamed up with Virginia Wright, a senior scientist at the Bloorview Research Institute in Toronto, Ontario, said the study’s qualitative component comparing different interventions to see which are more effective is being conducted at three sites: Glenrose Rehabilitation Hospital; Holland Bloorview Kids Rehabilitation Hospital in Toronto; and the Rehabilitation Institute of Chicago.

Kids and teens with cerebral palsy participating in the study will be assigned to one of four groups which will receive either robotic-assisted gait training, conventional physical therapy, a combination of robotic-assisted gait training and conventional physical therapy, and the control group, which receives no treatment in the study.

“We are interested in how the treatment affects walking, but also how it affects the child’s confidence to participate in physical activities and their participation in other activities in their homes and communities,” Wiart said.

“In the qualitative part, we will talk to parents and children about their beliefs and values about walking and why their mobility goals are important to them. It is essential to understand families’ goals and values about walking, because many families are more focused on ensuring their child can move around effectively and are less focused on how their child moves,” she said.

“To date, there has been a very limited amount of qualitative research focusing on parents’ and even more so children’s perspectives on and experiences with robotic gait training interventions. In particular, children’s voices are often left out,” said Shanon Phelan, assistant professor in the UofA Faculty of Rehabilitation Medicine’s Department of Occupational Therapy, and a member of Wiart’s team of investigators.

“Robotic gait training interventions are becoming more and more popular, especially for parents who are seeking out the newest technologies and interventions. We tend to assume all children want to walk or use a robot because it’s cool, but that’s not always the case and it’s important to listen to the child’s perspective on this.”

The Lokomat device used in the study’s Edmonton component is provided by the Glenrose Rehabilitation Hospital Foundation. John Andersen and Rhonda Rosychuk are also part of Wiart’s Edmonton research team.

Charles Moore
Charles is a force to be reckoned with in the world of print and new media. From an interview with him in LowEndMac: ”His articles, features, and commentaries have appeared in more than 40 magazines, newspapers and websites in Canada, the US, the UK, and Australia… a columnist for The Halifax Daily News and the Saint John Telegraph Journal, Atlantic Fisherman, and news editor and columnist for Applelinks.com, a columnist and contributing editor for MacOpinion and PBCentral, as well as writing for Low End Mac.”

Source Cerebral Palsy News Today

Evaluation of the effectiveness of robotic gait training and gait-focused physical therapy programs for children and youth with cerebral palsy: a mixed methods RCT, Lesley Wiart, Rhonda J Rosychuk, and F Virginia Wright. BMC Neurol. 2016; 16: 86. Published online 2016 Jun 2. doi: 10.1186/s12883-016-0582-7

  Further reading
Effect of robotic-assisted gait training in a large population of children with motor impairment due to cerebral palsy or acquired brain injury, Beretta E, Storm FA, Strazzer S, Frascarelli F, Petrarca M, Colazza A, Cordone G, Biffi E, Morganti R, Maghini C, Piccinini L, Reni G, Castelli E. Arch Phys Med Rehabil. 2019 Sep 25. pii: S0003-9993(19)31092-5. doi: 10.1016/j.apmr.2019.08.479. [Epub ahead of print]

Comparison of a robotic-assisted gait training program with a program of functional gait training for children with cerebral palsy: design and methods of a two group randomized controlled cross-over trial, Hilderley AJ, Fehlings D, Lee GW, Wright FV. Springerplus. 2016 Oct 28;5(1):1886. eCollection 2016. Full text

Effectiveness of robot-assisted gait training in children with cerebral palsy: a bicenter, pragmatic, randomized, cross-over trial (PeLoGAIT), Ammann-Reiffer C, Bastiaenen CH, Meyer-Heim AD, van Hedel HJ. BMC Pediatr. 2017 Mar 2;17(1):64. doi: 10.1186/s12887-017-0815-y. Full text

Exercise interventions for cerebral palsy, Ryan JM, Cassidy EE, Noorduyn SG, O’Connell NE. Cochrane Database Syst Rev. 2017 Jun 11;6:CD011660. doi: 10.1002/14651858.CD011660.pub2. Review. Full text

Also see
Robotic gait training for kids with CP—it’s cool but does it work? in University of Alberta
Can robotic gait training really help kids with cerebral palsy? University of Alberta is trying it in Metro News
Robot-assisted Gait Training Benefits Children with Motor Impairments, Study Shows in Cerebral Palsy News Today
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