Robotic Walking Therapy

Children with spastic cerebral palsy experience jerky movement, muscle tightness and joint stiffness that can make everyday tasks like walking more challenging. Typically, children participate in a physical therapy program of muscle training and exercise in order to improve strength, balance, flexibility, motor development and mobility.

In recent years, Robotic Assisted Gait Training (RAGT) has been recognized as a promising new therapy that uses a robotic exoskeleton to improve walking in people with cerebral palsy. Sounds very cool – but how does it actually work? Participants simply put on the wearable robotic device, which can either actively or passively aid the user’s movement. Traditional, rigid exoskeletons made from hard and heavy materials use power to actively aid the user’s movement. They can be expensive and bulky to wear. More recently, soft exoskeletons that are flexible and lightweight have emerged to address the limitations of rigid exoskeletons. Soft exoskeletons are mostly used to passively aid the user’s movement. They tend to be more comfortable for the user and easy-to-use. However, soft exoskeletons are also limited by their low structural rigidity, reduced power and the pre-requisite that users possess certain standing and walking abilities. Parents may wonder, Can Soft RAGT actually improve a child’s walking?

In a recent study, researchers compared the effects of routine rehabilitation training (physical therapy and other complementary therapies) versus routine rehabilitation training combined with Soft Robotic Exoskeleton (SRE) assisted walking training, on the lower limb motor function in children with spastic CP. Children who received SRE-assisted walking training received slightly less routine rehabilitation training to ensure that duration of treatment was consistent in both groups.

Children who met the following inclusion criteria were eligible to participate:

 

1. Diagnosis of Spastic CP and categorized within levels I to III of the Gross Motor Function Classification System (GMFCS), and the calf triceps muscle spasticity rated as levels I to III on the Modified Ashworth Scale (MAS);
2. Aged between 3–10 years, with the ability to understanding instructions and cooperate with the training program;
3. Capability to walk for 6 min, with or without the aid of assistive devices; and
4. Absence of orthopedic surgery or botulinum toxin injections within the previous 6 months.

What were the findings?

According to the study, the combination of SRE-assisted walking training with routine rehabilitation training was more effective in improving lower limb motor function in children with spastic CP, compared to routine rehabilitation alone. Specifically, children who received SRE-assisted walking training demonstrated greater improvement in walking speed based on the 10-metre walk test and walking distance based on the 6-min walk test. They also showed greater improvement in all secondary outcome measures (gross motor function, balance, energy consumption of walking).

The study says that follow-up research must be done to study the long-term effects of SRE-assisted walking training. More studies with large sample size and in-dept analysis of improvement in walking pattern are needed to support widespread clinical use of SREs. Parents interested in RAGT can talk to the child’s health care provider to learn more.