Overground Robot-Assisted Gait Training for Pediatric Cerebral Palsy

Seung Ki Kim, Dongho Park, Beomki Yoo, Dain Shim, Joong-On Choi, Tae Young Choi, Eun Sook Park, Seung Ki Kim, Dongho Park, Beomki Yoo, Dain Shim, Joong-On Choi, Tae Young Choi, Eun Sook Park

Abstract

The untethered exoskeletal robot provides patients with the freest and realistic walking experience by assisting them based on their intended movement. However, few previous studies have reported the effect of robot-assisted gait training (RAGT) using wearable exoskeleton in children with cerebral palsy (CP). This pilot study evaluated the effect of overground RAGT using an untethered torque-assisted exoskeletal wearable robot for children with CP. Three children with bilateral spastic CP were recruited. The robot generates assistive torques according to gait phases automatically detected by force sensors: flexion torque during the swing phase and extension torque during the stance phase at hip and knee joints. The overground RAGT was conducted for 17~20 sessions (60 min per session) in each child. The evaluation was performed without wearing a robot before and after the training to measure (1) the motor functions using the gross motor function measure and the pediatric balance scale and (2) the gait performance using instrumented gait analysis, the 6-min walk test, and oxygen consumption measurement. All three participants showed improvement in gross motor function measure after training. Spatiotemporal parameters of gait analysis improved in participant P1 (9-year-old girl, GMFCS II) and participant P2 (13-year-old boy, GMFCS III). In addition, they walked faster and farther with lower oxygen consumption during the 6-min walk test after the training. Although participant P3 (16-year-old girl, GMFCS IV) needed the continuous help of a therapist for stepping at baseline, she was able to walk with the platform walker independently after the training. Overground RAGT using a torque-assisted exoskeletal wearable robot seems to be promising for improving gross motor function, walking speed, gait endurance, and gait efficiency in children with CP. In addition, it was safe and feasible even for children with severe motor impairment (GMFCS IV).

Keywords: cerebral palsy; exoskeleton; gait; pediatric; robotic training.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The powered exoskeleton used in the clinical experiments. (a) A controller back-pack including a battery, (b) a pelvic frame that rigidly supports the backpack and connects two hip joint actuators, (c) hip joint actuators, (d) knee joint actuators, (e) thigh bands, (f) ankle-foot-orthosis, and (g) shoes. The ground contact sensors are installed under the sole of the ankle-foot-orthosis.
Figure 2
Figure 2
Changes in the 6-min walking test (6MWT) (A) and oxygen consumption (B) in children with CP through before, after 8 sessions, and at the end of robot-assisted gait training (RAGT). In the 6MWT, participant P1 walked with no device, participant P2 walked with bilateral crutches, and participant P3 used a platform walker. The oxygen cost was measured during the 6MWT. Participant P3 did not perform the oxygen consumption test due to complaints of discomfort with the mask while walking.

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