[Background]
Partial weight support gait training is known to be an effective therapy. Likewise, robot-assisted gait training enables children to have effective gait training as it partially supports body weight and to walk longer. Robot-assisted gait training is established as a treatment option, but the clinical evidence on the neurologic recovery or musculoskeletal system is rare. So we assessed the impact of robot-assisted gait training on motor function and body composition in children with cerebral palsy by comparing the functional change of usual care period and robotic therapy period.
[Study Design]
Single-blinded, randomized, cross-over trial
[Participants and settings]
A total of 20 children diagnosed with spastic cerebral palsy pf GMFCS II~IV were recruited in the tertiary educational rehabilitation hospital. The inclusion criteria are like as follow; Children (1) diagnosed with spastic cerebral palsy(3~12 years-old); (2) gross motor function classification system Level II~IV ; (3) height of 98 ~ 160 centimeters; (4) follow the instructions and communicate if they feel pain or discomfort; We excluded patients with any of the following ; (1) cognitive impairment so that each assessment cannot be performed properly ; (2) history of neurosurgery or orthopedic surgery operated on limbs ; (3) severe joint contracture (knee joint : more than 20 degrees flexion contracture, hip joint more than 40 degree contracture).
[Materials and Methods]
Children were randomized into two groups; Group 1 (Robotic Training - Usual Care), Group 2 (Usual Care-Robotic training). Group 1 had got the robot-assisted gait training(RT) 3 times a week in addition to the usual care for 6 weeks and then had got the routine physical therapy for 6 weeks of usual care(UC). Group 2 had got the therapy in the opposite order. For the primary outcome, gross motor function measure (GMFM-88) score, functional independence measure (WeeFIM) score was measured, and the manual muscle power, the range of motion (ROM), modified Ashworth scale (MAS) were assessed before and after each treatment periods for secondary outcome. The motor evoked potential (MEP), balance function, body composition were assessed before and after RT period. Delta value for each period was compared by paired T-test.
[Results]
The means age, GMFCS level, height, weight, and BMI of the two groups were not significantly different. The improvement of C and D dimension of GMFM-88 score of RT period was higher than that of UC period(p<0.05). Changes of manual muscle power, ROM, MAS, and weeFIM scores were not different between the RT period and UC period. Latencies of MEP, balance function were not changed, but skeletal muscle mass increased in GMFCS level 2-3 group after RT(p<0.05).
[Conclusion]
Robot-assisted gait training has the favorable effect not only on the recovery of motor function but also on body composition in children with cerebral palsy. |
