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Randomized Controlled Trial
, 98 (11), 2126-2133

Robotic Resistance Treadmill Training Improves Locomotor Function in Children With Cerebral Palsy: A Randomized Controlled Pilot Study

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Randomized Controlled Trial

Robotic Resistance Treadmill Training Improves Locomotor Function in Children With Cerebral Palsy: A Randomized Controlled Pilot Study

Ming Wu et al. Arch Phys Med Rehabil.

Abstract

Objective: To determine whether applying controlled resistance forces to the legs during the swing phase of gait may improve the efficacy of treadmill training as compared with applying controlled assistance forces in children with cerebral palsy (CP).

Design: Randomized controlled study.

Setting: Research unit of a rehabilitation hospital.

Participants: Children with spastic CP (N=23; mean age, 10.6y; range, 6-14y; Gross Motor Function Classification System levels, I-IV).

Interventions: Participants were randomly assigned to receive controlled assistance (n=11) or resistance (n=12) loads applied to the legs at the ankle. Participants underwent robotic treadmill training 3 times a week for 6 weeks (18 sessions). A controlled swing assistance/resistance load was applied to both legs starting from the toe-off to mid-swing phase of gait during training.

Main outcome measures: Outcome measures consisted of overground walking speed, 6-minute walk distance, and Gross Motor Function Measure scores and were assessed pre and post 6 weeks of training and 8 weeks after the end of training.

Results: After 6 weeks of treadmill training in participants from the resistance training group, fast walking speed and 6-minute walk distance significantly improved (18% and 30% increases, respectively), and 6-minute walk distance was still significantly greater than that at baseline (35% increase) 8 weeks after the end of training. In contrast, overground gait speed and 6-minute walk distance had no significant changes after robotic assistance training.

Conclusions: The results of the present study indicated that robotic resistance treadmill training is more effective than assistance training in improving locomotor function in children with CP.

Keywords: Cerebral palsy; Child; Locomotion; Rehabilitation.

Figures

Figure 1
Figure 1
Flowchart of participants’ enrollment and randomization.
Figure 2
Figure 2
Experimental setup for the robotic assistance/assistance treadmill training. Two motors and cable spools are attached to a fixed frame located in the front of the treadmill, and are used to apply a controlled assistance force to the legs at ankle, and two are attached to a frame located at the back of the treadmill, and are used to apply a resistance force to the legs. A computer is used to control the coordinated movement of 4 motors.
Figure 3
Figure 3
Average of self-selected, fast walking velocities, 6 minute walking distance pre, post 6 weeks of robotic treadmill training and 8 weeks after the end of treadmill training, i.e., follow up. A. overground walking speed for participants from the resistance treadmill training group; B. overground walking speed for participants from the assistance treadmill training group; C. 6 minute walking distance for participants from the resistance training group; D. 6 minute walking distance for participants from the assistance training group. Three trials were tested for walking speed and averaged across participants for each group. Error bars indicate standard deviation of each gait parameter. SSV, self-selected velocity; FV, fast velocity. * indicates significant difference, p < 0.05.
Figure 4
Figure 4
Changes in walking self-selected walking speeds, A, fast walking speed, B, and 6-minute walking distance, C, after robotic resistance/assistance treadmill training, and 8 weeks after the end of training, i.e., follow up test. Data shown in the figure are the mean and standard deviation of walking speeds and distance across participants. * indicates significant difference, p < 0.05.

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