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Castro P, Martí M, Oliván-Blázquez B, Boñar N, García V, Gascón-Santos S, Panzano A, Vela S, Tajadura S, Peña A, Tris-Ara MJ. Benefits of robotic gait assistance with ATLAS 2030 in children with cerebral palsy. Front Pediatr 2024; 12:1398044. [PMID: 39135857 PMCID: PMC11318455 DOI: 10.3389/fped.2024.1398044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/25/2024] [Indexed: 08/15/2024] Open
Abstract
Objective This study aims to assess the impact of integrating ATLAS 2030 into the conventional therapy regimen for children with Cerebral Palsy (CP) compared to conventional therapy alone regarding gross motor function, range of motion (ROM) and spasticity. Design A non-randomized controlled trial conducted in outpatient rehabilitation settings and special education schools, following the recommendations by the Consolidated Standards of Reporting Trials (CONSORT) statement. Participants Thirty children with CP divided into intervention and control groups. Intervention The intervention group received three months of therapy (twice per week) with the ATLAS 2030 device in addition to their standard therapy, while the control group underwent standard therapy alone. Main outcome measure Gross motor function assessed using the Gross Motor Function Measure of 88 items (GMFM-88). Secondary outcomes Spasticity, measured by the Modified Ashworth Scale (MAS), and ROM of the lower limbs. Results Statistically significant differences were observed between groups, in favour the intervention group, in both the GMFM-88 total score and dimension A, B and D. Similar findings were noted for spasticity and ROM, demonstrating significant improvements in the intervention group. Conclusion ATLAS 2030 proves to be a safe and valuable tool for the rehabilitation of children with CP, showing improvements in motor function, spasticity and ROM.
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Affiliation(s)
- Pilar Castro
- Asociación Tutelar Aragonesa de Discapacidad Intelectual (ATADES), Zaragoza, Spain
| | - María Martí
- Asociación Tutelar Aragonesa de Discapacidad Intelectual (ATADES), Zaragoza, Spain
| | | | | | | | | | - Alicia Panzano
- Asociación Tutelar Aragonesa de Discapacidad Intelectual (ATADES), Zaragoza, Spain
| | - Sara Vela
- Asociación Tutelar Aragonesa de Discapacidad Intelectual (ATADES), Zaragoza, Spain
| | - Sara Tajadura
- Asociación Tutelar Aragonesa de Discapacidad Intelectual (ATADES), Zaragoza, Spain
| | - Ana Peña
- Department of Paediatric Rehabilitation, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - María Josefa Tris-Ara
- Department of Paediatric Rehabilitation, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Wang Y, Zhang P, Li C. Systematic review and network meta-analysis of robot-assisted gait training on lower limb function in patients with cerebral palsy. Neurol Sci 2023; 44:3863-3875. [PMID: 37495708 PMCID: PMC10570202 DOI: 10.1007/s10072-023-06964-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of robot-assisted gait training (RAGT) in treating lower extremity function in patients with cerebral palsy (CP) and compare the efficacy differences between different robotic systems. METHODS PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, CBM, and Wanfang databases were searched to collect randomized controlled trials of RAGT for lower extremity dysfunction in patients with CP from the time the databases were created until December 26, 2022. The D and E of Gross Motor Function Measure-88 (GMFM-88) assessed lower limb motor function. Berg Balance Scale (BBS) was used to assess balance function. Walking endurance and speed were assessed using the 6-minute walk test (6MWT) and walking speed. The modified Ashworth Scale (MAS) was used to assess the degree of muscle spasticity in the lower extremities. The Cochrane Risk Assessment Scale and the Physiotherapy Evidence Database (PEDro) scale were used for qualitative assessment in the studies included. RevMan 5.4 was used for data merging and statistical analysis. R 4.2.0 and ADDIS 1.16.8 were used to map the network relationships and to perform the network meta-analysis. RESULTS A total of 14 studies were included in the review. The meta-analysis showed that RAGT significantly improved GMFM-88 D and E, BBS, and 6MWT scores in CP patients compared with conventional rehabilitation. However, for walking speed and MAS, the intervention effect of RAGT was insignificant. The network meta-analysis showed that the best probability ranking for the effect of the 3 different robots on the GMFM-88 D score was LokoHelp (P = 0.66) > Lokomat (P = 0.28) > 3DCaLT (P = 0.06) and the best probability ranking for the GMFM-88 E score was LokoHelp (P = 0.63) > 3DCaLT (P = 0.21) > Lokomat (P = 0.16). CONCLUSION RAGT positively affects walking and balance function in patients with CP, while efficacy in improving gait speed and muscle spasticity is unknown. The best treatment among the different robots is LokoHelp. Future high-quality, long-term follow-up studies are needed to explore the clinical efficacy of RAGT in depth.
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Affiliation(s)
- Yueying Wang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Peipei Zhang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
| | - Chao Li
- Department of Rehabilitation and Physiotherapy, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
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Fu WS, Wu BA, Song YC, Qu CH, Zhao JF. Virtual reality combined with robot-assisted gait training to improve walking ability of children with cerebral palsy: A randomized controlled trial. Technol Health Care 2022; 30:1525-1533. [PMID: 35661029 DOI: 10.3233/thc-212821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Children with cerebral palsy (CP) have disorders of posture and movement and which can limit physical activities such as walkingOBJECTIVE: This study aims to investigate the effectiveness of virtual reality (VR) combined with robot-assisted gait training (RAGT) on walking ability in children with CP and clarify the most effective degree of weight reduction. METHODS Sixty CP children were recruited and randomly allocated into four different groups. The control group received conventional physical therapy (n= 15), and task groups performed VR combined with RAGT with 15% (Group A, n= 15) /30% (Group B, n= 15) /45% (Group C, n= 15) weight loss. All participants were given 50 min of therapy per session four times a week for 12 weeks and were assessed pre-and post-test with the surface electromyography (EMG), the Modified Ashworth Scale, the Gross Motor Function Measure (GMFM) dimension E and D, and Six-Minute Walking Test (6-MWT). RESULTS All indicators had improved significantly in each group after the intervention (P< 0.05). The result of our study demonstrated that the more effective impacts of VR combined with RAGT on walking ability compared to the control group (P< 0.05), and 30% of weight loss had the best improvement in CP children (P< 0.01). CONCLUSIONS VR combined RAGT can effectively improve walking ability in children with CP, especially when the weight loss is 30%.
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Affiliation(s)
- Wen-Sheng Fu
- School of Physical Education, Shanxi University of Finance and Economics, Taiyuan, Shanxi, China
| | - Bao-Ai Wu
- School of Physical Education, Shanxi University, Taiyuan, Shanxi, China
| | - Yi-Cun Song
- School of Physical Education, Shanxi University, Taiyuan, Shanxi, China
| | - Chen-Huan Qu
- School of Physical Education, Shanxi University, Taiyuan, Shanxi, China
| | - Jin-Feng Zhao
- School of Physical Education, Shanxi University, Taiyuan, Shanxi, China
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Abidin N, Ünlü Akyüz E, Cankurtaran D, Karaahmet ÖZ, Tezel N. The effect of robotic rehabilitation on posture and trunk control in non-ambulatory cerebral palsy. Assist Technol 2022:1-7. [PMID: 35385378 DOI: 10.1080/10400435.2022.2059592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 10/18/2022] Open
Abstract
The purpose of this study was to investigate the effects of a combined robot-assisted gait training (RAGT) with standard physiotherapy (PT) on trunk control and posture in non-ambulatory children with cerebral palsy (CP). This nonrandomized, controlled study included 31 CP assigned into two groups. Study Group: RAGT (three times a week, 30 min/session, for 6 weeks) + PT. Control group: PT only. The patients were evaluated using gross motor function measure (GMFM)-88 (Section B, Sitting) and Trunk Impairment Scale (TIS), pre-treatment and 3rd month post-treatment. In the RAGT group, significant improvements were observed in the GMFM-B and TIS scores at the 3rd month post-treatment (p < 0.05). Comparison of the changes in GMFM-B and TIS scores from end to beginning of the study, the change in TIS static are significantly higher in the RAGT group than control group (p < 0.05). Addition of RAGT to standard physiotherapy seems to improve trunk control, sitting balance, and posture in non-ambulatory CP.
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Affiliation(s)
- Nihan Abidin
- Clinic of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ece Ünlü Akyüz
- Clinic of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Damla Cankurtaran
- Clinic of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Özgür Zeliha Karaahmet
- Clinic of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Nihal Tezel
- Clinic of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Manikowska F, Brazevic S, Krzyżańska A, Jóźwiak M. Effects of Robot-Assisted Therapy on Gait Parameters in Pediatric Patients With Spastic Cerebral Palsy. Front Neurol 2022; 12:724009. [PMID: 35002911 PMCID: PMC8732368 DOI: 10.3389/fneur.2021.724009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Gait dysfunction is a crucial factor that restricts independence and quality of life in children with cerebral palsy (CP). Gait training based on robotic-assisted therapy (RAT) is widely used, but information about effectiveness and ideal patient profile is not sufficient. Aim of this study was to assess the effect of RAT on gait parameters in spastic children with CP, and to determine whether changes in gait parameters are different among patients on different ambulatory levels. Method: A total of 26 children with bilateral spastic CP were divided into two groups based on their functional ability: non-assisted ambulator (NAS) or assisted ambulator (AS); and underwent a RAT program (30 training sessions of RAT during 10 weeks). Gait analysis was performed: before the therapy (t1), right after (t2), and 6 weeks later (t3). Results: No significant changes in spatiotemporal parameters or gait deviation index at t2 or t3. Double support symmetry significantly improved (t1 vs. t3, p = 0.03) for the whole group (NAS + AS). Walking speed symmetry significantly improved (t2 vs. t3, p = 0.02) for group AS. Conclusion: RAT based on our protocol did not change spatiotemporal parameters and kinematics of walking except limited improvement in some aspects of gait symmetry. We did not find differences in changes in selected objective gait parameters among children with CP in different ambulatory levels.
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Affiliation(s)
- Faustyna Manikowska
- Gait and Motion Analysis Laboratory, Poznań University of Medical Sciences, Poznań, Poland
| | - Sabina Brazevic
- Gait and Motion Analysis Laboratory, Poznań University of Medical Sciences, Poznań, Poland
| | | | - Marek Jóźwiak
- Gait and Motion Analysis Laboratory, Poznań University of Medical Sciences, Poznań, Poland
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Delgado E, Cumplido C, Ramos J, Garcés E, Puyuelo G, Plaza A, Hernández M, Gutiérrez A, Taverner T, Destarac MA, Martínez M, García E. ATLAS2030 Pediatric Gait Exoskeleton: Changes on Range of Motion, Strength and Spasticity in Children With Cerebral Palsy. A Case Series Study. Front Pediatr 2021; 9:753226. [PMID: 34900862 PMCID: PMC8652111 DOI: 10.3389/fped.2021.753226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Cerebral Palsy (CP), the most common motor disability in childhood, affects individual's motor skills, movement and posture. This results in limited activity and a low social participation. The ATLAS2030 exoskeleton is a pediatric device that enables gait rehabilitation for children with neurological or neuromuscular pathologies with gait pathology. Purpose: To study changes in relation to range of motion (ROM), strength and spasticity in children with CP after using the ATLAS2030 gait exoskeleton. Methods and Participants: Three children (mean age 8.0 ± 2.0), two girls and one boy, two of them with GMFCS IV and one with GMFCS III, received robot-assisted gait training (RAGT) with ATLAS2030 for one month. Results: The average time of exoskeleton use was 54.7 ± 10.4 min in all sessions, and all participants were able to perform all exercises. The strength of all muscle groups was increased after the 10 sessions for the participants assessed and the limited ROM in the sagittal plane (hip and knee extension and ankle dorsiflexion) decreased after the use of the exoskeleton compared to the initial state. Spasticity was reduced at the end of the sessions after the use of the exoskeleton compared to their initial state. Conclusion: The ROM, spasticity and strength were improved after RAGT with ATLAS2030 exoskeleton in these children with CP. However, further studies with larger samples should be carried out to confirm our findings.
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Affiliation(s)
- Elena Delgado
- Centre for Automation and Robotics, Spanish National Research Council (CSIC-UPM), Madrid, Spain
| | - Carlos Cumplido
- Centre for Automation and Robotics, Spanish National Research Council (CSIC-UPM), Madrid, Spain
| | - Jaime Ramos
- Centre for Automation and Robotics, Spanish National Research Council (CSIC-UPM), Madrid, Spain
| | - Elena Garcés
- Marsi Bionics S.L., Madrid, Spain
- Doctoral Program in Health Sciences, Alcalá de Henares University, Madrid, Spain
| | - Gonzalo Puyuelo
- Marsi Bionics S.L., Madrid, Spain
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain
| | - Alberto Plaza
- Marsi Bionics S.L., Madrid, Spain
- Polytechnic University of Madrid, Madrid, Spain
| | - Mar Hernández
- Centre for Automation and Robotics, Spanish National Research Council (CSIC-UPM), Madrid, Spain
| | - Alba Gutiérrez
- Centre for Automation and Robotics, Spanish National Research Council (CSIC-UPM), Madrid, Spain
| | | | | | | | - Elena García
- Centre for Automation and Robotics, Spanish National Research Council (CSIC-UPM), Madrid, Spain
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Gonzalez A, Garcia L, Kilby J, McNair P. Robotic devices for paediatric rehabilitation: a review of design features. Biomed Eng Online 2021; 20:89. [PMID: 34488777 PMCID: PMC8420060 DOI: 10.1186/s12938-021-00920-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/06/2021] [Indexed: 01/11/2023] Open
Abstract
Children with physical disabilities often have limited performance in daily activities, hindering their physical development, social development and mental health. Therefore, rehabilitation is essential to mitigate the adverse effects of the different causes of physical disabilities and improve independence and quality of life. In the last decade, robotic rehabilitation has shown the potential to augment traditional physical rehabilitation. However, to date, most robotic rehabilitation devices are designed for adult patients who differ in their needs compared to paediatric patients, limiting the devices' potential because the paediatric patients' needs are not adequately considered. With this in mind, the current work reviews the existing literature on robotic rehabilitation for children with physical disabilities, intending to summarise how the rehabilitation robots could fulfil children's needs and inspire researchers to develop new devices. A literature search was conducted utilising the Web of Science, PubMed and Scopus databases. Based on the inclusion-exclusion criteria, 206 publications were included, and 58 robotic devices used by children with a physical disability were identified. Different design factors and the treated conditions using robotic technology were compared. Through the analyses, it was identified that weight, safety, operability and motivation were crucial factors to the successful design of devices for children. The majority of the current devices were used for lower limb rehabilitation. Neurological disorders, in particular cerebral palsy, were the most common conditions for which devices were designed. By far, the most common actuator was the electric motor. Usually, the devices present more than one training strategy being the assistive strategy the most used. The admittance/impedance method is the most popular to interface the robot with the children. Currently, there is a trend on developing exoskeletons, as they can assist children with daily life activities outside of the rehabilitation setting, propitiating a wider adoption of the technology. With this shift in focus, it appears likely that new technologies to actuate the system (e.g. serial elastic actuators) and to detect the intention (e.g. physiological signals) of children as they go about their daily activities will be required.
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Affiliation(s)
- Alberto Gonzalez
- BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Lorenzo Garcia
- BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Jeff Kilby
- BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Peter McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
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Cumplido C, Delgado E, Ramos J, Puyuelo G, Garcés E, Destarac MA, Plaza A, Hernández M, Gutiérrez A, García E. Gait-assisted exoskeletons for children with cerebral palsy or spinal muscular atrophy: A systematic review. NeuroRehabilitation 2021; 49:333-348. [PMID: 34219676 DOI: 10.3233/nre-210135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cerebral Palsy (CP) and Spinal Muscular Atrophy (SMA) are common causes of motor disability in childhood. Gait exoskeletons are currently being used as part of rehabilitation for children with walking difficulties. OBJECTIVE To assess the safety and efficacy and describe the main characteristics of the clinical articles using robot-assisted gait training (RAGT) with exoskeleton for children with CP or SMA. METHODS A computer search was conducted in five bibliographic databases regarding clinical studies published in the last ten years. In order to be included in this review for further analysis, the studies had to meet the following criteria: (1) assess efficacy or safety of interventions; (2) population had to be children with CP or SMA aged between 3 and 14; (3) exoskeleton must be bilateral and assist lower limbs during walking. RESULTS Twenty-one articles were selected, of which only five were clinical trials. 108 participants met the inclusion criteria for this study, all with a diagnosis of CP. The evidence level of the selected papers was commonly low. CONCLUSIONS RAGT therapy seems to be safe for children with CP. However, further investigation is needed to confirm the results related to efficacy. There is no evidence of RAGT therapy for SMA children.
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Affiliation(s)
- Carlos Cumplido
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas (CSIC-UPM), Madrid, Spain
| | - Elena Delgado
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas (CSIC-UPM), Madrid, Spain
| | - Jaime Ramos
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas (CSIC-UPM), Madrid, Spain
| | - Gonzalo Puyuelo
- Marsi Bionics S.L., Madrid, Spain.,Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Madrid, Spain
| | - Elena Garcés
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas (CSIC-UPM), Madrid, Spain.,Marsi Bionics S.L., Madrid, Spain.,Programa de Doctorado en Ciencias de la Salud. Universidad de Alcalá, Madrid, Spain
| | | | - Alberto Plaza
- Marsi Bionics S.L., Madrid, Spain.,Universidad Politécnica de Madrid, Madrid, Spain
| | - Mar Hernández
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas (CSIC-UPM), Madrid, Spain
| | - Alba Gutiérrez
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas (CSIC-UPM), Madrid, Spain
| | - Elena García
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas (CSIC-UPM), Madrid, Spain
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