Aims. The aim of the study was to assess the effectiveness of robotic-assisted gait treadmill training (Lokomat) as an adjunct to traditional physiotherapy in improving the range of motion, muscle strength and decreasing spasticity in lower extremities in children with cerebral palsy. Materials and Methods. Twenty-six participants, with mean 7.69 ± 2.90 years, levels I-IV on Gross Motor Classification System (38.5% level I-II and 61.5% level III-IV) with a bilateral and unilateral form of cerebral palsy underwent intensive 20 Lokomat and 20 traditional physiotherapy sessions, each training session lasting 40 minutes. Preand post-testing was done using goniometer measure, manual muscle testing and modified Ashworth scale. Results. Positive effects were seen in participant who underwent a combination of Lokomat training and traditional therapy. An increase in the range of motion was minimal (2 - 4 degrees) in hip flexion, extension, and abduction. A significant improvement was achieved in ankle dorsiflexion on the right (p = 0.003) and left side (p = 0.006), while the values of knee extension for the left and right extremity were p = 0.062 left and p = 0.075, respectively. An increase in muscle strength of the lower limb was seen in 30.8% - 80% of participants. Reduction of spasticity in adductors, hamstrings and gastrocnemius were seen in 26.9% of participants. Conclusion. Lokomat training is an adjunct to conventional physiotherapy treatment. It has a negligible effect on the increase in the range of motion and muscle strength of the lower limb and reduction of spasticity in children with cerebral palsy.
References
1.
van Gelder L, Booth ATC, van de Port I, Buizer AI, Harlaar J, van der Krogt MM. Real-time feedback to improve gait in children with cerebral palsy. Gait & Posture. 2017;52:76–82.
2.
Fang CY, Tsai JL, Li GS, Lien ASY, Chang YJ. Effects of Robot‐Assisted Gait Training in Individuals with Spinal Cord Injury: A Meta‐analysis. BioMed Research International. 2020;2020(1).
3.
Ghiasi F, Hadian MR, Bagheri H, Yekaninejad MS, Saberi H, Noroozi A. Change of Spasticity Following Robotic-Assisted Gait Training in Patients with Chronic Incomplete Spinal Cord Injury: Preliminary Results. American Journal of Neuroprotection and Neuroregeneration. 2012;4(1):53–7.
4.
Ross SA, Engsberg JR. Relation between spasticity and strength in individuals with spastic diplegic cerebral palsy. Developmental Medicine & Child Neurology. 2002;44(3):148–57.
5.
Fosdahl MA, Jahnsen R, Pripp AH, Holm I. Change in popliteal angle and hamstrings spasticity during childhood in ambulant children with spastic bilateral cerebral palsy. A register-based cohort study. BMC Pediatrics. 2020;20(1).
6.
Lindén O, Hägglund G, Rodby-Bousquet E, Wagner P. The development of spasticity with age in 4,162 children with cerebral palsy: a register-based prospective cohort study. Acta Orthopaedica. 2019;90(3):286–91.
7.
Collado-Garrido L, Parás-Bravo P, Calvo-Martín P, Santibáñez-Margüello M. Impact of Resistance Therapy on Motor Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 16(22):4513.
8.
Gil-Castillo J, Barria P, Aguilar Cárdenas R, Baleta Abarza K, Andrade Gallardo A, Biskupovic Mancilla A, et al. A Robot-Assisted Therapy to Increase Muscle Strength in Hemiplegic Gait Rehabilitation. Frontiers in Neurorobotics. 16.
9.
Pantzar-Castilla EHS, Wretenberg P, Riad J. Knee flexion contracture impacts functional mobility in children with cerebral palsy with various degree of involvement: a cross-sectional register study of 2,838 individuals. Acta Orthopaedica. 2021;92(4):472–8.
10.
Cloodt E, Wagner P, Lauge-Pedersen H, Rodby-Bousquet E. Knee and foot contracture occur earliest in children with cerebral palsy: a longitudinal analysis of 2,693 children. Acta Orthopaedica. 2021;92(2):222–7.
11.
Guzik A, Drużbicki M, Wolan-Nieroda A, Turolla A, Kiper P. Estimating Minimal Clinically Important Differences for Knee Range of Motion after Stroke. Journal of Clinical Medicine. 9(10):3305.
12.
Guzik A, Drużbicki M, Perenc L, Wolan-Nieroda A, Turolla A, Kiper P. Establishing the Minimal Clinically Important Differences for Sagittal Hip Range of Motion in Chronic Stroke Patients. Frontiers in Neurology. 12.
13.
Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Controlled Clinical Trials. 1989;10(4):407–15.
14.
Oskoui M, Coutinho F, Dykeman J, Jetté N, Pringsheim T. An update on the prevalence of cerebral palsy: a systematic review and meta‐analysis. Developmental Medicine & Child Neurology. 2013;55(6):509–19.
15.
Hanssen B, Peeters N, Vandekerckhove I, De Beukelaer N, Bar-On L, Molenaers G, et al. The Contribution of Decreased Muscle Size to Muscle Weakness in Children With Spastic Cerebral Palsy. Frontiers in Neurology. 12.
16.
Bohannon RW, Smith MB. Interrater Reliability of a Modified Ashworth Scale of Muscle Spasticity. Physical Therapy. 1987;67(2):206–7.
17.
Warken B, Graser J, Ulrich T, Borggraefe I, Heinen F, Meyer-Heim A, et al. Practical Recommendations for Robot-Assisted Treadmill Therapy (Lokomat) in Children with Cerebral Palsy: Indications, Goal Setting, and Clinical Implementation within the WHO-ICF Framework. Neuropediatrics. 46(04):248–60.
18.
Borggraefe I, Schaefer JS, Klaiber M, Dabrowski E, Ammann-Reiffer C, Knecht B, et al. Robotic-assisted treadmill therapy improves walking and standing performance in children and adolescents with cerebral palsy. European Journal of Paediatric Neurology. 2010;14(6):496–502.
19.
Winchester P, Querry R. Robotic Orthoses for Body Weight–Supported Treadmill Training. Physical Medicine and Rehabilitation Clinics of North America. 2006;17(1):159–72.
20.
Meyer-Heim A, van Hedel HJA. Robot-Assisted and Computer-Enhanced Therapies for Children with Cerebral Palsy: Current State and Clinical Implementation. Seminars in Pediatric Neurology. 2013;20(2):139–45.
21.
Lefmann S, Russo R, Hillier S. The effectiveness of robotic-assisted gait training for paediatric gait disorders: systematic review. Journal of NeuroEngineering and Rehabilitation. 2017;14(1).
22.
Sustainability of motor performance after robotic-assisted treadmill therapy in children: an open, non-randomized baseline-treatment study. Edizioni Minerva Medica.
23.
Papageorgiou E, Simon-Martinez C, Molenaers G, Ortibus E, Van Campenhout A, Desloovere K. Are spasticity, weakness, selectivity, and passive range of motion related to gait deviations in children with spastic cerebral palsy? A statistical parametric mapping study. PLOS ONE. 14(10):e0223363.
24.
Østensjø S, Carlberg EB, Vøllestad NK. Motor impairments in young children with cerebral palsy: relationship to gross motor function and everyday activities. Developmental Medicine & Child Neurology. 2004;46(9):580–9.
25.
Wichers M, Hilberink S, Roebroeck M, van Nieuwenhuizen O, Stam H. Motor impairments and activity limitations in children with spastic cerebral palsy: A Dutch population-based study. Journal of Rehabilitation Medicine. 2009;41(5):367–74.
26.
World Health Organization International classification of function, disability, and health. World Health Organization. 2001;(ttps://apps.who.int/iris/bitstream/handle/10665/4 2407/9241545429.pdf;jsessionid=534935F940A2D13 6F296C43D7C614870?sequence=1).
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