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Robot-driven downward pelvic pull to improve crouch gait in children with cerebral palsy
J Kang1, D Martelli1, V Vashista2
1Department of Mechanical Engineering, Columbia University, New York, NY 10027, USA.
Insights
Robotic training using downward pelvic pull can strengthen leg muscles and improve walking coordination in children with cerebral palsy (CP). This intervention enhances posture and gait, offering a promising solution for crouch gait in CP patients.
Area of Science:
- Biomedical Engineering
- Neurology
- Physical Therapy
Background:
- Crouch gait, common in children with cerebral palsy (CP), involves excessive hip/knee flexion and weak plantar flexor muscles.
- Soleus muscle weakness is a primary contributor to crouch gait, impacting upright posture and propulsion during walking.
Purpose of the Study:
- To investigate the efficacy of a robotic training paradigm applying downward pelvic force to improve posture and gait in children with CP.
- To test the hypothesis that downward pelvic pull strengthens extensor muscles (especially soleus) and enhances muscle coordination during walking.
Main Methods:
- A robotic training system, the Tethered Pelvic Assist Device, applied downward pelvic force to participants with crouch gait while walking on a treadmill.
- Electromyography (EMG) of soleus and gastrocnemius muscles and walking kinematics were used to assess training effects.
Main Results:
- The robotic training was feasible and demonstrated enhanced upright posture and improved muscle coordination in participants.
- Significant improvements were observed in walking parameters, including increased step length, greater range of motion in lower limb angles, enhanced toe clearance, and a normalized heel-to-toe walking pattern.
Conclusions:
- Robotic-assisted downward pelvic pull is a viable and promising intervention for children with cerebral palsy experiencing crouch gait.
- This training method effectively addresses key biomechanical deficits associated with crouch gait, leading to functional improvements in walking and posture.
Abstract:
Children with cerebral palsy commonly exhibit an abnormality called crouch gait, which is characterized by excessive flexion of the hips/knees and weak plantar flexor muscles during the stance phase. One of the major reasons for this pathological gait is weakness in soleus muscles. During the mid-stance phase of gait when the toe and heel are both on the ground, the soleus keeps the shank upright and facilitates extension of the knee angle. It also provides propulsive forces on the body during the late stance phase of the gait cycle. We hypothesized that walking with downward pelvic pull will (i) strengthen extensor muscles, especially the soleus, against the applied downward force and (ii) improve muscle coordination during walking. We then tested a robotic training paradigm to improve both posture and gait of children with crouch gait. In this paradigm, participants with crouch gait were subjected to downward pelvic force when walking on a treadmill, provided by a cable-driven robot called Tethered Pelvic Assist Device. Electromyography of soleus and gastrocnemius muscles and walking kinematics of the participants showed the feasibility of this training, enhanced upright posture of the participants, and improved muscle coordination. In addition, walking features of these participants, such as increased step length, range of motion of the lower limb angles, toe clearance, and heel-to-toe pattern, improved. This robotic training method can be a promising intervention for children with cerebral palsy who have a crouch gait.
