Robot-assisted gait training improves walking and cerebral connectivity in children with unilateral cerebral palsy
Laura Julien1,2, Guillemette Moreau-Pernet3, Emmanuelle Rochette1
1Department of Pediatrics, CRECHE, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.
Insights
Robot-assisted gait training (RAGT) improved walking speed and functional brain connectivity in children with cerebral palsy. This short-term therapy showed benefits in gait and sensorimotor networks, enhancing rehabilitation outcomes.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Robotics
Background:
- Robot-assisted gait training (RAGT) shows promise for cerebral palsy (CP) rehabilitation.
- Neuroplastic effects of RAGT in CP require further investigation.
Purpose of the Study:
- To investigate the neuroplastic effects of RAGT on gait and functional connectivity in children with unilateral CP.
- To compare RAGT with conventional physiotherapy for walking rehabilitation in CP.
Main Methods:
- Forty children with unilateral CP (aged 4-18) were randomized into RAGT or control groups.
- Intervention involved ten 20-minute RAGT sessions over two weeks; control received conventional physiotherapy.
- Outcomes included gait speed, 6-minute walking test, GMFM-88, and MRI-based functional and structural connectivity.
Main Results:
- RAGT significantly improved gait speed and 6-minute walking test distance compared to controls.
- Resting-state functional connectivity within the sensorimotor network increased post-RAGT.
- No significant changes were observed in GMFM-88 dimensions or corticospinal tract structural connectivity.
Conclusions:
- Short-term, repetitive RAGT offers benefits for walking abilities in children with unilateral CP.
- RAGT positively influences functional cerebral connectivity, suggesting a neuroplastic adaptation.
- Further research is needed to explore long-term effects and optimal RAGT protocols.
Background:
Robot-assisted gait training (RAGT) is promising to help walking rehabilitation in cerebral palsy, but training-induced neuroplastic effects have little been investigated.
Methods:
Forty unilateral cerebral palsy children aged 4-18 years were randomly allocated in a monocentric study to ten 20-minute RAGT sessions with the G-EO system, five days a week (n = 20) or to a control group (who continued conventional care with six 30-minute physiotherapy sessions, three days a week) (n = 20), two weeks running, from September 2020 to December 2021. Clinical and MRI outcomes were compared before and one month after therapy. The primary outcome was gait speed. Secondary outcomes were a 6-minute walking test distance, Gross Motor Function Measure-88 (GMFM-88) dimensions D and E, Patient Global Impression of Improvement, resting-state functional connectivity within the sensorimotor network, and structural connectivity in the corticospinal tracts.
Results:
Gait speed and the 6-minute walking test distance improved more after RAGT. Resting-state functional connectivity increased after RAGT but decreased in controls between superior and lateral healthy or lateral injured sensorimotor networks. GMFM-88 and structural connectivity in corticospinal tracts were unchanged. Impression of improvement in children was better after RAGT.
Conclusion:
Short-term benefit of repetitive RAGT on walking abilities and functional cerebral connectivity was found in unilateral cerebral palsy children.
Impact Statement:
Short-term repetitive robot-assisted gait training improves gait speed and walking resistance and increases cerebral functional connectivity in unilateral cerebral palsy. GMFM dimensions D and E were unchanged after short-term repetitive robot-assisted gait training in unilateral cerebral palsy.
