Locomotor training through a novel robotic platform for gait rehabilitation in pediatric population: short report

Journal of NeuroEngineering and Rehabilitation, Nov 2016

Background Cerebral Palsy (CP) is a disorder of posture and movement due to a defect in the immature brain. The use of robotic devices as alternative treatment to improve the gait function in patients with CP has increased. Nevertheless, current gait trainers are focused on controlling complete joint trajectories, avoiding postural control and the adaptation of the therapy to a specific patient. This paper presents the applicability of a new robotic platform called CPWalker in children with spastic diplegia. Findings CPWalker consists of a smart walker with body weight and autonomous locomotion support and an exoskeleton for joint motion support. Likewise, CPWalker enables strategies to improve postural control during walking. The integrated robotic platform provides means for testing novel gait rehabilitation therapies in subjects with CP and similar motor disorders. Patient-tailored therapies were programmed in the device for its evaluation in three children with spastic diplegia for 5 weeks. After ten sessions of personalized training with CPWalker, the children improved the mean velocity (51.94 ± 41.97 %), cadence (29.19 ± 33.36 %) and step length (26.49 ± 19.58 %) in each leg. Post-3D gait assessments provided kinematic outcomes closer to normal values than Pre-3D assessments. Conclusions The results show the potential of the novel robotic platform to serve as a rehabilitation tool. The autonomous locomotion and impedance control enhanced the children’s participation during therapies. Moreover, participants’ postural control was substantially improved, which indicates the usefulness of the approach based on promoting the patient’s trunk control while the locomotion therapy is executed. Although results are promising, further studies with bigger sample size are required.

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Locomotor training through a novel robotic platform for gait rehabilitation in pediatric population: short report

Bayón et al. Journal of NeuroEngineering and Rehabilitation Locomotor training through a novel robotic platform for gait rehabilitation in pediatric population: short report C. Bayón 0 S. Lerma O. Ramírez 0 J.I. Serrano 0 M.D. Del Castillo 0 R. Raya 0 J.M. Belda-Lois I. Martínez E. Ro on 0 1 0 Neural and Cognitive Engineering group, Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas , Ctra Campo Real km 0.2, Arganda del Rey, Madrid 28500 , Spain 1 Postgraduate Program, Universidade Federal do Espírito Santo , Vitória , Brazil Background: Cerebral Palsy (CP) is a disorder of posture and movement due to a defect in the immature brain. The use of robotic devices as alternative treatment to improve the gait function in patients with CP has increased. Nevertheless, current gait trainers are focused on controlling complete joint trajectories, avoiding postural control and the adaptation of the therapy to a specific patient. This paper presents the applicability of a new robotic platform called CPWalker in children with spastic diplegia. Findings: CPWalker consists of a smart walker with body weight and autonomous locomotion support and an exoskeleton for joint motion support. Likewise, CPWalker enables strategies to improve postural control during walking. The integrated robotic platform provides means for testing novel gait rehabilitation therapies in subjects with CP and similar motor disorders. Patient-tailored therapies were programmed in the device for its evaluation in three children with spastic diplegia for 5 weeks. After ten sessions of personalized training with CPWalker, the children improved the mean velocity (51.94 ± 41. 97 %), cadence (29.19 ± 33.36 %) and step length (26.49 ± 19.58 %) in each leg. Post-3D gait assessments provided kinematic outcomes closer to normal values than Pre-3D assessments. Conclusions: The results show the potential of the novel robotic platform to serve as a rehabilitation tool. The autonomous locomotion and impedance control enhanced the children's participation during therapies. Moreover, participants' postural control was substantially improved, which indicates the usefulness of the approach based on promoting the patient's trunk control while the locomotion therapy is executed. Although results are promising, further studies with bigger sample size are required. Cerebral palsy; Rehabilitation robotic; Gait; Posture; Exoskeleton device; Spastic diplegia; Case report - Background One of the most important consequences of Cerebral Palsy (CP) in children is mobility impairment, characterized by reduced speed and endurance or shortened step length during gait [1]. In last decades, robot-based therapy has complemented conventional strategies in CP gait rehabilitation [2, 3]. Several rehabilitation devices have been recently proposed with this aim [4, 5]. The majority of these platforms (e.g. Lokomat [4], GT-1 [5]) includes the approach of Partial Body-Weight Support (PBWS) and guided and repetitive movement. However, therapies carried out with common available devices are similar for all subjects, despite the cognitive and physical differences among them make important to tailor the therapy to the specific patient’s needs. Taking into account that maintaining a proper posture during walking is a relevant aspect in the case of children with CP [6, 7], new strategies are needed to improve postural control while over-ground movement is allowed. In order to address these limitations, a novel robotic platform (CPWalker [8]) has been designed. It can © The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. implement new types of therapies in children with CP. The shift that CPWalker introduces on the treatments is supported by three main pillars: a) the option of free and over-ground movement (not restricted to treadmill) in rehabilitation environment; b) the improvement of postural control of head and trunk using a biofeedback strategy; and c) the use of “Assist As Needed” (AAN) strategies in specific and selected subtasks of walking. Methods Patients Three pediatric patients with spastic diplegia (one female), two suffering from spastic CP and one from Hereditary Spastic Paraparesis (HSP), were recruited to participate in this study (Table 1). The inclusion criteria for the patient’s recruitment was: a) capable of understanding the proposed exercises; b) aged 11 to 18 years; c) maximum weight 75 (...truncated)


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C. Bayón, S. Lerma, O. Ramírez, J.I. Serrano, M.D. Del Castillo, R. Raya, J.M. Belda-Lois, I. Martínez, E. Rocon. Locomotor training through a novel robotic platform for gait rehabilitation in pediatric population: short report, Journal of NeuroEngineering and Rehabilitation, 2016, pp. 98, 13, DOI: 10.1186/s12984-016-0206-x