A robot-based gait training therapy for pediatric population with cerebral palsy: goal setting, proposal and preliminary clinical implementation

Background: The use of robotic trainers has increased with the aim of improving gait function in patients with limitations. Nevertheless, there is an absence of studies that deeply describe detailed guidelines of how to correctly implement robot-based treatments for gait rehabilitation. This contribution proposes an accurate robot-based training program for gait rehabilitation of pediatric population with Cerebral Palsy (CP). Methods: The program is focused on the achievement of some specifications defined by the International Classification of Functioning, Disability and Health framework, Children and Youth version (ICF-CY). It is framed on 16 non-consecutive sessions where motor control, strength and power exercises of lower limbs are performed in parallel with a postural control strategy. A clinical evaluation with four pediatric patients with CP using the CPWalker robotic platform is presented. Results: The preliminary evaluation with patients with CP shows improvements in several aspects as strength (74.03 +/- 40.20%), mean velocity (21.46 +/- 33.79%), step length (17.95 +/- 20.45%) or gait performance (e.g. 66 +/- 63.54% in Gross Motor Function Measure-88 items, E and D dimensions). Conclusions: The improvements achieved in the short term show the importance of working strength and power functions meanwhile over-ground training with postural control. This research could serve as preliminary support for future clinical implementations in any robotic device. Trial registration: The study was carried out with the number R-0032/12 from Local Ethical Committee of the Hospital Infantil Nino Jesus. Public trial registered on March 23, 2017: ISRCTN18254257.