Influence of gait analysis on decision-marketing for lower extremity surgery

Robotic-assisted treadmill training enhances motor functioning, endurance, and speed in 15 children with cerebral palsy

I BORGGRAEFE A, A KUMAR A, J SCHAEFER B, ANDREAS MEYER-HEIM B,
STEFFEN BERWECK A, FLORIAN HEINEN A

  1. 1. Department for Pediatric Neurology and Developmental Neurology, Children’s Hospital, 2. University of Munich, Munich, Germany;
  2. 3. Rehabilitation  Centre Affoltern, Children’s Hospital, University of Zurich, Affoltern am Albis, Switzerland

Background/Objectives: To evaluate the feasibility and outcome of robotic-assisted treadmill training by a robotic Driver Gait Orthosis in patients with cerebral palsy (CP) regarding function, endurance, and speed.

Design: Prospective clinical before-after trial.

Participants/Settings: Fifteen patients with bilateral spastic CP were eligible for the study. Gross Motor Function Classification System levels ranged from II to IV. The mean age was 10 years (range 5-21y, SD 5y). Patients had to be able to signal pain and discomfort reliably. Exclusion criteria were adapted to the guidelines presented in 2006 by the Pediatric Lokomat expert group. Each patient was subjected to robotic-assisted treadmill training using the Driven Gait Orthosis Lokomat in an outpatient manner. A complete intervention of treadmill therapy consisted of 12 training session in 3 weeks (four sessions/week) conducted by a physiotherapist. The mean training duration was 30 minutes.

Methods: Outcome measures were performed before and after each training cycle. The primary outcome variable was the walking section of the Gross Motor Function Measure (GMFM;E) as walking is the specific task performed in this therapy. Secondary outcome variables were the standing dimension (D) of the GMFM, the 10m walking test and 6 minutes walk test. Statistical analysis was done using repeated t-test for paired samples. Significance level was set on p<0.05.

Results: All patients were able to finish the 12 training sessions. The mean walking distance in the first training session was 517m (range 108-812m, SD 207m) compared to 1334m (range 423-2003m, SD 384m) in the last (12th) training. There was a mean improvement from 49.4 to 54.4% in the standing dimension (D) of the GMFM (p<0.065) and a significant improvement from 42.2 to 47.9% in the walking dimension (E) of the GMFM (p<0.009). The average speed measured by the 10m walking test showed a significant increase by 15% from 0.6 to 0.69m/s (p<0.049). The mean walking distance in 6 minutes increased by 13% from 153 to 173m (p<0.035).

Conclusions: Robotic-assisted treadmill training with the Lokomat in 15 patients with bilateral CP was performed conveniently in an outpatient setting without any drop outs. The intervention in the walking dimension of the GMFM was more statistically relevant than the change in the standing dimension.

Acknowledgements: The work was generously supported by the Hauner Verein and Stiftung Omnibus.

 
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