The effect of robotic assisted gait training on physical activity, motor function, and quality of life in children with spastic cerebral palsy: Exploratory pilot study

Abstract

Background: Children with spastic cerebral palsy (CP) experience motor impairments and reduced physical activity, negatively impacting health and quality of life. Objective: The study aimed to assess the effects of wearable exoskeleton robot-assisted gait training on physical activity, motor function, and quality of life in children with CP. Methods: Ten children with spastic CP (mean age 9.20 +/- 2.57 years; gross motor function classification system levels I-IV) received twelve 30-min sessions of robot-assisted gait training over six weeks at a university hospital rehabilitation center. Physical activity was measured using a tri-axial accelerometer to assess energy expenditure, metabolic equivalents (METs), intensity levels, vector magnitude counts per minute (VM CPM), and step counts. Motor function was evaluated using the Gross Motor Function Measure (GMFM), Timed Up and Go Test (TUG), and 6-Minute Walk Test (6MWT). Quality of life was assessed with the Cerebral Palsy Quality of Life questionnaire (CP-QOL). Repeated measures MANOVA and Cohen's d were used for statistical analysis. Results: Significant improvements were observed in METs (p = 0.02, d = 0.38), light (p = 0.03, d = 0.51) and moderate physical activity time (p = 0.01, d = 0.42), and VM CPM (p = 0.02, d = 0.55), along with reduced sedentary time (p = 0.02, d = -0.49). Functional outcomes improved in GMFM (p<0.01, d = 0.22), TUG (p = 0.03, d = -0.33), and 6MWT (p = 0.02, d = 0.52). No significant changes were found in CP-QOL scores. Conclusion: Wearable robot-assisted gait training appears to enhance physical activity and mobility in children with spastic CP and may be considered a promising therapeutic intervention.