The effect of patient-specific factors on responsiveness to robot-assisted gait training in patients with bilateral spastic cerebral palsy

Article type: Research Article

Authors: Klobucká, Stanislava^{a; *} | Klobucký, Robert^b | Kollár, Branislav^c

Affiliations: [a] Rehabilitation Centre Harmony, Bratislava, Slovakia | [b] Institute for Sociology, Slovak Academy of Sciences, Bratislava, Slovakia | [c] 1^st Department of Neurology, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia

Correspondence: [*] Address for correspondence: Stanislava Klobucká, Rehabilitation Centre Harmony, Bratislava, Slovakia. E-mail: [email protected].

Abstract: BACKGROUND:No general recommendations are yet available for the application of robot-assisted treadmill therapy for children with cerebral palsy regarding the length and intensity of the intervention. OBJECTIVE:The aim of the study was to evaluate patient-specific determinants of responsiveness to robot-assisted gait training (RAGT) in patients with bilateral spastic cerebral palsy. METHOD:During 12 months, the patients underwent 1–4 blocks of RAGT, representing 16–82 TUs. The following parameters were evaluated before (V0) and after each therapeutic block (V1–V4): dimension A (lying and rolling), B (sitting), C (crawling and kneeling), D (standing), E (walking, running and jumping) of the Gross Motor Function Measure (GMFM-88). We evaluated the change in motor functions in relation to the severity of disability, age, gender and number of therapeutic units. RESULTS:Ninety-seven patients aged between 3.7 and 27 years (mean age 10.02 years (SD±5.29); Gross Motor Function Classification System level I [n = 5], II [n = 25], III [n = 48], IV [n = 19]) underwent 16–82 TUs (overall average number 34.06 TUs, SD±16.41) of RAGT. In the patient group, we recorded clinically meaningful improvement and statistically significant improvement (p < 0.001) in gross motor functions with gradual increase in the effect size after each therapeutic block. Using correlation and regression analysis, we found a statistically significant associations between the number of therapeutic units, severity of disability, and improvement in motor functions after RAGT. CONCLUSION:We have identified two determinants –the severity of disability and the number of therapeutic units –which could have a decisive and predictive character in setting rehabilitation/designing programmes. The duration of the applied RAGT period, frequency and intensity could be a crucial factor for the potential of improvement in children with BS-CP.

Keywords: Neurorehabilitation, Lokomat, cerebral palsy, gross motor function

DOI: 10.3233/NRE-210130

Journal: NeuroRehabilitation, vol. 49, no. 3, pp. 375-389, 2021