Efficacy of robot-assisted gait training combined with botulinum toxin injections in cerebral palsy

Aim: Cerebral palsy (CP) is the most common neuromuscular disorder of the childhood for which various therapeutic modalitiesavailable, which range from conservative approach to surgery. In the present study, we aimed to evaluate the efficacy of robotassisted gait training in patients with cerebral palsy following botulinum toxin injections in the lower extremity.Material and Methods: The study enrolled children (4 to 16 years of age) diagnosed with CP presenting to the Physical Therapyoutpatient clinic who had level 1 to 4 walking difficulty associated with lower extremity spasticity according to the GMFCS (GrossMotor Function Classification System) and received botulinum toxin injections to the lower extremity within the previous month.CP patients received robot-assisted gait training five times a week over 3 weeks for a total of 15 sessions by two physiotherapistsunder the supervision of a physician. Study assessments included measurements of the range of motion (ROM) of the joints and thepopliteal angle, GMFCS-88, Berg Balance Scale (BBS) and the and Pediatric Functional Independence Measure (WeeFIM) which wereconducted before and after treatment.Results: A total of 14 pediatric patients (8 girls, 6 boys) were included in the study. The mean age of the children was 9.93±3.54years. A statistically significant reduction in the popliteal angle was found at post-treatment assessments compared to baseline.Berg Balance Scale, WeeFIM and GMFCS-88scores were significantly improved following treatment.Conclusion: Robot-assisted gait training following botulinum toxin injections were found to provide marked improvements in motorfunctions, balance, spasticity and functional status in children with CP.

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1. Wimalasundera N, Stevenson VL. Cerebral Palsy. Pract Neurol 2016;16:184-94.
2. O’Shea TM. Diagnosis, treatment and prevention of cerebral palsy. Clin Obstet Gynecol 2008;51:816-28.
3. Multani I, Manji J, Hastings-Ison T, et al. Botulinum toxin in the management of children in cerebral palsy. Paediatr Drugs 2019;21:261-81.
4. Meyer-Heim A, Ammann-Reiffer C, Schmartz A, et al. Improvement of walking abilities after roboticassisted locomotion training in children with cerebral palsy. Arch Dis Child 2009;94:615-20.
5. Borggraefe I, Schaefer JS, Klaiber M, et al. Robotassisted treadmill therapy improves walking and standing performance in children and adolescents with cerebral palsy. Eur J Paediatr Neurol 2010;14:496- 502.
6. Katz K, Rosenthal A, Yosipovitch Z. Normal ranges of popliteal angle in children.J Pediatr Orthop 1992;12:229-31.
7. Russell DJ, Avery LM, Rosenbaum PL, et al. Improved scaling of the gross motor function measure for children with cerebral palsy: evidence of reliability and validity. Phys Ther 2000;80:873-85.
8. Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther 2008;88:559-66.
9. Ottenbacher, KJ, Msall ME, Lyon N, et al. Measuring developmental and functional status in children with disabilities. Dev Med Child Neurol 1999;41:186-94.
10. Scholtes VA, Dallmeijer AJ, Knol DL, et al. The combined effect of lower-limb multilevel botulinum toxin type A and comprehensive rehabilitation on mobility in children with cerebral palsy: a randomized clinical trial. Arch Phys Med Rehabil 2006;87:1551-8.
11. Nagel A, Dercks M, Sprinz A, et al. Robotic-assisted gait training improves gait parameters and functional mobility in patients with cerebral palsy–preliminary results of a longitudinal study. Neuropediatrics 2010;41:1365.
12. Shumway-Cook A, Hutchinson S, Kartin D, et al. Effect of balance training on recovery of stability in children with cerebral palsy. Dev Med Child Neurol 2003;45:591-602.
13. Drużbicki M, Rusek W, Szczepanik M, et al. Assessment of the impact of orthotic gait training on balance in children with cerebral palsy. Acta Bioeng Biomech 2010;12:53-8.
14. Van Hedel HJ, Meyer-Heim A, Rüsch-Bohtz C. Robotassisted gait training might be beneficial for more severely affected children with cerebral palsy. Dev Neurorehabil 2016;19:410-5.
15. Smania N, Bonetti P, Gandolfi M, et al. Improved gait after repetitive locomotor training in children with cerebral palsy. Am J Phys Med Rehabil 2011;90:137- 49.