A Narrative Review on Robotic-Assisted Gait Training in Children and Adolescents with Cerebral Palsy: Training Parameters, Choice of Settings, and Perspectives

Abstract

About 70% of children and adolescents with cerebral palsy experience gait impairments which affect their autonomy and well-being. Robotic-assisted gait training using the Lokomat is particularly promising for rehabilitation as it provides a standardized environment favoring the massive repetition of the movement, in which physical demands are low on the therapist and high training loads can be achieved. As no guidelines exist regarding training protocols and Lokomat settings, the goal of this narrative review was to summarize previously published information on the use of RAGT in children and adolescents with cerebral palsy and to provide an opinion on possibilities for improving future research. The thirteen studies reviewed reported both positive and null effects of Lokomat training on gait. Half of the studies combined the Lokomat with other types of training, and only five used a control intervention to assess its benefit. Overall, training was administered 1–5 times per week for 20–60 min, over 1–12 weeks. Although Lokomat settings were not always described, progressively decreasing body weight support and guidance while increasing the treadmill speed appeared to be prioritized. The variety of training protocols and settings used did not allow pooling of the studies to assess the effects of interventions on gait parameters in children and adolescents with cerebral palsy. This narrative review highlights the need for homogenization of interventions so that clear guidelines can emerge and be applied in rehabilitation centers.