Baseline Gross Motor Function Affects the Outcome of Robot-Assisted Therapy in Ambulatory Individuals with Spastic Cerebral Palsy.

Faustyna Manikowska,Paweł Chmara,Brian Po-Jung Chen,Marek Jóźwiak,Anna Krzyżańska

doi:10.3390/brainsci11121563

Faustyna Manikowska, Paweł Chmara + Show 3 more

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https://doi.org/10.3390/brainsci11121563

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Abstract

Robotic-assisted therapy (RAT) is a task-specific approach for treating gait disorders in individuals with neurological impairments. However, the effectiveness of RAT is not clear for different severities of involvement, pathologies, and ages. This study aimed to assess the functional and clinical status outcomes after RAT in individuals with cerebral palsy (CP). Twenty-eight individuals with bilateral spastic CP were enrolled (female = 10; male = 18; age = 15.2 ± 2.0 years). The RAT program consisted of 30 sessions: five sessions weekly for six weeks. Gross Motor Function Measure (GMFM) and clinical physical examinations were evaluated before and after RAT. Our results suggested that the RAT program with the described protocol can improve the general gross motor functions of individuals with CP in Gross Motor Function Classification System (GMFCS) levels I and II, and primarily improves performance on less complex GMFM items for those in GMFCS levels III and IV. The lower baseline functional level was related to a greater functional improvement. Older individuals were noticed to improve more in GMFM dimension D. Regarding impairments evaluated by clinical examinations, no change was found after RAT intervention. It is worth mentioning that the strength of knee muscles was not affected either.

Highlights

Cerebral palsy (CP) is a non-progressive damage of the immature brain, which manifests by complex impairment
We found a statistically significant improvement in gross motor functions assessed by Gross Motor Function Measure (GMFM) both in total score (p < 0.01) and in each specific dimension
We found that baseline gross motor function, age, and Gross Motor Function Classification System (GMFCS) level were associated with some changes in function

Summary

Introduction

Cerebral palsy (CP) is a non-progressive damage of the immature brain, which manifests by complex impairment. Weakness, reduced selective motor control, and spasticity, among other symptoms, affect the motor function ability of patients. The heterogeneity of this disease being caused by injury to the brain’s motor system leads to infinite combinations of clinical symptoms. Individuals with neurological deficits present various degrees of disability that interfere with their function and daily life activities [1]. The primary treatment goal for children with CP is to facilitate the individual’s ability to perform activities in daily life [2,3]. Treatment goals should meet subjective aims and at the same time take into consideration the restrictions resulting from neurological impairments, functional deficits, and body deformities

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