Abstract
BackgroundWalking in daily life is complex entailing various prerequisites such as leg strength, trunk stability or cognitive and motor dual task (DT) activities. Conventional physiotherapy can be complemented with robot-assisted gait therapy (RAGT) and exergames to enhance the number of step repetitions, feedback, motivation, and additional simultaneously performed tasks besides walking (e.g., dual-task (DT) activities). Although DT gait training leads to improvements in daily ambulation in adult patient groups, no study has evaluated RAGT with a DT exergame in children with neurological gait disorders. Therefore, we investigated children’s functional and cognitive prerequisites to walk physiologically during RAGT with a DT exergame and analysed the influence of DT on leg muscle activity.MethodsChildren and adolescents (6–18 years) with neurological gait disorders completed RAGT with and without a DT exergame in this quasi-experimental study. We assessed several measures on the body function and activity domains (according to the International Classification of Functioning, Disability, and Health (ICF)) and determined whether these measures could distinguish well between children who walked physiologically during the DT RAGT or not. We measured leg muscle activity with surface electrodes to identify changes in EMG-amplitudes and –patterns.ResultsTwenty-one children participated (7 females, 6.5–17.3 years, Gross Motor Function Classification System (GMFCS) levels I-IV). Most activity measures distinguished significantly between participants performing the DT exergame physiologically or not with moderate to good sensitivity (0.8 ≤ sensitivity≤1.0) and specificity (0.5 ≤ specificity≤0.9). Body function measures differentiated less well. Despite that the EMG-amplitudes of key stance muscles were significantly lower during DT versus no DT exergaming, the mean activation patterns of all muscles correlated high (ρ > 0.75) between the conditions.ConclusionThis study is the first that investigated effects of a DT exergame during RAGT in children with neurological gait disorders. Several performance measures could differentiate well between patients who walked with physiological versus compensatory movements while performing the DT exergame. While the DT exergame affected the leg muscle activity amplitudes, it did not largely affect the activity patterns of the muscles.
Highlights
Walking in daily life is complex entailing various prerequisites such as leg strength, trunk stability or cognitive and motor dual task (DT) activities
During game playing with DT, five out of 20 participants walked with compensatory movements, whereas during game playing without DT, only one adolescent walked with compensatory movements
We suggest that patients with higher motor abilities according to the Functional Ambulation Category (FAC) or WeeFIM mobility might profit from a combination of walking in a driven gait orthosis (DGO) with an additional motor-cognitive task, because these patients can train with a physiological walking pattern, while they are still being challenged by the additional DT
Summary
Walking in daily life is complex entailing various prerequisites such as leg strength, trunk stability or cognitive and motor dual task (DT) activities. While some studies showed that children could improve spatio-temporal gait parameters (e.g., cadence, velocity, and stride length) or walking and standing abilities (e.g., 6 min walk test or Gross Motor Function Measure) through the intensive therapy in the DGO [2, 10, 11], we still observe that children can have difficulties in transferring the improved functions into daily life relevant walking activities Part of these difficulties might arise from impairments in motor functions such as muscle strength, trunk stability or balance, which are essential for daily life walking. Despite that they already showed effects of a DT (e.g. interference in postural control, in walking distance during given time or a deterioration in the performance of the cognitive tasks) in different populations, we are unaware of studies who investigated effects of a DT combining game playing and walking in a DGO in children and adolescents with neurological disorders
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