Abstract
Goal: To determine the efficacy of wearable adaptive resistance training for rapidly improving walking ability in children with cerebral palsy (CP). Methods: Six children with spastic CP (five males, one female; mean age 14y 11mo; three hemiplegic, three diplegic; Gross Motor Function Classification System [GMFCS] levels I and II) underwent ten, 20-minute training sessions over four weeks with a wearable adaptive resistance device. Strength, speed, walking efficiency, timed up and go (TUG), and six-minute walk test (6MWT) were used to measure training outcomes. Results: Participants showed increased average plantar flexor strength (17 ± 8%, p = 0.02), increased preferred walking speed on the treadmill (39 ± 25%, p = 0.04), improved metabolic cost of transport (33 ± 9%, p = 0.03), and enhanced performance on the timed up and go (11 ± 9%, p = 0.04) and six-minute walk test (13 ± 9%, p = 0.04). Conclusions: The observed increase in preferred walking speed, reduction in metabolic cost of transport, and improved performance on clinical tests of mobility highlights the potentially transformative nature of this novel therapy; the rate at which this intervention elicited improved function was 3 – 6 times greater than what has been reported previously.
Highlights
AFFECTING 17 million people globally [1], cerebral palsy (CP) is a movement disorder caused by injury to the developing brain, characterized by deficits in strength [2] and neuromuscular coordination [1]
While surgical and pharmacological interventions successfully contribute to the management of the most severe presentations of CP [7], lifelong walking disability remains for most individuals affected by CP
All data assessed in the statistical comparisons a Indicates the maximum voluntary contraction value for the plantar flexors, presented as the average between limbs and normalized to body mass
Summary
AFFECTING 17 million people globally [1], cerebral palsy (CP) is a movement disorder caused by injury to the developing brain, characterized by deficits in strength [2] and neuromuscular coordination [1]. To meet this need, a wearable robotic device was recently developed to address deficits in muscle recruitment and reinforce neuromuscular control patterns that may produce lasting improvements in locomotor function [14]. Utilizing onboard sensors and a closed-loop control strategy that responds immediately to user input, this novel training modality provides perfectly synchronized resistance to re-train ankle plantar flexor muscle function during the stance phase of walking This device, unlike passive gait training interventions, provides an opportunity to monitor user engagement in real-time, allowing for the immediate performance feedback necessary for increasing task skill [15]. We hypothesized that these improvements would translate to better performance on clinically validated tests of walking function
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