Abstract
Children with a neurological disorder such as cerebral palsy (CP) severely suffer from a reduced quality of life because of decreasing independence and mobility. Although there is no cure yet, a lower-limb exoskeleton (LLE) has considerable potential to help these children experience better mobility during overground walking. The research in wearable exoskeletons for children with CP is still at an early stage. This paper shows that the number of published papers on LLEs assisting children with CP has significantly increased in recent years; however, no research has been carried out to review these studies systematically. To fill up this research gap, a systematic review from a technical and clinical perspective has been conducted, based on the PRISMA guidelines, under three extended topics associated with "lower limb", "exoskeleton", and "cerebral palsy" in the databases Scopus and Web of Science. After applying several exclusion criteria, seventeen articles focused on fifteen LLEs were included for careful consideration. These studies address some consistent positive evidence on the efficacy of LLEs in improving gait patterns in children with CP. Statistical findings show that knee exoskeletons, brushless DC motors, the hierarchy control architecture, and CP children with spastic diplegia are, respectively, the most common mechanical design, actuator type, control strategy, and clinical characteristics for these LLEs. Clinical studies suggest ankle-foot orthosis as the primary medical solution for most CP gait patterns; nevertheless, only one motorized ankle exoskeleton has been developed. This paper shows that more research and contribution are needed to deal with open challenges in these LLEs.
Highlights
CEREBRAL Palsy (CP), Spinal Cord Injury (SCI), Spina Bifida (SB), and Traumatic Brain Injury (TBI) are the primary causes of mobility disorder in children [1]
It can be concluded that 2.2 kg for AFOs and 3.2 kg for knee exoskeletons seems appropriate for children with CP
This paper provides a systematic review of the existing literature on lower limb robotic exoskeletons for children with CP to fill an open research gap in this area
Summary
CEREBRAL Palsy (CP), Spinal Cord Injury (SCI), Spina Bifida (SB), and Traumatic Brain Injury (TBI) are the primary causes of mobility disorder in children [1]. CP is the most common mobility disorder in children [2, 3], with 8,000 to 10,000 children being diagnosed with cerebral palsy worldwide every year [4]. Common to most individuals with CP is major trouble controlling movement, posture, and balance [5]. Routine medical care, such as surgery [7], physical therapy [8], and muscle injections [9], can enhance walking ability in children affected by CP, but decreased knee extension generally persists or recurs after treatment. In spite of treatments to help the individuals who can walk, some children with CP worsen and lose their capacity to walk when they are grown-ups [10, 11]
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