Abstract
Background
Robot-assisted gait training (RAGT) is promising to help walking rehabilitation in cerebral palsy, but training-induced neuroplastic effects have little been investigated.
Methods
Forty unilateral cerebral palsy children aged 4–18 years were randomly allocated in a monocentric study to ten 20-minute RAGT sessions with the G-EO system, five days a week (n = 20) or to a control group (who continued conventional care with six 30-minute physiotherapy sessions, three days a week) (n = 20), two weeks running, from September 2020 to December 2021. Clinical and MRI outcomes were compared before and one month after therapy. The primary outcome was gait speed. Secondary outcomes were a 6-minute walking test distance, Gross Motor Function Measure-88 (GMFM-88) dimensions D and E, Patient Global Impression of Improvement, resting-state functional connectivity within the sensorimotor network, and structural connectivity in the corticospinal tracts.
Results
Gait speed and the 6-minute walking test distance improved more after RAGT. Resting-state functional connectivity increased after RAGT but decreased in controls between superior and lateral healthy or lateral injured sensorimotor networks. GMFM-88 and structural connectivity in corticospinal tracts were unchanged. Impression of improvement in children was better after RAGT.
Conclusion
Short-term benefit of repetitive RAGT on walking abilities and functional cerebral connectivity was found in unilateral cerebral palsy children.
Impact statement
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Short-term repetitive robot-assisted gait training improves gait speed and walking resistance and increases cerebral functional connectivity in unilateral cerebral palsy.
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GMFM dimensions D and E were unchanged after short-term repetitive robot-assisted gait training in unilateral cerebral palsy.
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Data availability
The data that support the findings of this study are not directly available for sharing as they were collected and registered in our institution using the RedCAP system. Requests to access the data can be submitted to the corresponding author and will be reviewed by the hospital research department before transfer agreement. Research projects of high relevance or controls of raw data are acceptable for sharing data.
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Acknowledgements
The authors thank Dr V. Reynaud and Dr M. Grolier for GaitRite recording, the neuropediatricians (Dr P. Lacombe, Dr G. Remerand), and rehabilitation specialists (Dr E. Ramain and Dr C. Cardenoux) who addressed patients, Prof. Merlin for advice on the initial study protocol, all the physiotherapists who managed children, the Ekipe Medical Recherche Association, and the children and their families for their active participation.
Funding
L. Julien received a grant from the University of Clermont Auvergne for this work. The study was funded by the University Hospital of Clermont-Ferrand.
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L.J., G.M.P., E.R., S.B., B.P., A.S., B.P., C.C. performed acquisition or analysis of data. L.J., G.M.P., E.R., A.S., J.J.L., B.P., and C.S. participated in conception and design. C.S. drafted the main manuscript. A.S., B.P., E.R., and J.J.L. revised the manuscript. All authors approved the final draft for submission.
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Julien, L., Moreau-Pernet, G., Rochette, E. et al. Robot-assisted gait training improves walking and cerebral connectivity in children with unilateral cerebral palsy. Pediatr Res 96, 1306–1315 (2024). https://doi.org/10.1038/s41390-024-03240-1
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DOI: https://doi.org/10.1038/s41390-024-03240-1
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