Robot-assisted gait training improves walking and cerebral connectivity in children with unilateral cerebral palsy

• Published in: Pediatric research 2024-10, Vol.96 (5), p.1306-1315
• Main Authors: Julien, Laura, Moreau-Pernet, Guillemette, Rochette, Emmanuelle, Lemaire, Jean-Jacques, Pontier, Bénédicte, Bourrand, Sacha, Pereira, Bruno, Chassain, Carine, Sontheimer, Anna, Sarret, Catherine
• Format: Article
• Language: English
• Subjects: Adolescent; Cerebral palsy; Cerebral Palsy - physiopathology; Cerebral Palsy - rehabilitation; Child; Child, Preschool; Clinical outcomes; Clinical Research Article; Exercise Therapy - methods; Female; Gait; Human health and pathology; Humans; Life Sciences; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Motor ability; Neurodevelopmental disorders; Neuronal Plasticity; Pediatric Surgery; Pediatrics; Physical therapy; Rehabilitation; Robotics; Robots; Treatment Outcome; Walking
• ISSN: 0031-3998; 1530-0447; 1530-0447
• DOI: 10.1038/s41390-024-03240-1

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 Short-term repetitive robot-assisted gait training improves gait speed and walking resistance and increases cerebral functional connectivity in unilateral cerebral palsy. GMFM dimensions D and E were unchanged after short-term repetitive robot-assisted gait training in unilateral cerebral palsy.