École de Kinésiologie et des Sciences de L'Activité Physique, Faculté de Médecine, Université de Montréal, 2100, Boul. Édouard-Montpetit, H3T 1J4 Montréal, Québec, Canada; Centre de Recherche du Centre de Réadaptation Marie-Enfant, CHU Sainte-Justine, 5200 Rue Bélanger, H1T 1C9 Montréal, Québec, Canada.
Centre de Recherche du Centre de Réadaptation Marie-Enfant, CHU Sainte-Justine, 5200 Rue Bélanger, H1T 1C9 Montréal, Québec, Canada; Département des Sciences de L'Activité Physique, Université de Québec à Montréal, C.P. 8888, Succursale Centre-Ville, H3C 3P8 Montréal, Québec, Canada.
Neurophysiol Clin. 2020 Nov;50(6):507-519. doi: 10.1016/j.neucli.2020.09.005. Epub 2020 Oct 1.
Robotic gait training presents a promising training modality. Nevertheless, evidence supporting the efficacy of such therapy in children with cerebral palsy remains insufficient. This study aimed to assess the effect of robotic gait training in children/adolescents with cerebral palsy.
Twenty-four children/adolescents with bilateral cerebral palsy (12 female, 10.1 ± 3.1 years, Gross Motor Function Classification System II to IV) took part in this study. They received two 30-45 min sessions/week of Lokomat training for 12-weeks. Muscle strengths, 6-min walk exercise and gait parameters were evaluated pre- and post-training and at 6-months-follow-up. Training effect according to the level of impairment severity (moderate vs severe) was analyzed using a change from the baseline procedure.
A significant increase in muscle strength was observed after training (p ≤ 0.01). Hip flexors and knee extensors strength changes were maintained or improved at follow-up (p < 0.05). Comfortable walking speed was significantly increased by +20% after training with a slight reduction at follow-up compared to post-training condition (-2.7%, p < 0.05). A significant step length increase was observed after training (14%, p ≤ 0.001). The distance covered in 6 min was higher in post-training (+24%, p ≤ 0.001) and maintained at follow-up compared to pre-training conditions. No significant changes in kinematic patterns were observed. The analysis by subgroup showed that both groups of children (with moderate and severe impairments) improved muscle strength and walking capacities after Lokomat training.
The suggested Lokomat training induced improvement in walking capacity of children/adolescents with cerebral palsy whatever the level of severity. Hence, Lokomat training could be viewed as a valuable training modality in this population.
机器人步态训练是一种很有前途的训练方式。然而，支持这种疗法对脑瘫儿童有效的证据仍然不足。本研究旨在评估机器人步态训练对脑瘫儿童/青少年的效果。
24 名双侧脑瘫儿童/青少年（12 名女性，10.1±3.1 岁，粗大运动功能分级系统 II 至 IV 级）参与了这项研究。他们接受了为期 12 周的 Lokomat 训练，每周 2 到 3 次，每次 30 到 45 分钟。在训练前、训练后和 6 个月随访时评估肌肉力量、6 分钟步行运动和步态参数。根据损伤严重程度（中度与重度）水平，使用从基线开始的变化来分析训练效果。
训练后肌肉力量显著增加（p≤0.01）。髋关节屈肌和膝关节伸肌的力量变化在随访时保持或改善（p<0.05）。与训练后相比，训练后舒适行走速度增加了 20%（-2.7%，p<0.05）。训练后步长显著增加（14%，p≤0.001）。6 分钟内覆盖的距离在训练后更高（增加了 24%，p≤0.001），并且与训练前相比保持不变。运动学模式没有明显变化。亚组分析显示，两组儿童（中重度障碍）在接受 Lokomat 训练后，肌肉力量和行走能力都得到了改善。
建议的 Lokomat 训练可改善脑瘫儿童/青少年的步行能力，无论严重程度如何。因此，Lokomat 训练可以被视为该人群中一种有价值的训练方式。
