Department of Pediatrics, CRECHE, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.
Clermont Auvergne University, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France.
Pediatr Res. 2024 Oct;96(5):1306-1315. doi: 10.1038/s41390-024-03240-1. Epub 2024 May 20.
Robot-assisted gait training (RAGT) is promising to help walking rehabilitation in cerebral palsy, but training-induced neuroplastic effects have little been investigated.
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.
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.
Short-term benefit of repetitive RAGT on walking abilities and functional cerebral connectivity was found in unilateral cerebral palsy children.
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.
机器人辅助步态训练（RAGT）有望帮助脑瘫患者进行行走康复，但训练引起的神经可塑性影响尚未得到充分研究。
本单中心研究将 40 名 4-18 岁的单侧脑瘫儿童随机分为两组，一组接受 G-EO 系统的 10 次 20 分钟的 RAGT，每周 5 天（n=20），另一组接受常规治疗（继续进行 6 次 30 分钟的物理治疗，每周 3 天，n=20），为期两周，从 2020 年 9 月至 2021 年 12 月。治疗前后比较临床和 MRI 结果。主要结果是步行速度。次要结果是 6 分钟步行测试距离、粗大运动功能测量-88（GMFM-88）维度 D 和 E、患者整体改善印象、感觉运动网络内的静息状态功能连接以及皮质脊髓束内的结构连接。
RAGT 后步行速度和 6 分钟步行测试距离提高更多。RAGT 后静息状态功能连接增加，但对照组中健康的上侧和外侧感觉运动网络或受伤的外侧感觉运动网络之间的连接减少。GMFM-88 和皮质脊髓束内的结构连接没有变化。RAGT 后儿童的改善印象更好。
在单侧脑瘫儿童中，重复 RAGT 短期对行走能力和功能性大脑连接有获益。
短期重复机器人辅助步态训练可提高单侧脑瘫儿童的步行速度和步行阻力，并增加大脑功能连接。GMFM 维度 D 和 E 在单侧脑瘫儿童短期重复机器人辅助步态训练后没有变化。
