Lokomat机器人辅助步态训练对改善脑瘫患儿下肢功能效果的Meta分析

doi:10.11852/zgetbjzz2024-0833

中国儿童保健杂志 ›› 2025, Vol. 33 ›› Issue (6): 653-659.DOI: 10.11852/zgetbjzz2024-0833

Lokomat机器人辅助步态训练对改善脑瘫患儿下肢功能效果的Meta分析

武英华^1,2,3, 周宇⁴, 闫富丽^1,2,3, 高晶⁴

1.佳木斯大学康复医学院,黑龙江佳木斯 154007;
2.佳木斯大学附属第三医院;
3.黑龙江省儿童神经康复重点实验室;
4.淮安市妇幼保健院儿童康复科

收稿日期:2024-07-16 修回日期:2024-11-01 发布日期:2025-06-05 出版日期:2025-06-10
通讯作者: 高晶,E-mail:gaojing392@163.com
作者简介:武英华(2000—),女,硕士研究生,主要从事小儿脑瘫康复方面的研究。
基金资助:
江苏省自然科学基金(BK20230292);江苏省卫生健康委医学科研项目(M2022022);淮安市科技局自然科学研究项目(HAB202333);淮安市科技计划项目(HAB202126)

Meta-analysis on the effect of Lokomat robot-assisted gait training on lower limb function in patients with cerebral palsy

WU Yinghua^1,2,3, ZHOU Yu⁴, YAN Fuli^1,2,3, GAO Jing⁴

1. Department of Rehabilitation Medicine, Jiamusi University, Jiamusi, Heilongjiang 154007, China;
2. The Third Affiliated Hospital of Jiamusi University;
3. Heilongjiang Provincial Key Laboratory of Pediatric Neurological Rehabilitation;
4. Department of Child Rehabilitation, Huai′an Maternal and Child Health Care Hospital

Received:2024-07-16 Revised:2024-11-01 Online:2025-06-10 Published:2025-06-05
Contact: GAO Jing,E-mail:gaojing392@163.com

摘要/Abstract

摘要： 目的系统评价Lokomat机器人辅助训练改善脑瘫患儿下肢功能的效果,为指导临床康复实践提供科学依据。方法检索PubMed、Web of Science、Embase、Cochrane Library、中国知网、万方、维普和中国生物医学文献数据库中关于Lokomat机器人辅助训练对脑瘫患儿下肢功能影响的文献,检索时限为建库至2024年7月。两名研究者独立对数据库文献进行筛选、提取数据和偏倚风险评估,使用RevMan 5.4软件进行Meta分析。结果最终纳入11项随机对照试验,涉及脑瘫样本量为502例。Meta 分析显示:试验组粗大运动功能评估量表(GMFM-88) D区评分(SMD=0.40,95%CI:0.06～0.74,P=0.02)、GMFM-88 E区评分(SMD=0.43,95%CI:0.07～0.79,P=0.02)、自由步行速度(MD=0.11,95%CI:0.06～0.16,P＜0.001)和BBS评分(MD=3.50,95%CI:1.27～5.74,P=0.002)明显优于对照组,两组间6min步行距离差异无统计学意义(P＞0.05)。结论 Lokomat机器人辅助步态训练可在一定程度上改善脑瘫患儿的下肢运动、步行和平衡能力,可作为一种安全有效的康复手段在临床应用。

关键词: 脑性瘫痪, Lokomat, 机器人辅助训练, 康复, Meta分析

Abstract: Objective To systematically evaluate the effectiveness of Lokomat robotic-assisted gait training in improving lower limb function in children with cerebral palsy, in order to provide a scientific basis for guiding clinical rehabilitation practice. Methods PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang Data, VIP, and China Biology Medicine(CBM) were searched for literature on the effect of Lokomat robotic-assisted gait training on lower limb function in children with cerebral palsy, with a retrieval period from the inception of the databases to July 2024. Two researchers independently screened the literature, extracted data, and assessed risk of bias. Meta-analysis was conducted using RevMan 5.4 software. Results A total of 11 randomized controlled trials were included, involving 502 patients with cerebral palsy. Meta-analysis showed that GMFM-88 D score(SMD=0.40, 95%CI:0.06 - 0.74, P=0.02), GMFM-88 E score(SMD=0.43, 95%CI:0.07 - 0.79, P=0.02), free walking speed(MD=0.11, 95%CI:0.06 - 0.16, P＜0.001), and BBS score(MD=3.50, 95%CI:1.27 - 5.74, P=0.002) were better in the experimental group than those in the control group. There was no significant difference in 6-minute walk distance between the two groups(P＞0.05). Conclusion Lokomat robotic-assisted gait training can improve lower limb motor function, walking ability, and balance in children with cerebral palsy to a certain extent, and may serve as a safe and effective rehabilitation method for chinical application.

Key words: cerebral palsy, Lokomat, robot-assisted training, rehabilitation, Meta-analysis

中图分类号:

R179

武英华, 周宇, 闫富丽, 高晶. Lokomat机器人辅助步态训练对改善脑瘫患儿下肢功能效果的Meta分析[J]. 中国儿童保健杂志, 2025, 33(6): 653-659.

WU Yinghua, ZHOU Yu, YAN Fuli, GAO Jing. Meta-analysis on the effect of Lokomat robot-assisted gait training on lower limb function in patients with cerebral palsy[J]. Chinese Journal of Child Health Care, 2025, 33(6): 653-659.

参考文献

[1] 中国康复医学会儿童康复专业委员会, 中国残疾人康复协会小儿脑性瘫痪康复专业委员会, 中国医师协会康复医师分会儿童康复专业委员会, 等. 中国脑性瘫痪康复指南(2022)第一章:概论[J]. 中华实用儿科临床杂志, 2022, 37(12): 887-892.
Chinese Association of Rehabilitation Medicine Pediatric Rehabilitation Committee, Chinese Association of Rehabilitation of Disabled Persons Rehabilitation Committee for Cerebral Palsy, Chinese Medical Doctor Association Pediatric Rehabilitation Committee, et al. Chinese rehabilitation guidelines for cerebral palsy(2022):Editorial board[J]. Chin J Appl Clin Pediatr, 2022, 37(12): 887-892.(in Chinese)
[2] Novak I, Morgan C, Adde L, et al. Early, accurate diagnosis and early intervention in cerebral palsy: Advances in diagnosis and treatent[J].JAMA Pediatr, 2017, 171(9): 897-907.
[3] Sadowska M, Sarecka-Hujar B, Kopyta I. Cerebral palsy: Current opinions on definition, epidemiology, risk factors, classification and treatment options[J].Neuropsychiatr Dis Treat, 2020(16): 1505-1518.
[4] 陶璟,霍宇飞,于随然.面向儿童的下肢康复外骨骼机器人研发进展[J].中国康复医学杂志, 2021, 36(11):1445-1449.
Tao J, Huo YF, Yu SR.Research and development progress of lower limb rehabilitation exoskeleton robots for children[J].Chin J Rehabil Med, 2021, 36(11): 1445-1449.(in Chinese)
[5] Reyes F, Niedzwecki C, Gaebler-Spira D.Technological advancements in cerebral palsy rehabilitation[J]. Phys Med Rehabil Clin N Am, 2020, 31(1): 117-129.
[6] 唐心意, 喻洪流, 李慧, 等. 脑性瘫痪儿童下肢康复机器人研究现状与展望[J]. 中国康复医学杂志, 2022, 37(7): 971-976.
Tang XY, Yu HL, Li H, et al. Research status and prospects of lower limb rehabilitation robots for children with cerebral palsy[J]. Chin J Rehabil Med, 2022, 37(7): 971-976.(in Chinese)
[7] Jezernik S, Colombo G, Keller T, et al. Robotic orthosis lokomat: A rehabilitation and research tool[J]. Neuromodulation, 2003, 6(2): 108-115.
[8] Klobucká S, Klobucky R, Kollár B. Effect of robot-assisted gait training on motor functions in adolescent and young adult patients with bilateral spastic cerebral palsy: A randomized controlled trial[J]. Neuro Rehabilitation, 2020, 47(4): 495-508.
[9] 马婷婷, 张皓. 机器人辅助步态训练对痉挛型脑性瘫痪患儿运动和步行功能的效果[J]. 中国康复理论与实践, 2021, 27(11): 1260-1265.
Ma TT, Zhang H. Effect of robot-assisted gait training on motor and walking function in children with spastic cerebral palsy[J].Chin Rehabil Theory Pract,2021, 27(11): 1260-1265.(in Chinese)
[10] Druz.bicki M, Rusek W, Snela S, et al. Functional effects of robotic-assisted locomotor treadmill thearapy in children with cerebral palsy[J]. J Rehabil Med, 2013, 45(4): 358-363.
[11] Arellano-Martínez IT, Rodríguez-Reyes G, Quiñones-Uriostegui I, et al. Spatial-temporal analysis and clinical findings of gait: Comparison of two modalities of treatment in children with cerebral palsy-spastic hemiplegia. Preliminary report[J].Cir Cir, 2013, 81(1): 14-20.
[12] Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: A new edition of the cochrane handbook for systematic reviews of interventions[J].Cochrane Database Syst Rev, 2019, 10(10): ED000142.
[13] Albanese E, Bütikofer L, Armijo-Olivo S, et al. Construct validity of the physiotherapy evidence database(PEDro) quality scale for randomized trials: Item response theory and factor analyses[J]. Res Synth Methods,2020,11(2): 227-236.
[14] Ammann-Reiffer C, Bastiaenen C, Meyer-Heim AD, et al. Lessons learned from conducting a pragmatic, randomized, crossover trial on robot-assisted gait training in children with cerebral palsy(PeLoGAIT)[J]. J Pediatr Rehabil Med, 2020, 13(2): 137-148.
[15] Mahgoub MSE, Younan WWA, Zahran SS. Effect of locomotor training with a robotic-gait orthosis(lokomat) in spasticity modulation of spastic hemiplegic children(a randomized controlled trial)[J]. Fizjoterapia Polska, 2020, 20(4): 94-101.
[16] Wallard L, Dietrich G, Kerlirzin Y, et al. Effect of robotic-assisted gait rehabilitation on dynamic equilibrium control in the gait of children with cerebral palsy[J]. Gait Posture, 2018, 60: 55-60.
[17] Peri E, Turconi AC, Biffi E, et al. Effects of dose and duration of robot-assisted gait training on walking ability of children affected by cerebral palsy[J]. Technol Health Care, 2017, 25(4): 671-681.
[18] 熊华春,陈精慧,王军,等. 下肢康复机器人训练对痉挛型脑瘫患儿粗大运动功能及平衡功能的影响[J].郑州大学学报(医学版), 2021, 56(3): 370-375.
Xiong HC, Chen JH, Wang J, et al. Effect of lower limb rehabilitation robot training on gross motor function and balance function in children with spastic cerebral palsy[J]. J Zhengzhou Univ(Med Sci), 2021, 56(3): 370-375.(in Chinese)
[19] 陈精慧.下肢康复机器人训练对痉挛型脑性瘫痪患儿运动功能的疗效研究[D].郑州:郑州大学, 2021.
Chen JH. Study on the efficacy of lower limb rehabilitation robot training on motor function in children with spastic cerebral palsy[D]. Zhengzhou:Zhengzhou University, 2021.(in Chinese)
[20] 郑宏超, 王琼, 杨丽. 下肢机器人配合运动疗法训练对脑瘫患儿步行能力的影响[J]. 临床医学研究与实践, 2021, 6(33): 166-168,179.
Zhen HC, Wang Q, Yang I. Effect of lower limb robot-assisted exercise therapy on walking ability in children with cerebral palsy[J]. Clin Res Pract, 2021, 6(33): 166-168,179.(in Chinese)
[21] Young AJ, Ferris DP. State of theart and future directions for lower limb robotic exoskeletons[J]. IEEE Trans Neural Syst Rehabil Eng, 2017, 25(2): 171-182.
[22] 华裕, 朱敏, 张跃. 儿童康复机器人应用现状及发展趋势[J]. 中国康复理论与实践, 2018, 24(6): 667-670.
Hua Y, Zhu M, Zhang Y. Current status and development trends of pediatric rehabilitation robots[J]. Chin Rehabil Theory Pract,2018, 24(6): 667-670.(in Chinese)
[23] Kim SK, Park D, Yoo B, et al. Overground robot-assisted gait training for pediatric cerebral palsy[J]. Sensors, 2021, 21(6): 2087.
[24] Wang Y, Zhang P, Li C. Systematic review and network meta-analysis of robot-assisted gait training on lower limb function in patients with cerebral palsy[J]. Neurol Sci, 2023, 44(11): 3863-3875.
[25] Carvalho I, Pinto SM, Chagas D, et al. Robotic gait training for individuals with cerebral palsy: A systematic review and meta-analysis[J]. Arch Phys Med Rehabil, 2017, 98(11): 2332-2344.
[26] Damiano DL. Activity, activity, activity: Rethinking our physical therapy approach to cerebral palsy[J]. Phys Ther, 2006, 86(11): 1534-1540.
[27] Shishov N, Melzer I, Bar-Haim S. Parameters and measures in assessment of motor learning in neurorehabilitation: A systematic review of the literature[J]. Front Hum Neurosci, 2017, 11: 82.
[28] Pan L, Song A, Xu G, et al. Hierarchical safety supervisory control strategy for robot-assisted rehabilitation exercise[J]. Robotica, 2013, 31(5): 757-766.
[29] Michmizos KP, Krebs HI. Pediatric robotic rehabilitation: Current knowledge and future trends in treating children with sensorimotor impairments[J]. NeuroRehabilitation, 2017, 41(1): 69-76.
[30] Aurich-Schuler T, Warken B, Graser JV, et al. Practical recommendations for robot-assisted treadmill therapy(Lokomat) in children with cerebral palsy: Indications, goal setting, and clinical implementation within the WHO-ICF framework[J]. Neuropediatrics, 2015, 46(4): 248-260.

Lokomat机器人辅助步态训练对改善脑瘫患儿下肢功能效果的Meta分析

Meta-analysis on the effect of Lokomat robot-assisted gait training on lower limb function in patients with cerebral palsy

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

[1]	范桃林, 赵倩, 刘杰, 范敏, 魏慧群. 儿童脑性瘫痪足踝畸形康复的研究进展[J]. 中国儿童保健杂志, 2025, 33(6): 648-652.
[2]	刘银花, 廖子菁, 顾颖, 戴冬梅, 任彩玲, 张峰. 家庭共同活动框架游戏对孤独症谱系障碍幼儿的疗效分析[J]. 中国儿童保健杂志, 2025, 33(6): 671-674.
[3]	杨蕾, 叶锦林, 咸亚静, 李现红. 阅读疗法在残疾儿童康复领域的应用进展[J]. 中国儿童保健杂志, 2025, 33(4): 409-414.
[4]	程义超, 史佳欣, 王佳城, 姜志梅. 认知行为疗法对改善孤独症谱系障碍儿童焦虑症状的Meta分析[J]. 中国儿童保健杂志, 2025, 33(4): 431-438.
[5]	李望, 陈培友, 吴志建, 叶巍. 以家庭为基础的运动干预对学龄前儿童超重肥胖影响的Meta分析[J]. 中国儿童保健杂志, 2025, 33(2): 214-220.
[6]	李丽芳, 李晶, 张长杰. 孤独症谱系障碍儿童语言障碍特点及语言能力提升的康复干预模式[J]. 中国儿童保健杂志, 2025, 33(1): 97-102.
[7]	谢婷婷, 裴梓贻, 张悦. 音乐疗法在儿童康复中的应用研究进展[J]. 中国儿童保健杂志, 2024, 32(9): 1004-1007.
[8]	鲁果果, 黄晓金, 李国华, 赵永利. 青少年血清维生素D水平与非酒精性脂肪性肝病相关性的Meta分析[J]. 中国儿童保健杂志, 2024, 32(8): 897-901.
[9]	刘家豪, 郭津, 公超, 方立雅, 连贝贝, 李佳蔚, 刘媛媛. 脑性瘫痪儿童共病尿失禁的研究进展[J]. 中国儿童保健杂志, 2024, 32(7): 772-777.
[10]	许婷, 刘鹏鸿, 李树峰, 高胜利, 刘丽霞. 网络认知行为疗法对青少年抑郁症状疗效Meta分析[J]. 中国儿童保健杂志, 2024, 32(7): 778-784.
[11]	高夫宁, 汤健, 陈文翔, 张磊, 朱敏. GMFCSⅠ-Ⅱ级痉挛型双瘫儿童足弓发育的研究及康复治疗方案[J]. 中国儿童保健杂志, 2024, 32(5): 484-490.
[12]	刘家豪, 公超, 连贝贝, 郭津. 脑瘫儿童共病骨折的病因和干预措施[J]. 中国儿童保健杂志, 2024, 32(5): 511-515.
[13]	刘方, 贠国俊, 黄美欢, 郭莹莹, 赵欣. 本体感觉评估在脑瘫儿童中的应用[J]. 中国儿童保健杂志, 2024, 32(5): 534-537.
[14]	宰伟仪, 徐宁, 吴伟, 王月莹. 不同康复疗法改善痉挛型脑瘫患儿运动功能障碍疗效的网状Meta分析[J]. 中国儿童保健杂志, 2024, 32(5): 543-551.
[15]	蔚然, 孔锐, 关陆阳, 王永露, 叶侃. 益生菌对孤独谱系障碍患者核心症状干预效果的荟萃分析[J]. 中国儿童保健杂志, 2024, 32(3): 322-328.