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

WU Yinghua; ZHOU Yu; YAN Fuli; GAO Jing

doi:10.11852/zgetbjzz2024-0833

PDF(3467 KB)

Chinese Journal of Child Health Care ›› 2025, Vol. 33 ›› Issue (6) : 653-659. DOI: 10.11852/zgetbjzz2024-0833

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

Author information +

History +

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

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

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 https://doi.org/10.11852/zgetbjzz2024-0833

References

[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.