The Effect of Robot-assisted Walking Training on Motor Functions, Respiratory Parameters and Functional Capacity in Cerebral Palsy

Detailed Description

Cerebral Palsy (CP) is a group of permanent disorders affecting movement, posture, and motor control caused by non-progressive disturbances in the developing brain. In addition to motor impairments such as spasticity, muscle weakness, and impaired balance, children with CP frequently demonstrate reduced cardiopulmonary capacity and decreased endurance during daily activities. Limitations in trunk control, altered gait mechanics, and reduced physical activity levels may negatively influence respiratory function over time. For this reason, modern pediatric rehabilitation approaches increasingly emphasize interventions that address both motor performance and physiological capacity.

Neurodevelopmental treatment (NDT) is one of the most commonly used therapeutic approaches in pediatric neurorehabilitation. The approach focuses on facilitating normal movement patterns, improving postural control, enhancing functional mobility, and promoting participation in daily activities through task-specific exercises and therapist-guided movement strategies. Although NDT-based interventions are widely applied, complementary technologies that increase movement repetition and provide structured gait practice may further enhance rehabilitation outcomes.

Robot-assisted gait training has been developed to deliver repetitive, task-specific walking practice with controlled parameters such as walking speed and body alignment. These systems enable individuals with neurological impairments to practice symmetrical gait cycles while receiving external mechanical support and consistent sensory input. Such repetitive locomotor training may contribute to motor learning, improve walking ability, and potentially increase cardiopulmonary engagement during rehabilitation. However, evidence regarding the combined effects of robot-assisted gait training and conventional neurodevelopmental treatment on both motor and respiratory outcomes in children with Cerebral Palsy remains limited.

This study investigates the effects of adding robot-assisted gait training to a neurodevelopmental treatment-based rehabilitation program in ambulatory children with Cerebral Palsy. The intervention program is designed to target multiple components of functional performance, including postural control, balance, lower-extremity strength, coordination, and breathing mechanics. Participants are allocated into two intervention groups: a neurodevelopmental treatment group and a neurodevelopmental treatment plus robot-assisted rehabilitation group. Both interventions are administered by a physiotherapist experienced in pediatric neurological rehabilitation.

The neurodevelopmental treatment program consists of a structured series of exercises designed to improve trunk stability, balance control, and functional mobility. The exercise protocol includes diaphragmatic breathing training intended to facilitate respiratory muscle activation and improve breathing patterns. Balance and gait-related tasks are incorporated through tandem walking and step-length training, which aim to enhance dynamic stability and gait symmetry. Functional strengthening exercises include repeated sit-to-stand activities performed on a supported balance surface, which target lower-extremity muscle activation and postural transitions commonly used in daily activities.

Additional exercises focus on trunk and pelvic control. Pelvic elevation (bridging) exercises are used to strengthen the hip extensors and improve pelvic stability, while quadrupedal balance tasks with contralateral reaching challenge trunk coordination and postural control. Functional stepping activities performed using a step platform provide task-specific practice of stepping movements and weight transfer. Finally, weight-shifting activities in a seated position are performed with therapist-applied approximation to stimulate proprioceptive input and improve trunk alignment.

Participants in the experimental group perform a modified version of the same neurodevelopmental exercise sequence with reduced repetition volumes to maintain a similar overall session duration. Following completion of these exercises, the participants undergo robot-assisted gait training using a robotic walking system. During robotic training, the child walks with mechanical guidance provided by the device, which supports the lower extremities and facilitates repetitive gait cycles. The robotic walking session is performed under controlled conditions with a walking speed of 0.08 km/h and no treadmill inclination. The robotic component of the intervention provides additional locomotor practice and aims to reinforce coordinated walking patterns through high-repetition training.

The rehabilitation sessions are designed to provide a combination of respiratory activation, postural control exercises, and functional gait-related activities. Through repeated exposure to these activities, the program seeks to stimulate neuromuscular adaptation and improve movement efficiency. The integration of robotic gait training may further increase the amount of walking practice while ensuring safe and consistent movement patterns.

Pulmonary function is evaluated using digital spirometry to obtain objective measurements of respiratory performance. Spirometric assessment provides quantitative values reflecting airway function and respiratory capacity. The study focuses on key spirometric indicators that are commonly used to assess pulmonary performance in clinical and research settings. These objective respiratory measurements allow for the examination of potential physiological changes associated with gait training and increased physical engagement.

By combining conventional neurodevelopmental therapy with robotic locomotor training, this study aims to explore whether a technology-supported rehabilitation approach can enhance functional outcomes beyond those achieved through conventional therapy alone. The results are expected to contribute to the growing body of research investigating the integration of robotic technologies into pediatric neurorehabilitation and may provide insight into their potential influence on both motor and respiratory performance in children with Cerebral Palsy.

Inclusion criteria

• Children aged 8-18 years with a diagnosis of spastic type cerebral palsy (SP)
• Classified as Level I-III according to the Gross Motor Function Classification System (GMFCS)
• Height ≥100 cm to ensure compatibility with robotic device braces
• Adequate cognitive and behavioral cooperation to participate in exercise sessions

Exclusion criteria

• Musculoskeletal surgery within the past 12 months
• Botulinum Toxin A injection within the past 6 months
• History of uncontrolled or irregular epilepsy/seizures
• Cardiovascular disease contraindicating exercise participation