Effect of Robot-Assisted Treadmill Training on Motor Functions Depending on Severity of Impairment in Patients with Bilateral Spastic Cerebral Palsy
Authors
Stanislava Klobucká1, Michal Kováč2, Elena Žiaková1,3 and Robert Klobucký4 1Rehabilitation Centre Harmony, Bratislava, Slovakia; 2Clinic of Neurology, Faculty Hospital, Nové Zámky, Slovakia; 3Slovak Medical University, Faculty of Nursing and Health Professional Studies, Bratislava, Slovakia; 4Slovak Academy of Sciences, Institute for Sociology, Bratislava, Slovakia
Gout, urate crystals, methods of not-staining, polarizing microscope.
Abstract
Objective: To assess impact of RATT (robot-assisted treadmill training) on motor function in patients with cerebral palsy depending on the severity of motor impairment. Design: Uncontrolled prospective pilot study with pre-post treatment outcome comparison according to severity of motor impairment. Setting: Outpatient Rehabilitation Centre. Participants: Fifty-one patients aged 4 - 27 years with bilateral spastic cerebral palsy. Interventions: Patients were divided into two groups according to severity of motor impairment determined by the Gross Motor Function Classification Scale (GMFCS). All 51 participants underwent 20 RATT sessions over a 5-6 week period in an outpatient approach using the Lokomat® driven gait orthosis (DGO). Outcome Measures: Dimension A(lying, rolling), B(sitting), C(crawling, kneeling), D (standing) and E(walking, running, jumping) within the Gross Motor Function Measure (GMFM-88), 6-minute walking test, 10-meter walk test, Functional Ambulation Categories (FAC). Results: Patients demonstrated statistically significant improvements in all GMFM-88 dimensions. Improvements in GMFM A, B and C were significantly larger in the more severely affected cohort (GMFCS III, IV) compared to the mildly affected cohort (GMFCS I, II). In contrast, GMFM D and E improvements were greater in the mildly affected cohort, but not statistically significant. Mean (SD) maximum gait speed of 0.75 (0.48) to 0.89 (0.52) m/s; mean (SD) 6 Min WT of 154 (103.21) to 191.21 (114.55) m; as well as the mean (SD) FAC of 1.44 (1.22) to 1.89 (1.33) showed a statistically significant level of improvement (p= .000). Conclusion: RATT is a promising treatment option in ambulatory and non-ambulatory patients with cerebral palsy. The severity of motor impairment affects the amount of improvement that can be achieved. Keywords: Robot-assisted treadmill training, cerebral palsy, gross motor function measure, impairment, neurodevelopmental concept.
