Is robotic gait training effective for individuals with cerebral palsy? A systematic review and meta-analysis of randomized controlled trials.

ABSTRACT

AIM: To determine if robotic gait training for individuals with cerebral palsy is more effective than the standard of care for improving function. METHOD: PubMed, Embase, Scopus, and Cochrane databases were searched from 1980-January, 2022 for articles that investigated robotic gait training versus standard of care (i.e. physical therapy or standard gait training) for individuals with cerebral palsy. Articles were included if a randomized controlled trial design was used, and excluded if robotic gait training was combined with another neuromuscular intervention, such as functional electrical stimulation. A meta-analysis of outcomes measured in at least four studies was conducted. RESULTS: Eight citations met all criteria for full-text review and inclusion in the meta-analysis. A total of 188 individuals with cerebral palsy, ages four to 35, and Gross Motor Function Classification System levels I-IV were studied. Level of evidence ranged from 2b-1b. All studies utilized a tethered, assistive device for robotic gait training. The overall effect was not significantly different between the robotic gait training and control interventions for six minute walk test performance (95% CI -0.17, 0.73; P = 0.22), free walking speed (95% CI -0.18, 0.57; P = 0.30), or Gross Motor Function Measures D (Standing) (95% CI -0.29, 0.39; P = 0.77) and E (Walking, Running and Jumping) (95% CI -0.11, 0.57; P = 0.19). CONCLUSION: Tethered robotic devices that provide assistive gait training for individuals with cerebral palsy do not provide a greater benefit for improving mobility than the standard of care.