Unraveling Mechanisms Underlying the Effectiveness of Robot-Assisted Gait Training in Children with Cerebral Palsy

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Unraveling Mechanisms Underlying the Effectiveness of Robot-Assisted Gait Training in Children with Cerebral Palsy

Bonato, Paolo

The objective of this paper is to discuss potential mechanisms that affect the outcomes of robot-assisted gait training in children with cerebral palsy. Our group and others have shown that gait function can be significantly improved in children with cerebral palsy by relying upon robotic technology. However, it has been also emphasized that the magnitude of motor gains achieved in this patient population varies dramatically from subject to subject. This observation has motivated many to explore mechanisms potentially related to the differences in robot-assisted gait training outcomes observed across individuals. Factors that we explore and discuss in this paper include the baseline functional ability level of the individual receiving gait training, the specific type of gait deviations observed at baseline, the mechanical characteristics of the robot used for training, the level of engagement of the child during the therapeutic session, and finally the ability of individuals to generate motor adaptation strategies in response to the forces generated by the robot. We observe that the ability of individuals to generate motor adaptation strategies has been disregarded by previous research work and suggest that methodologies suitable to assess the ability of children with cerebral palsy to ”respond” to the forces generated by the robot should be developed and tested.