Effect of Robot-Assisted Treadmill Training on Motor Functions Depending on Severity of Impairment in Patients with Bilateral Spastic Cerebral Palsy

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.