تستعرض هذه المقالة فوائدَ استخدام الرَّجل الآليّ/الرُّوبوت لتأهيل الأطفال الَّذين يعانون من صعوبة في الحركة بسبب تلف الدِّماغ والأثرَ الإيجابيَّ للتَّقنيات الحديثة في تمكين هؤلاء الأطفال من الحركة. توضع خطَّة العلاج بشكل فرديّ لتلبية احتياجات كلِّ مريض حسب حالته وقدراته، ومن خلال التَّمارين المكثَّفة المتكرِّرة والموجَّهة نحو الهدف تُرسَّخ المهارات الحركيَّة وتتحسَّن قوَّة العضلات وترتفع قدرة الطِّفل على التَّحمُّل. وغالباً ما يتضمَّن العلاجُ عناصرَ من الواقع الافتراضيّ والألعاب لجذب انتباه الأطفال وتحفيزهم.
The Role of Robotic-Assisted Gait Training in Paediatric Motor Rehabilitation
Yanking the crutches resting on the wall next to her, eight-year-old Maya hoists herself off the mattress and, with the help of her walking aide, makes her way to the kitchen, where her mother is preparing breakfast. Maya is one of 18 million individuals living with cerebral palsy (CP), a group of neurological disorders that appear in infancy or early childhood, impairing the brain’s ability to control movement, posture, and balance. While all individuals with CP face challenges in these areas, symptoms vary widely, ranging from tremors and muscle weakness to speech impediments, intellectual disabilities, and difficulties with motor function. Despite significant advancements in care, there is no cure for cerebral palsy.
In the span of a decade, Yousef had to relearn how to walk twice. The first was under jollier circumstances, as a one-year-old learning to transition from his typical four-limbed crawl to a two-limbed strut under the watching eyes of his amused parents. Six years later on a seemingly ordinary night, little Yousef found himself the victim of a pedestrian car accident. Doctors proclaimed him a traumatic brain injury (TBI) survivor, and he began the laborious task of regaining motor function and control.
Though differing in pathologies, Yousef and Maya may be part of a proportion of the 65% of mobile-deficit acquired brain injury (ABI) survivors who could benefit from Robotic-Assisted Gait Training (RAGT).
RAGT employs robotic devices and systems to support and guide lower limb movement during walking. These technologies often include wearable exoskeletons that provide bodyweight support, assist in compensating for muscle weaknesses, and ensure correct gait patterns. End-effector devices, such as treadmills, guide the feet along predefined paths, enhancing gait rehabilitation. Advanced sensory systems and algorithms provide real-time feedback, allowing for precise training adjustments. Movement patterns, velocity and resistance, are finely controlled, ensuring that movements are performed in the correct form and at the proper intensity, factors which are too complicated to manage during physical therapy.
Robotic-Assisted Walking Therapy for Children
The result is a highly personalised, optimally difficult training experience tailored to each patient’s needs, progress and abilities. Through these highly intense, repetitive and goal-oriented exercises, motor skills are ingrained, practised and reinforced, and muscle strength and endurance are enhanced. Furthermore, RAGT often incorporates virtual reality and gaming elements to capture patients’ attention and maintain motivation, allowing for longer training sessions and increased tolerance.
As such, existing literature points to the possible benefits of pairing RAGT with physical therapy to enhance neuroplasticity and improve the potential for recovery walking following paediatric brain injury.
The role of RAGT in Cerebral Palsy motor rehabilitation is promising. The literature demonstrates positive functional and biomechanical outcomes, as well as enhanced spatiotemporal parameters in CP patients. Cerebral Palsy patients experienced enhanced gait speed, step length, endurance, hip and knee strength and cadence (number of steps taken in a minute). Their Gross Motor Function Measure (GMFM) levels were unchanged. GMFM is a standardised clinical assessment tool used to measure changes in gross motor function primarily in the paediatric CP population. Studies also noted patients’ improved step length, which is the distance between the point of initial contact of one foot and the point of initial contact of the other foot, as well as enhanced stride length, defined as the distance between consecutive points of initial contact of the same foot. A case study revealed that post-RAGT, performance improved in the 6-minute walk test (6MWT), used to evaluate aerobic capacity and endurance. The test sheds light on pulmonic and cardiovascular function, as well as blood and peripheral circulation and metabolism during exercise. Patients in the case study also exhibited increased GMFM. Their Physiological Cost Index, an estimate of energy expenditure during walking, declined.
Research in Traumatic Brain Injury (TBI) is sparse. The few studies demonstrate improvements in spatial symmetry, swing time, stance time, step length and speed following RAGT. A recent paediatric study also revealed significant improvements when combining RAGT and Physical Therapy. Children with significant ABI exhibited a significant improvement in the 6MWT and GMFM. They also showcased enhanced standing and walking abilities and these improvements were observed across all Gross Motor Function Classification System (GMFCS) levels. The study also stressed the importance of suggesting robot-assisted treatment as early as possible during the developmental years of life, where gait patterns and motor abilities can still be modified. Similarly, the effect of the duration between the time of injury and when therapy is commenced may account for differences in improvements among individuals, suggesting that the sooner combined therapy is conducted, the greater the chances of it being effective.
Despite the prospects of promising results, caution must be entertained before reaching a definitive conclusion on the effect and role of RAGT in motor rehabilitation. Further research and standardised clinical trials with large sample sizes are required to fully understand the therapeutic function of RAGT, particularly in ABI/TBI cases. The optimal conditions and support systems for motor rehabilitation following different pathologies/injuries and at various stages of recovery should also be further explored. Lastly, the type, severity and location of injury may result in varying biomechanical and physiological issues, thus influencing the recovery journey.
Robotic-Assisted Gait Training represents a groundbreaking approach to motor rehabilitation, offering hope to individuals like Maya and Yousef. When combined with physical therapy, it has the potential to improve mobility and quality of life for those with CP and TBI. However, realising its full potential requires continued research, larger studies, and a deeper understanding of the diverse needs of patients.
Sources
Beretta, E., Storm, F. A., Strazzer, S., Frascarelli, F., Petrarca, M., Colazza, A., Cordone, G., Biffi, E., Morganti, R., Maghini, C., Piccinini, L., Reni, G., & Castelli, E. (2020). Effect of Robot-Assisted Gait Training in a large population of children with motor impairment due to Cerebral Palsy or Acquired Brain Injury. Archives of Physical Medicine and Rehabilitation, 101(1), 106–112. https://doi.org/10.1016/j.apmr.2019.08.479
Birth Injury Justice Center. (2012). Cerebral Palsy Statistics in Children – Learn Important Statistics. Child Birth Injuries. https://www.childbirthinjuries.com/cerebral-palsy/statistics/
Karunakaran, K. K., Pamula, S. D., Bach, C. P., Legelen, E., Saleh, S., & Nolan, K. J. (2023). Lower extremity robotic exoskeleton devices for overground ambulation recovery in acquired brain injury—A review. Frontiers in Neurorobotics, 17. https://doi.org/10.3389/fnbot.2023.1014616
National Institute of Neurological Disorders and Stroke. (2024, July 19). Cerebral Palsy. http://Www.ninds.nih.gov. https://www.ninds.nih.gov/health-information/disorders/cerebral-palsy
Physiopedia. (2011). Six Minute Walk Test / 6 Minute Walk Test. Physiopedia. https://www.physio-pedia.com/Six_Minute_Walk_Test_/_6_Minute_Walk_Test
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