Eficacia del tratamiento con robot de marcha asistida en niños y adolescentes con parálisis cerebral

Resumen

Introduction Cerebral palsy (CP) describes a group of developmental disorders of movement and posture, causing limitation of activity. Improving walking ability, making it as autonomous as possible with or without technical aids, is essential in the treatment of children and adolescents with CP to help them promote activity and participation in their environment. Objectives 1-To know the effectiveness of robotic gait training systems to improve aspects of standing and walking in children and adolescents with CP. 2-To know the effectiveness of a physiotherapy treatment that includes robotic-assisted gait training in comparison with the isolated physiotherapy treatment in children and adolescents with CP, in the quality of life, aspects of gait, and muscle strength, range of motion and spasticity of the lower limbs. Methodology Two independent studies were carried out: 1- Network meta-analysis; and 2- Clinical trial. 1-A network meta-analysis of clinical trials was carried out comparing treatments performed with robot-assisted gait training (RAGT) versus other physiotherapy (PT) treatments, following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. - Network Meta-Analysis. The protocol was registered in PROSPERO with the code CRD42020176247. 2-A quasi-experimental, prospective, longitudinal study was carried out, with a non-equivalent control group. The experimental group (GE) underwent treatment with the robotic gait training system Walkbot combined with physiotherapy, while the control group (CG) underwent physiotherapy treatment without RAGT. The protocol was registered at ClinicalTrials.gov with registration number NCT04329793. Results 1-No statistically significant results were found for any of the outcome comparisons made, with low magnitude of the effect size according to Cohen in resistance [RAGT vs FT d=0.25, RAGT+FT vs FT d=0.27], and in step length [RAGT vs FT d=0.16; RAGT + FT vs FT d=0.34]; and very low in the GMFMD [RAGT vs FT d=-0.03; RAGT + FT vs FT d=0.05], in the GMFME [RAGT vs Ft d=0.10; RAGT + FT vs FT d=0.07], and gait speed [RAGT vs FT d=0.28; RAGT + FT vs FT d=-0.09]. 2-In the clinical trial, the GE (RAGT combined with physiotherapy) improved standing, with a small effect size η2=0.016 in the GMFMD (IV). Likewise, muscle strength increased in left hip flexion [η2=0.128, medium effect size], right hip flexion [η2=0.142, large effect size], right hip extension [η2 =0.035, small effect size], left hip abduction [η2=0.179, large effect size], right hip abduction [η2=0.196, large effect size], left knee flexion [ η2=0.222, large effect size] and right knee flexion [η2=0.147, large effect size]. In lower limb ROM, left knee flexion [η2=0.071, medium effect size] and right knee flexion [η2=0.053, small effect size] improved. There were no differences between groups in quality of life, gross motor gait function, and lower limb spasticity. Conclusions 1-No differences were found in the outcome of the treatment in the variables analyzed depending on whether or not the robotic-assisted gait training was included in the physiotherapy treatments. 2-The clinical trial showed better results in the participants who underwent the physiotherapy treatment combined with the robotic-assisted gait training, in standing and in increasing strength and ROM in the lower limbs.