Robot-Assisted Gait Training Combined with Conventional Physiotherapy in Postoperative Patients with Diplegic Cerebral Palsy: A Pilot Single Cohort Observational Study

Abstract

Background: Cerebral palsy (CP) is the most common cause of disability in developmental age, affecting motor and postural skills. With growth, lower-limb orthopedic surgery often becomes necessary. Post-surgical walking rehabilitation programs generally involve conventional therapy with only limited evidence on the use of robot-assisted gait training (RAGT). The aim of the present pilot study is to assess the feasibility and the preliminary functional outcomes of an intensive 3-week rehabilitation of 15 sessions with Lokomat combined with 15 sessions of conventional physiotherapy. Methods: In total, 27 patients with diplegic cerebral palsy who underwent orthopedic surgery were recruited. Outcomes collected: the 6 min walking test (primary outcome), the Gross Motor Function Measure-88, the Gillette Functional Assessment Questionnaire, 3D gait analysis, and spasticity and force metrics of the lower limbs. Paired statistical tests were used to assess pre–post changes. Results: A pre–post statistically significant improvement was observed in gait endurance in the 6MWT (Δ = 28.56 ± 34.28 m; p < 0.001) and in gross motor functional skills. Gait parameters showed some functional and structural improvements, and joint stiffness was reduced in some measures. Conclusions: This combined rehabilitative approach seems to be promising in postoperative patients with CP. Future studies, involving a control group and larger sample size, are needed to generalize our results.