“Stepping forward” wearable overground exoskeletons can improve gait and balance in people with cerebral palsy: a systematic review with meta-analysis

Abstract

Purpose: This review evaluates the effects of wearable overground exoskeleton-assisted therapy for people with cerebral palsy. Materials and methods: Following PRISMA guidelines, Medline, PsychInfo, Embase, Scopus, Web of Science, and CINAHL, were searched in July 2025. Inclusion criteria were studies of participants with cerebral palsy of any age or severity, using overground robotic exoskeletons, measuring any outcomes of impairment, function, participation and user experience data. Conference abstracts, proof of concept studies, and non-English studies were excluded. Study quality was evaluated using the QualSyst Tool. Meta-analyses were conducted in R v4.5.0. Results: Twenty-one studies of overall good quality met inclusion criteria, with 241 participants (median age 9.6 years, range 3–40). Post-intervention, mean differences (MD) favoured robotic training for walking endurance (MD 6.14 m; 95% CI 0.49–11.80; p = 0.0332), balance (MD 3.43; 95% CI 1.69–5.16; p = 0.0001), speed (MD 0.11 m/s; 95% CI 0.06–0.15; p < 0.0001), and high-level mobility (MD 3.49; 95% CI 0.87–6.12; p = 0.0091). Other outcomes were inconsistently reported, limiting recommendations. Conclusions: Emerging evidence supports wearable overground exoskeleton-assisted therapy for balance, endurance, speed, and high-level mobility for people with cerebral palsy. Future studies should evaluate user experience, and a broader range of measures to fully capture potential benefits. Review registration: https://doi.org/10.17605/OSF.IO/EPWSK.