European journal of physical and rehabilitation medicine · 2025
Treatment dosage effects of treadmill-based exoskeletal robotic-assisted gait training in individuals with pediatric brain injuries: a systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Lin Tzuchi, Tsai Yiting, Chang Yunchuan, Lai Chienhung, Su Shengwen
Аннотация
INTRODUCTION: Pediatric brain injuries frequently result in impaired mobility and functional limitations. Although treadmill-based exoskeletal robotic-assisted gait training (RAGT) may enhance gait performance, the optimal treatment parameters remain undefined. The present study evaluated the effects of treadmill-based exoskeletal RAGT on walking-related outcomes in children with brain injuries and examined the influence of training dosage on therapeutic outcomes.
EVIDENCE ACQUISITION: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six databases (PubMed, Embase, Science Direct, ProQuest, Cochrane Library, and PEDro) were searched for studies published between January 2010 and February 2025. Eligible studies included participants aged 2-18 years with brain injuries who received treadmill-based exoskeletal RAGT. Risk of bias was assessed using the Risk of Bias tool 2.0, Risk of Bias in Nonrandomized Studies of Intervention tool, and PEDro scale. Meta-analyses were conducted to estimate pooled effects and explore dose-response relationships.
EVIDENCE SYNTHESIS: Twenty-four studies (N.=837) met the inclusion criteria; twenty were included in this meta-analysis. RAGT significantly increased gait speed (standardized mean difference [SMD]=0.40; 95% confidence interval [CI]=0.04 to 0.76; I2=30%; P=0.003) and Gross Motor Function Measure (GMFM) Dimension D (SMD=1.02; 95% CI=0.23 to 1.81; I2=83%; P=0.001). Improvements in the 6-minute walk test (SMD=0.43; 95% CI=-0.28 to 1.14; I2=76%; P=0.23) and GMFM Dimension E (SMD=0.49; 95% CI=-0.13 to 1.12; I2=77%; P=0.12) were nonsignificant. Subgroup and meta-analyses identified high session frequency, ≥20 total sessions, and initial body weight support ≤50% as factors associated with superior outcomes. By contrast, excessive frequency and high initial body weight support adversely affected GMFM Dimension E scores.
CONCLUSIONS: Treadmill-based exoskeletal RAGT with conventional physical therapy improves gait speed and gross motor function in children with brain injuries. These findings provide preliminary guidance for optimizing training dosage. Additional high-quality trials with standardized protocols and extended follow-ups are required to validate these outcomes.
EVIDENCE ACQUISITION: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six databases (PubMed, Embase, Science Direct, ProQuest, Cochrane Library, and PEDro) were searched for studies published between January 2010 and February 2025. Eligible studies included participants aged 2-18 years with brain injuries who received treadmill-based exoskeletal RAGT. Risk of bias was assessed using the Risk of Bias tool 2.0, Risk of Bias in Nonrandomized Studies of Intervention tool, and PEDro scale. Meta-analyses were conducted to estimate pooled effects and explore dose-response relationships.
EVIDENCE SYNTHESIS: Twenty-four studies (N.=837) met the inclusion criteria; twenty were included in this meta-analysis. RAGT significantly increased gait speed (standardized mean difference [SMD]=0.40; 95% confidence interval [CI]=0.04 to 0.76; I2=30%; P=0.003) and Gross Motor Function Measure (GMFM) Dimension D (SMD=1.02; 95% CI=0.23 to 1.81; I2=83%; P=0.001). Improvements in the 6-minute walk test (SMD=0.43; 95% CI=-0.28 to 1.14; I2=76%; P=0.23) and GMFM Dimension E (SMD=0.49; 95% CI=-0.13 to 1.12; I2=77%; P=0.12) were nonsignificant. Subgroup and meta-analyses identified high session frequency, ≥20 total sessions, and initial body weight support ≤50% as factors associated with superior outcomes. By contrast, excessive frequency and high initial body weight support adversely affected GMFM Dimension E scores.
CONCLUSIONS: Treadmill-based exoskeletal RAGT with conventional physical therapy improves gait speed and gross motor function in children with brain injuries. These findings provide preliminary guidance for optimizing training dosage. Additional high-quality trials with standardized protocols and extended follow-ups are required to validate these outcomes.