How resistive ankle exoskeleton training affects walking outcomes in cerebral palsy.

BACKGROUND

Improving walking ability is a central goal in the clinical management of cerebral palsy (CP). The objective of this study was to assess how gait training with a resistive ankle exoskeleton affects walking performance in individuals with CP.

METHODS

Sixteen ambulatory individuals (GMFCS levels I-III) with CP between the ages of 8 and 21 completed the study. Participants completed a pre-training assessment and then 12 sessions of treadmill-based gait training with the Biomotum Spark ankle exoskeleton providing plantarflexor resistance with plantar-pressure biofeedback. Outcomes were assessed during walking without ankle resistance before, and at follow-up visits within one week and three weeks after training.

FINDINGS: Ankle-resisted gait training had a positive effect on most mobility-related outcome measures. 6MWT distance increased by 17% (p = 0.02) on the post vs baseline assessment. Self-selected walking speed increased by 16% (p = 0.003) and 23% (p < 0.001) on the within-1-week post and 3-week post assessments, respectively, compared to baseline. Fast walking speed increased by 10% (p = 0.008) and 17% (p = 0.016) on the within-1-week post and 3-week post assessments, respectively, compared to baseline.

INTERPRETATION: Gait training with a resistive ankle exoskeleton providing biofeedback elicited clinically significant improvements in walking endurance and speed. These results demonstrate the clinical safety and efficacy of gait training with ankle exoskeleton resistance in CP.