Neuropediatrics 2013; 44 - FV15_05
DOI: 10.1055/s-0033-1337742

Which covariates influence effectiveness of intensified robotic-assisted treadmill therapy in children with cerebral palsy

S Schroeder 1, M Homburg 2, B Warken 2, H Auffermann 2, S Berweck 3, K Jahn 4, F Heinen 2, I Borggraefe 2
  • 1Dr. von Haunersches Kinderspital, Deutsches Zentrum für Schwindel und Gleichgewichtsstörungen, München, Germany
  • 2Dr. von Haunersches Kinderspital, München, Germany
  • 3Behandlungszentrum Vogtareuth, Vogtareuth, Germany
  • 4Deutsches Zentrum für Schwindel und Gleichgewichtsstörungen, Klinik und Poliklinik für Neurologie, München, Germany

Aims: In children with cerebral palsy (CP), intensified robotic-assisted treadmill therapy (iRobAT) has been shown to improve ICF domains of function, activity, and participation. Yet the influencing covariates on effectiveness of this expensive and time-consuming intervention remain unclear. The purpose of this study is to look for improvement in groß motor function in children with CP in correlation to the following covariates: gender, age, GMFCS level, combination with botulinum toxin (BoNT), therapy intensity, and repetitive iRobAT blocks.

Methods: Intervention: 12 sessions in a 3-week period, 30 to 60 minutes each.

Assessments: Before and after iRobAT bock (V2 vs. V1). Design: Retrospective analysis of cohort and outcome data. Formation of three subgroups: Group A, first iRobAT block; Group B/C, 2 resp.3 iRobAT blocks. Outcome measures: GMFM 66 score and dimensions D (standing), dimension E (walking, running, jumping). Statistics: Wilcoxon signed rank test, Spearman's correlation coefficient.

Results: Group A: 83 patients were included (48 male, 24 prior BoNT injection), Age: 10.8 years (SD 6.7), GMFCS level: 2.6 (SD 0.9), iRobAT distance: 12.6 km (SD: 4.2), iRobAT duration: 7.2 hours (SD 1.9). GMFM 66 improvement: 2.4%, dimension D: 5.2%, dimension E: 4.0%. Significant negative correlation between: GMFM 66 & GMFCS Level, Dimension D & Age, Dimension E & GMFCS Level and Age, GMFCS Level & iRobAT duration and distance, BoNT & Age. Significant positive correlations between age and iRobAT duration and distance. Group B: 23 patients (age 8.0 years; SD 4.8) received 2 iRobAT blocks, 9 patients (7.2 years, SD 4.6) received 3. The first block was significantly more effective than follow-up blocks. Patients receiving three blocks were the youngest. GMFM 66 improvements remained clinically meaningful beyond the normal development of motor performance.

Conclusion: The covariates age and GMFCS level have a significant impact on the effectiveness of iRobAT. The first block is most effective, but repetitive iRobAT blocks add motor performance beyond the regular corridor of motor development in children with CP.