Meta-analysis of the efficacy of lower robot-assisted gait training on lower limb function in children with cerebral palsy

doi:10.11852/zgetbjzz2022-1326

Abstract

Abstract: Objective To study the efficacy of robot-assisted gait training (RAGT) on lower limb function in children with cerebral palsy through systematic review, in order to provide evidence-based reference for the application of lower robot-assisted gait training. Methods The randomized controlled trials on robotic gait training for lower limb rehabilitation in children with cerebral palsy were retrieved through CNKI, VIP, Wanfang, PubMed, Embase, and Cochrane Library, which were published from inception to September 2022. Two researchers independently screened the literature according to the inclusion and exclusion criteria, and completed the process of data extraction, checking the data and quality evaluation. RevMan5.3 was used to perform Meta-analysis and present the related results for gross motor functions, including standing, walking, running and jumping (GMFM-D, GMFM-E), muscle tone (MAS), balance function (BBS), step speed, and step length. Results A total of 16 randomized controlled trials with 759 children with cerebral palsy were included in this study. The control group received conventional rehabilitation therapy, while the experimental group was given RAGT/RAGT additionally. Compared with the control group, after RAGT, the GMFM-D raw score (MD=5.53, 95%CI:4.47 - 6.60, P<0.01), GMFM-D percentage (MD=11.46, 95%CI:6.75 - 16.17,P<0.01), and GMFM-E raw score (MD=8.41, 95%CI:5.31 - 11.51, P<0.01), GMFM-E percentage (MD=11.20, 95%CI:6.14 - 16.26, P<0.01), GMFM D+E total score (MD=9.93, 95%CI:5.78 - 14.08, P<0.01), MAS score (MD=-0.45, 95%CI:―0.51 - ―0.38, P<0.01), BBS score (MD=5.90, 95%CI:3.60 - 8.20, P<0.01), and stride speed (MD=4.03, 95%CI:0.94 - 7.11, P=0.01) of children in the experimental group all improved with significant differences (P>0.05), but there was no statistically significant difference in step length (MD=0.40, 95%CI:-0.02 - 0.82, P=0.06) between the two groups. Conclusions RAGT has a positive effect on lower limb function in children with cerebral palsy, but there is heterogeneity in the existing studies. Therefore, randomized controlled trials with large samples and rigorous intervention protocols are warranted in the future.

Key words: cerebral palsy, robot-assisted gait training, gross motor function, balance

摘要： 目的通过系统评价研究下肢康复机器人辅助步态训练(RAGT)对脑瘫患儿下肢功能的疗效,为下肢康复机器人在临床儿童康复的应用提供循证医学证据。方法计算机检索中国知网、维普数据库、万方数据库、PubMed数据库、Embase医药数据库、Cochrane Library中关于脑瘫患儿下肢康复机器人步态训练的随机对照试验,文献检索时限限定为从建库至2022年9月。由2名研究员独立按照纳入、排除标准筛选文献,并完成提取数据,核对数据和质量评价等过程,最终采用RevMan5.3对粗大运动功能-站立,走、跑、跳(GMFM-D,GMFM-E),肌张力(MAS),平衡功能(BBS),步速,步长进行Meta分析及相关结果展示。结果本研究共纳入16篇随机对照试验,共纳入759例脑瘫患儿。试验组干预措施为RAGT/RAGT+常规康复疗法,对照组干预措施为常规康复疗法。分析结果显示,相对于对照组,经RAGT后,试验组GMFM D原始分(MD=5.53, 95%CI:4.47~6.60, P<0.01)、百分比(MD=11.46, 95%CI:6.75~16.17,P<0.01),GMFM E原始分(MD=8.41, 95%CI:5.31~11.51, P<0.01)、百分比(MD=11.20, 95%CI:6.14~16.26, P<0.01),GMFM D+E总分(MD=9.93, 95%CI:5.78~14.08, P<0.01),MAS得分(MD=-0.45, 95%CI:-0.51~-0.38, P<0.01),BBS得分(MD=5.90, 95%CI:3.60~8.20, P<0.01),步速(MD=4.03, 95%CI:0.94~7.11, P=0.01)均有改善,差异具有统计学意义(P<0.05),但试验组与对照组的步长(MD=0.40, 95%CI:-0.02~0.82, P=0.06)差异无统计学意义。结论 RAGT对脑瘫患儿的下肢功能具有积极的改善作用,但现有研究存在一定异质性,未来还需设计严谨的大样本随机对照试验来探究RAGT对脑瘫儿童的疗效。

关键词: 脑性瘫痪, 机器人辅助步态训练, 粗大运动功能, 平衡

CLC Number:

R742.3
R493

HUANG Xinping, WU Juanmei, WU Yingying, XIE Hongxiang, CHEN Fangchuan. Meta-analysis of the efficacy of lower robot-assisted gait training on lower limb function in children with cerebral palsy[J]. Chinese Journal of Child Health Care, 2023, 31(11): 1241-1247.

黄信萍, 吴娟妹, 吴莹莹, 谢鸿翔, 陈方川. 下肢康复机器人步态训练对脑性瘫痪儿童下肢功能疗效的Meta分析[J]. 中国儿童保健杂志, 2023, 31(11): 1241-1247.

References

[1] 中国康复医学会儿童康复专业委员会, 中国残疾人康复协会小儿脑性瘫痪康复专业委员会, 中国医师协会康复医师分会儿童康复专业委员会, 等. 中国脑性瘫痪康复指南(2022)第一章:概论[J]. 中华实用儿科临床杂志, 2022, 37(12):887-892.
Chinese Association of Rehabilitation Medicine Pediatric Rehabilitation Committee, Chinese Association of Rehabilitation of Disabled Persons Rehabilitation Committee for Cerebral Palsy, Chinese Medical Doctor Association Pediatric Rehabilitation Committee, et al. Chinese rehabilitation guidelines for cerebral palsy (2022):Editorial Board[J].Chin J Appl Clin Pediatr, 2022, 37(12):887-892.(in Chinese)
[2] 唐心意, 喻洪流, 李慧, 等. 脑性瘫痪儿童下肢康复机器人研究现状与展望[J]. 中国康复医学杂志, 2022, 37(7):971-976.
Tang XY, Yu HL, Li H, et al. Research status and prospect of lower limb rehabilitation robot for children with cerebralpalsy[J]. Chin J Rehabil Med, 2022, 37(7):971-976.(in Chinese)
[3] 中国康复医学会儿童康复专业委员会, 中国残疾人康复协会小儿脑性瘫痪康复专业委员会, 中国医师协会康复医师分会儿童康复专业委员会, 等. 中国脑性瘫痪康复指南(2022)第四章:康复治疗(上)[J]. 中华实用儿科临床杂志, 2022, 37(16):1201-1229.
Chinese Association of Rehabilitation Medicine Pediatric Rehabilitation Committee, Chinese Association of Rehabilitation of Disabled Persons Rehabilitation Committee for Cerebral Palsy, Chinese Medical Doctor Association Pediatric Rehabilitation Committee, et al. Chinese rehabilitation guidelines for cerebral palsy (2022) part 4:Rehabilitation treatment(Ⅰ)[J]. Chin J Appl Clin Pediatr, 2022, 37(16):1201-1229.(in Chinese)
[4] 郭海滨, 周璇, 杜青.下肢康复机器人对脑瘫患儿步行能力改善的研究进展[J]. 中国康复, 2021, 36(6):376-379.
Guo HB, Zhou X, Du Q. Research progress of lower limb rehabilitation robot on the improvement of walking ability of children with cerebral palsy[J]. Chin J Rehabil, 2021, 36(6):376-379.(in Chinese)
[5] 蔡婷婷, 张雯, 黄青梅, 等. 机器人在儿童神经发育障碍性疾病患者中的应用研究进展[J]. 中国护理管理, 2020, 20(11):1708-1713.
Cai TT, Zhang W, Huang QM, et al. Progress in the application of robots in children with neurodevelopmental disorders[J]. Chin J Nurs Manag, 2020, 20(11):1708-1713.(in Chinese)
[6] 华裕, 朱敏, 张跃. 儿童康复机器人应用现状及发展趋势[J]. 中国康复理论与实践, 2018, 24(6):667-670.
Hua Y, Zhu M, Zhang Y. Application and development of pediatric rehabilitation robot[J]. Chin J Rehabil Theory Pract, 2018, 24(6):667-670.(in Chinese)
[7] 石男强, 刘刚峰, 郑天骄, 等. 下肢康复机器人的研究进展与临床应用[J]. 信息与控制, 2021, 50(1):43-53.
Shi NQ, Liu GF,Zheng TJ, et al. Research progress and clinical application of lower limb rehabilitation robot[J]. Inf Control, 2021, 50(1):43-53.(in Chinese)
[8] Pool D, Valentine J, Taylor NF, et al.Locomotor and robotic assistive gait training for children with cerebral palsy[J]. Dev Med Child Neurol, 2021, 63(3):328-335.
[9] 陶璟, 霍宇飞, 于随然. 面向儿童的下肢康复外骨骼机器人研发进展[J]. 中国康复医学杂志, 2021, 36(11):1445-1449.
Tao J,Huo YF, Yu SR. Progress in the development of a lower limb rehabilitation exoskeleton robot for children[J]. Chin J Rehabil Med, 2021, 36(11):1445-1449.(in Chinese)
[10] Moucheboeuf G, Griffier R, Gasq D, et al. Effects of robotic gait training after stroke:A meta-analysis[J]. Ann Phys Rehabil Med, 2020, 63(6):518-534.
[11] 杨旭, 马秋平. 下肢康复机器人辅助训练改善脑卒中病人下肢功能效果的Meta分析[J]. 循证护理, 2018, 4(8):673-679.
Yang X, Ma QP. Meta-analysis of lower limb rehabilitation robot in stroke patient′s lower limb function improvement[J]. Chin J Evid Based Nurs, 2018, 4(8):673-679.(in Chinese)
[12] 李雪静, 吴佳佳, 叶涛, 等. 机器人辅助训练改善脑卒中早期康复患者下肢功能的Meta分析[J]. 康复学报, 2018, 28(2):61-66.
Li XJ, Wu JJ, Ye T, et al. A system review:effect of robot-assisted training on improvement of lower extremities function of stroke patients in earlyrehabilitation[J]. Rehabil Med, 2018, 28(2):61-66.(in Chinese)
[13] Smania N, Bonetti P, Gandolfi M, et al. Improved gait after repetitive locomotor training in children with cerebral palsy[J]. Am J Phys Med Rehabil, 2011, 90(2):137-149.
[14] 金星, 孟兆祥, 尹正录, 等. 康复机器人辅助步行训练对脑瘫患儿步行能力的影响[J]. 中国康复医学杂志, 2012, 27(9):822-824.
Jin X,Meng ZX, Yin ZL, et al. The effects of robot-assisted walking training on the walking ability in children with cerebral palsy[J]. Chin J Rehabil Med, 2012, 27(9):822-824.(in Chinese)
[15] Druz·bicki M, Rusek W, Snela S, et al. Functional effects of robotic-assisted locomotor treadmill thearapy in children with cerebral palsy[J]. J Rehabil Med, 2013, 45(4):358-363.
[16] 杨艳. 下肢康复机器人对脑性瘫痪儿童步行功能的影响[J]. 心理医生, 2016, 22(3):219-220.
Yang Y. Effect of lower limb rehabilitation robot on the walking function of children with cerebralpalsy[J].Psychol Dr, 2016, 22(3):219-220.(in Chinese)
[17] 朱敏杰. 康复机器人在脑性瘫痪患儿康复治疗中的疗效观察[J]. 中国实用医药, 2016, 11(29):283-284.
Zhu MJ. Observation of curative effect by rehabilitation robot in rehabilitation therapy for cerebral palsychildren[J]. Chin J Pract Med, 2016, 11(29):283-284.(in Chinese)
[18] 吕楠, 尚清, 马彩云, 等. 康复机器人对痉挛型脑性瘫痪患儿的康复效果[J]. 中国实用神经疾病杂志, 2017, 20(7):45-47.
Lü N, Shang Q, Ma CY, et al. Rehabilitation effect of roboton children with spastic cerebral palsy[J]. Chin J Pract Nerv Dis, 2017, 20(7):45-47.(in Chinese)
[19] 施幸冕. 下肢康复机器人对脑性瘫痪儿童步行功能的影响[J]. 中国药业, 2017, 26(A02):167-168.
Shi XM. Effect of lower limb rehabilitation robot on the walking function of children with cerebralpalsy[J]. Chin J Pharm, 2017, 26(A02):167-168.(in Chinese)
[20] Wallard L, Dietrich G, Kerlirzin Y, et al. Effect of robotic-assisted gait rehabilitation on dynamic equilibrium control in the gait of children with cerebral palsy[J]. Gait Posture, 2018, 60:55-60.
[21] 陆婷婷, 吉艳萍, 李嫚嫚, 等. 下肢康复机器人对脑性瘫痪儿童步行功能的影响[J]. 中国伤残医学, 2018, 26(9):29-30.
Lu TT,Ji YP, Li MM, et al. Effect of lower limb rehabilitation robot on the walking function of children with cerebral palsy[J]. Chin J Trauma Disabil Med, 2018, 26(9):29-30.(in Chinese)
[22] 张瑞娟. 康复机器人辅助步行训练对脑瘫患儿下肢肌张力及平衡能力的影响[J]. 中国实用医刊, 2018, 45(13):99-101.
Zhang RJ. Effect of rehabilitation robot-assisted walking training on lower limb muscle tone and balance in children with cerebralpalsy[J]. Chin J Pract Med, 2018, 45(13):99-101.(in Chinese)
[23] 叶楠, 樊启红, 陈治江, 等. 下肢机器人辅助步态训练对脑性瘫痪患儿康复效果及生活质量的影响研究[J]. 中国医学装备, 2020, 17(11):94-97.
Ye N, Fan QH, Chen ZJ, et al. Influence study of lower limb robot-assisted gait training on rehabilitation effects and quality of life of children patients with cerebralpalsy[J]. Chin J Med Equip, 2020, 17(11):94-97.(in Chinese)
[24] 郑宏超, 王琼, 杨丽. 下肢机器人配合运动疗法训练对脑瘫患儿步行能力的影响[J]. 临床医学研究与实践, 2021, 6(33):166-168,179.
Zheng HC, Wang Q, Yang L. Effect of lower limb robot combined with exercise therapy training on walking ability of children with cerebral palsy[J]. Clin Res Pract, 2021, 6(33):166-168,179.(in Chinese)
[25] 陈精慧. 下肢康复机器人训练对痉挛型脑性瘫痪患儿运动功能的疗效研究[D]. 郑州:郑州大学, 2021.
Chen JH. Effects of robot assisted gait training on the motor function of children with spastic cerebralpalsy[D].Zhengzhou:Zhengzhou University, 2021.(in Chinese)
[26] 熊华春, 周志恒, 周洋萍, 等. 下肢康复机器人训练联合家庭姿势管理对脑瘫患儿运动功能的疗效研究[J]. 中国儿童保健杂志, 2022, 30(7):711-714, 754.
Xiong HC, Zhou ZH, Zhou YP, et al. Efficacy of lower limb rehabilitation robot training combined with family posture management on motor function in children with cerebral palsy[J]. Chin J Child Health Care, 2022, 30(7):711-714, 754.(in Chinese)
[27] Yaşar B, Atc E, Razaei D A, et al. Effectiveness of robot-assisted gait training on functional skills in children with cerebral palsy[J]. J Pediatr Neurol, 2022, 20, 164-170.
[28] 马婷婷, 张皓. 机器人辅助步态训练对痉挛型脑性瘫痪患儿运动和步行功能的效果[J]. 中国康复理论与实践, 2021, 27(11):1260-1265.
Ma TT, Zhang H. Effect of robotic-assisted gait training on motor and walking for children with spastic cerebralpalsy[J]. Chin J Rehabil Theory Pract, 2021, 27(11):1260-1265.(in Chinese)
[29] Nam KY, Kim HJ, Kwon BS, et al. Robot-assisted gait training (Lokomat) improves walking function and activity in people with spinal cord injury:A systematic review[J]. J Neuroeng Rehabil, 2017, 14(1):24.
[30] Oeffinger D, Bagley A, Rogers S, et al. Outcome tools used for ambulatory children with cerebral palsy:Responsiveness and minimum clinically important differences[J]. Dev Med Child Neurol, 2008, 50(12):918-925.
[31] Carvalho I, Pinto SM, Chagas DDV, et al. Robotic gait training for individuals with cerebral palsy:A systematic review and meta-analysis[J]. Arch Phys Med Rehabil, 2017, 98(11):2332-2344.
[32] Volpini M, Aquino M, Holanda AC, et al. Clinical effects of assisted robotic gait training in walking distance, speed, and functionality are maintained over the long term in individuals with cerebral palsy:A systematic review and meta-analysis[J]. Disabil Rehabil, 2022, 44(19):5418-5428.
[33] Weinberger R, Warken B, K#xF6;nig H, et al. Three by three weeks of robot-enhanced repetitive gait therapy within a global rehabilitation plan improves gross motor development in children with cerebral palsy - a retrospective cohort study[J]. Eur J Paediatr Neurol, 2019, 23(4):581-588.
[34] Aurich-Schuler T, Grob F, van Hedel HJA, et al. Can Lokomat therapy with children and adolescents be improved? An adaptive clinical pilot trial comparing Guidance force, Path control, and FreeD[J]. J Neuroeng Rehabil, 2017, 14(1):76.
[35] 马婷婷, 张皓. 下肢康复机器人改善痉挛型脑性瘫痪儿童步行移动功能的物理治疗研究进展[J]. 中国康复理论与实践, 2021, 27(2):171-176.
Ma TT, Zhang H. Advance in physiotherapy of robot-assisted lower limb rehabilitation for walking function in children with spastic cerebralpalsy[J]. Chin J Rehabil Theory Pract, 2021, 27(2):171-176.(in Chinese)