title: Prospective controlled cohort study to evaluate changes of function, activity and participation in patients with bilateral spastic cerebral palsy after Robot-enhanced repetitive treadmill therapy.
abstract: BACKGROUND
  Robot-enhanced therapies are increasingly being used to improve gross motor performance in patients with cerebral palsy.
  
  
  OBJECTIVE
  To evaluate gross motor function, activity and participation in patients with bilateral spastic cerebral palsy (BS-CP) after Robot-enhanced repetitive treadmill therapy (ROBERT) in a prospective, controlled cohort study.
  
  
  METHODS
  Participants trained for 30-60 min in each of 12 sessions within a three-week-period. Changes in Gross Motor Function Measure (GMFM 66) scores, standardized walking distance, self-selected and maximum walking speed (ICF domain "Activity"), and Canadian Occupational Performance Measure (COPM; "Participation") were measured. Outcome measures were assessed three weeks in advance (V1), the day before (V2) as well as the day after, and 8 weeks after ROBERT (V3 + V4).
  
  
  RESULTS
  18 patients with BS-CP participated; age 11.5 (mean, range: 5.0-21.8) years, body weight 36.4 (15.0-72.0) kg. GMFCS levels I-IV were: n = 4; 5; 8; 1. There was no significant difference comparing V1 and V2. GMFM 66 (total +2.5 points, Dimension D +3.8 and E +3.2) and COPM (Performance +2.1 points, Satisfaction +1.8 points) showed statistically significant improvements for V3 or V4 compared to V1 or V2 representing clinically meaningful effect sizes. Age, GMFCS level, and repeated ROBERT blocks correlated negatively with GMFM improvement, but not with COPM improvement.
  
  
  CONCLUSIONS
  Following ROBERT, this prospective controlled cohort study showed significant and clinically meaningful improvements of function in ICF domains of "activity" and "participation" in patients with BS-CP. Further assessment in a larger cohort is necessary to allow more specific definition of factors that influence responsiveness to ROBERT program.
authors.affiliation: Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany; German Center for Vertigo and Balance Disorders, IFB(LMU), University of Munich, Germany. Electronic address: sebastian.schroeder@med.uni-muenchen.de.
authors.forename: A S
authors.initials: AS
authors.lastname: Schroeder
authors.affiliation: Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Homburg
authors.affiliation: Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Warken
authors.affiliation: Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Auffermann
authors.affiliation: Institute of Clinical Radiology, University of Munich, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Koerte
authors.affiliation: Specialist Centre for Paediatric Neurology, Epilepsy Centre for Children and Adolescents, Vogtareuth, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Berweck
authors.affiliation: German Center for Vertigo and Balance Disorders, IFB(LMU), University of Munich, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Jahn
authors.affiliation: Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Heinen
authors.affiliation: Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany; German Center for Vertigo and Balance Disorders, IFB(LMU), University of Munich, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Borggraefe
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005080:Exercise Test / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D012371:Robotics; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bilateral spastic cerebral palsy (BS-CP); Canadian Occupational Performance Measure (COPM); Gross Motor Function Measure (GMFM); ICF; Prospective controlled cohort study; Robot-enhanced repetitive treadmill therapy (ROBERT)