Robotic Assisted Gait Training and Therapist Assisted

Gait Training for Patients with Microcephaly

 Patient Case
The patient is a 22-year-old female with microcephaly and a global
developmental delay. She lives at home and her mother is the
primary caregiver helping her complete all her daily activities. She is
nonverbal but communicates with physical motions and pitch-based
noises. She can complete transfers with assistance and has limited
voluntary control of her upper extremities. She primarily uses a
wheelchair to ambulate but would like to ambulate on her feet with
assistive devices so that she can have increased social connections.
 Clinical Question
Is the use of robotic gait training (RAGT) or manual therapist
assisted gait training more effective (I)(C) for the
improvement of ambulation (O) for 22-year-old female with
microcephaly and global developmental delay (P). 
 Introduction
− Microcephaly is a neurologic condition that results in reduced growth in the brain and
leads to many cognitive and physical impairments. Leading to increased stress on
caregivers.
− Regardless of the severity of microcephaly, abnormalities may vary including
decreased head size, decreased height and osteodysplasia all which have
been addressed separately1
− There is a minimal amount of research on gait training protocols and ambulatory
interventions for patients with microcephaly
− To fill this gap in research, robot assisted gait training therapy and manual therapist
assisted gait training will be used to improve overall ambulation
− The purpose of this study is to investigate whether RAGT or manual therapist assisted gait
training will improve ambulation and stability in patients with microcephaly.
1
Woods CG, Parker A. Investigating microcephaly. Arch Dis Child. 2013;98(9):707-713. doi:10.1136/archdischild-2012-302882
 Subjects
− Participants have diagnosis of microcephaly
− Recruited from primary care providers in Mid-Michigan area
− Inclusion Criteria: − Exclusion Criteria:
− Age: 18-30 years old − Ability to ambulate
− Medical diagnosis of microcephaly − 10m walk-test(10MWT)1
− Normal cognitive function − >0.8 m/s
− Normal range of motion − Decreased range of motion (ROM)
− Uses wheelchair as primary mode of − Abnormal or impaired vision
ambulation − Participants in previous gait training
studies

1
Fariba Bahrami, Shohreh Noorizadeh Dehkordi, Mehdi D. Inter and intra rater reliability of the 10 meter walk test in the community dweller adults
with spastic cerebral palsy. Iranian J Child Neurol. 2017;11(1). Accessed December 3, 2022. https://pubmed.ncbi.nlm.nih.gov/28277557/
 Intervention-RAGT
1. Two initial fittings and acclimation sessions in
preparation for Lokomat sessions
2. Sessions start with 10-20 minutes on the
Lokomat, if tolerated in future session maximum
time of 30 minutes.
3. The following 4 parameters will be adjusted
based on patient2:
1. Body weight supported
2. Walking duration
3. Ambulation velocity  1
4. Guidance force provided 
1
Hilderley AJ, Fehlings D, Lee GW, Wright FV. Comparison of a robotic-assisted gait training program with a program of functional gait training for
children with cerebral palsy: design and methods of a two group randomized controlled cross-over trial. SpringerPlus. 2016;5(1).
doi:10.1186/s40064-016-3535-0
2
1,000th “Lokomat” high-tech robotic gait training device unveiled at Swiss Paraplegic Center during festive ceremony. Hocoma. Accessed
December 9, 2022. https://www.hocoma.com/media-releases/1000th-lokomat/
 Intervention-Manual Therapist Assisted Gait Training

1. Sessions start with fitting participant into harness.

• Unweighting 80% body weight decreasing with
increased strength
2. Treadmill speed increased in .1km/h increments
until comfortable gait pattern was achieved
3. 2 therapists will assist in movement of lower
extremities on the treadmill
4. Session lasts for 30 minutes, and parameters were
recorded2
1
Arazpour M, Sharifi G, Maleki MEM and M, Arazpour M, Sharifi G, Maleki MEM and M. Role of Gait Training in Recovery of Standing and Walking
in Subjects with Spinal Cord Injury. IntechOpen; 2018. doi:10.5772/intechopen.71312
2
Dodd KJ, Foley S. Partial body-weight-supported treadmill training can improve walking in children with cerebral palsy: a clinical controlled trial.
Dev Med Child Neurol. 2007;49(2):101-105. doi:10.1111/j.1469-8749.2007.00101.x
 Study Design
• Randomized Control Trial
– Primary Goal: Determine whether RAGT or therapist assisted gait training is
more affective for improvement in ambulation in patients with microcephaly
• Practice1
– 16 sessions
– 8 weeks
– 2 sessions/week
• Sample Size
– 10 Participants

1
Hilderley AJ, Fehlings D, Lee GW, Wright FV. Comparison of a robotic-assisted gait training program with a program of functional gait
training for children with cerebral palsy: design and methods of a two group randomized controlled cross-over trial. SpringerPlus.
2016;5(1). doi:10.1186/s40064-016-3535-0
 Data Collection
• Outcomes
– Functional Gait Assessment1
– 10m Walk Test
– Caregiver Questionnaire

• Other Outcomes
– Hip ROM
– Knee ROM
– Maximal Speed during therapy
– Individualized Goal Attainment Scores2

1
Wrisley DM, Marchetti GF, Kuharsky DK, Whitney SL. Reliability, internal consistency, and validity of data obtained with the functional gait
assessment. Phys Ther. 2004;84(10):906-918.
2
Wiart L, Rosychuk RJ, Wright FV. Evaluation of the effectiveness of robotic gait training and gait-focused physical therapy programs for children
and youth with cerebral palsy: a mixed methods RCT. BMC Neurol. 2016;16:86. doi:10.1186/s12883-016-0582-7
 Schedule
PRE-TEST 1 PRE-TEST 2 POST-TEST RETENTION

2 weeks 8 weeks 2 weeks

 Statistical Analysis
• Paired T test to compare participants between pre-test1 and pre-test2
– Effect Size will be calculated
• Two-way repeated measures ANOVA (parametric) will be used to look at
results from 10MWT and functional gait assessment
• Two-way repeated measures ANOVA (non-parametric) will be used if
data fails normality of distribution
 Anticipated Results
• Expected increase in ambulation ability of patients with
both RAGT and manual therapist assisted gait training
• Learn more about best protocol for teaching gait to patients
with microcephaly
• Learn amount of time needed for gait training protocol
 Limitations
• Sample Size
– Not many patients with microcephaly in the Mid-Michigan area
• Use Treadmills for gait training to minimize risk
• RAGT muscle groups 
– Using different muscle groups or more muscle groups could have
improved or changed outcomes