Mechanically assisted walking training for walking, participation, and quality of life in children with cerebral palsy

This new review assessed the effects of mechanically assisted walking training compared to control for walking, participation, and quality of life in children with cerebral palsy aged 3 to 18 years. 

The review authors included 17 studies, comparing any type of mechanically assisting walking training (with or without body weight support) with no walking training or the same dose of overground walking training in children with cerebral palsy (classified as Gross Motor Function Classification System (GMFCS) Levels I to IV). In total, 451 participants (mean age range 4 to 14 years) from outpatient settings took part in the studies.

Results

The results were as follows.

Compared to no walking training, mechanically assisted walking training:

·         without body weight support increased walking speed (1 study, 10 participants; moderate-quality evidence) and improved gross motor function postintervention (standardized mean difference MD [SMD] 1.30 scores], 95% CI 0.49 to 2.11; 2 studies, 60 participants; low-quality evidence); and

·         with body weight support increased walking speed (MD 0.07 m/s, 95% CI 0.06 to 0.08; 7 studies, 161 participants; moderate-quality evidence), but had little to no effect on gross motor function (MD 1.09%, 95% CI -0.57 to 2.75; 3 studies, 58 participants; low-quality evidence), participation (SMD 0.33, 95% CI -0.27 to 0.93; 2 studies, 44 participants; low-quality evidence), and quality of life (1 study, 26 participants; low-quality evidence).

Not many studies reported adverse events but those that did report that there were none at the end of the intervention (low-quality evidence). 

Compared to the same dose of overground walking training, mechanically assisted walking training:

·         without body weight support increased walking speed (MD 0.25 m/s, 95% CI 0.13 to 0.37; 2 studies, 55 participants; moderate-quality evidence), and improved gross motor function (1 study, 35 participants; moderate-quality evidence) and participation (1 study, 35 participants; moderate-quality evidence); and

·         with body weight support had little to no effect on walking speed (MD -0.02 m/s, 95% CI -0.08 to 0.04; 3 studies, 78 participants; low-quality evidence), gross motor function (MD -0.73%, 95% CI -14.38 to 12.92; 2 studies, 52 participants; low-quality evidence), and participation (1 study, 26 participants; moderate-quality evidence).

No study included in these comparisons measured adverse events or quality of life.

Conclusions

The review authors concluded that mechanically assisted walking training can provide repetitive high-intensity, task-specific training. It may be a useful way to provide practice for children with poor concentration when it is difficult to apply the same amount of overground walking. However, they note that the results are largely not clinically significant and come from studies with small sample sizes and that are at variable risk of bias. The intensity of the interventions also varied across studies. Together, this makes it difficult to draw robust conclusions.

Read the full review here on the Cochrane Library.