Robotic Knee Orthosis-assisted Walking in CP

Hospital for Special Surgery, New York10 enrolled

Overview

Robotic exoskeletons are becoming increasingly accepted to provide upright mobility in individuals with neurological disorders. These devices can assist in overcoming gravitational forces and reduce energy consumption. Agilik is one such device intended for children with neurological disorders. However, Agilik is relatively new, and its efficacy in children with CP is unknown. Therefore, this study aims to assess the effectiveness of Agilik as an assistive device for children with CP and crouch gait. In this pilot study, ten children with CP, GMFCS level II, and crouch gait will walk with Agilik under the supervision of a physical therapist. Assessments of walking with AFO and Agilik will evaluate the efficacy of the device. The pilot study will assess if Agilik decreases crouch and improves gait characteristics in children with CP.

Robotic knee orthosis (RKO) can assist with voluntary knee extension and potentially reduce crouch/flexed-knee gait, but the efficacy of this technology in children with CP is unknown. This study aims to assess the effectiveness of Agilik as an assistive device for children with CP. Ten children with CP, ages 8 to 17 years, and at GMFCS level II, will be recruited for this pilot study. Each child will participate in a total of four visits over four weeks duration. The first three visits will also include RKO device fitting and tuning, followed by RKO-assisted walking practice to help with device acclamation. The walking practice will last up to 30 minutes. A two-minute walk test (2MWT) will be conducted at the first visit, which will serve as a reference to assess any shift in endurance from device-tuning/practice visits. The fourth and final visit will include 2MWT and 3D motion capture of shod and RKO-assisted conditions and may take up to 3 to 4 hours.

Study Type

INTERVENTIONAL

Allocation

Purpose

OTHER

Masking

NONE

Enrollment

Interventions

RKO-assisted walking in children with CPDEVICE

The investigators will assess walking in each of the following conditions: shod (shoes or shoes + AFO) and RKO-assisted (shoes + RKO), to achieve the following: (1) Evaluate the effect of RKO, compared to shod upon endurance in children with CP at GMFCS level II, and (2) Evaluate the effect of RKO, compared to shod, upon temporal-spatial parameters, lower limb sagittal joint kinematics, and muscle EMG in children with CP at GMFCS level II.

Eligibility

Sex: ALLMin age: 8 YearsMax age: 17 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Diagnosed with cerebral palsy at GMFCS level II * Exhibits crouch gait * Between 8 to 17 years of age * Hip flexion contracture less than 5 degrees * Knee flexion contracture less than 20 degrees when measured in prone with hips extended * Thigh-foot angle is between 10 degrees (internal) to 25 degrees (external) in prone * Can walk a minimum distance of 10 meters without stopping Exclusion Criteria: * Plantarflexion contracture, when measured in neutral foot alignment * No other neurological, musculoskeletal, or cardiorespiratory health conditions or injuries * The presence of any cognitive impairment that could limit the ability to understand, follow simple directions, and inform when in pain * Inability to participate in the study because of recent orthopedic surgery (within twelve months) or botox intervention (within six months)

Outcomes

Primary Outcomes

Distance from 2MWT

The distance covered by participants during a two-minute walking test (2MWT) will be compared between RKO-assisted and shod conditions.

Time frame: From enrollment until data collection is performed, 4 weeks after enrollment

Step length

Mean step length (distance between the two feet measured from the heel of one foot to the heel of the contralateral foot while both feet are on the ground) during walking will be compared between RKO-assisted and shod conditions.