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Patient‐specific determinants of responsiveness to robot‐enhanced treadmill therapy in children and adolescents with cerebral palsy
Author(s) -
Schroeder Andreas Sebastian,
Von Kries Rüdiger,
Riedel Christina,
Homburg Maria,
Auffermann Helene,
Blaschek Astrid,
Jahn Klaus,
Heinen Florian,
Borggraefe Ingo,
Berweck Steffen
Publication year - 2014
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.12564
Subject(s) - cerebral palsy , gross motor function classification system , spasticity , etiology , medicine , treadmill , physical therapy , gross motor skill , psychology , spastic cerebral palsy , spastic , pediatrics , physical medicine and rehabilitation , motor skill , psychiatry
Aim The aim of the study was to evaluate patient‐specific determinants of responsiveness to robot‐enhanced repetitive treadmill therapy (ROBERT) in patients with early‐developed movement disorders. Method Patients were treated over 12 sessions during a 3‐week period. Gross Motor Function Measure‐66 (GMFM‐66) scores 1 day before ROBERT were compared with scores recorded 1 day after ROBERT. The association of GMFM‐66 baseline score, age, sex, aetiology, and add‐on botulinum toxin therapy to response to treatment was assessed. Results Eighty‐three patients aged between 4 and 18 years (48 males, 35 females; mean age 10y 8mo, SD 6y 1mo; Gross Motor Function Classification System level I [ n =12], II [ n =21], III [ n =35], IV [ n =10], and V [ n =1]) were each treated for a total of 7.2 (SD 1.9) treadmill walking hours. Aetiology was bilateral spastic cerebral palsy (BS‐CP; n =69), unilateral CP ( n =3), ataxic CP ( n =3), hereditary spastic paraparesis ( n =6), and genetic syndrome including spasticity ( n =2). Meaningful improvements were observed in GMFM‐66 (+2.5; 95% CI 2.0–3.0), GMFM‐D (+5.2; 95% CI 3.6–6.8), and GMFM‐E (+4.0; 95% CI 2.8–5.3). There was a high inter‐individual variability in treatment response. After multivariable adjustment, the improvements in GMFM‐66 and GMFM‐E scores were positively associated with the GMFM‐66 baseline score. The effect on GMFM‐D improvement was inversely associated with age. Interpretation Gross motor abilities at baseline and age were identified as relevant determinants for the high degree of interpersonal variability in response to ROBERT.