Can Lokomat therapy with children and adolescents be improved? An adaptive clinical pilot trial comparing Guidance force, Path control, and FreeD.

Fifteen adolescents completed a one-session comparison, so the sample was small and the study did not test long-term clinical outcomes. Participants had different diagnoses, ages, GMFCS levels, and daily mobility aids, so results may not apply to one subgroup. Only adolescents could participate because Path Control and FreeD required the adult Lokomat orthosis. The study measured immediate EMG, heart rate, and ratings during short 2-minute bouts, not walking function after repeated training. Therapist rating of physiological was subjective, though based on listed gait factors. EMG patterns were compared with healthy child norm curves rather than each patient's own healthy walking, and electrode placement or preprocessing may differ. Foot lifters were required for safety and may have altered distal muscle activity. Data were missing for tibialis anterior in 2 patients and gastrocnemius lateralis in 3 patients due to orthoses. One patient stopped early because they could not walk below 100% Guidance Force. FreeD was tested with Guidance Force 0% and Support Force 100%, settings that may be more demanding than typical clinical use.

The Mäxi Foundation, Fondation Gaydoul, and CRRP Neurorehabilitation of the Medical Faculty of the University of Switzerland funded the work. The supplied text does not state author conflicts.

Do not conclude that more robot freedom improves gait rehabilitation. This was a one-session pilot in a small adolescent sample, and FreeD often produced unphysiological patterns and discomfort.