Dual-task training of children with neuromotor disorders during robot-assisted gait therapy: prerequisites of patients and influence on leg muscle activity.
Sandra Ricklin, Andreas Meyer-Heim, Hubertus J A van Hedel
PMID 30223840WHAT IT FOUND
Adding arm pointing to a Lokomat walking game lowered game scores and made 5 of 20 children show compensatory walking.
Leg muscle activity during stance fell. Use GMFCS, WeeFIM mobility or FAC, not body-function tests, to judge who can try it.
Key findings
01Adding arm pointing to the Lokomat game lowered game scores to a median of 25 points from a median of 91 points, and 5 of 20 children walked with compensatory movements, while only one adolescent did so without pointing.
02GMFCS, WeeFIM mobility and FAC, which describe walking and daily activity performance, separated physiological from compensatory walking better than body-function measures.
03After correcting for the arm movement, dual-task game walking reduced stance-phase leg muscle activity, while the timing patterns of the measured muscles remained similar.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 20 children were analysed, and no sample size calculation was done, so the cut-off values should be read cautiously. The therapist rating walking as physiological or compensatory was unblinded and had no standardised checklist. The study tested a single session and did not measure everyday walking or long-term transfer. Some EMG values were missing because two children could not walk without orthoses and one VMO value had signal noise. The magic wand tracking was unreliable in some measurements, which reduced motivation. ID14 was excluded because they did not understand the game, so younger children may need more therapist input. Participants had different diagnoses and motor levels, so it is unclear how well the results apply to any single child.
Declared interests
Funded by the Clinical Research Priority Program Neuro-Rehabilitation of the University of Zurich, the Mäxi-Foundation and Fondation Gaydoul. The supplied text does not state author competing interests.
The easy way to misread this
Do not read this as proof that dual-task Lokomat game training improves daily walking. It tested a single session in 20 children, and when they had to point at game objects, 5 of 20 walked with compensatory movements and stance-phase leg muscle activity fell.