Prefrontal Cortex and Supplementary Motor Area Activation During Robot-Assisted Weight-Supported Over-Ground Walking in Young Neurological Patients: A Pilot fNIRS Study.
Hubertus J A van Hedel, Agata Bulloni, Anja Gut
PMID 36188767WHAT IT FOUND
Only a minority of children with neurological gait impairments showed the expected brain activation while walking in the Andago robot.
The brain imaging setup took about half an hour to prepare and was generally accepted, but the authors state it is too early for clinical use.
Key findings
01Large variability in brain responses meant only 4 of 11 analysed participants showed typical activation in the supplementary motor area and 3 of 11 in the prefrontal cortex during robot-assisted walking.
02The statistical comparison of brain activation between the robot and the treadmill did not reach significance, showing only a tendency towards a larger response for the robot in the supplementary motor area.
03Preparing the children for the brain imaging took a median of 28 minutes, and while generally accepted, some children reported pain or feeling strange wearing the cap.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The sample size was very small (11 analysed), and participants were split into three subgroups based on their brain response, which prevents serious statistical analysis. The patient group was heterogeneous, including different diagnoses (CP, stroke, TBI) and lesion types, making it hard to generalise the findings. fNIRS was unreliable for some children due to dense hair or high melanin concentration, which caused signal loss. The robot was used in 'straight-line mode' rather than the more natural 'patient-following mode', which may have lowered the cognitive demand and thus the expected brain activation.
Declared interests
The authors declare no commercial or financial conflicts of interest. The study was funded by the Anna-Müller Grocholski Foundation and the Mäxi Foundation, neither of which was involved in the study design or execution.
The easy way to misread this
Do not interpret the non-significant p-values or the small number of 'responders' as proof that robot-assisted walking fails to engage the brain. The study was too small and variable to draw any conclusion about efficacy; it only shows that measuring this in children is currently difficult and inconsistent.