Making Strides

How robotic legs are working for kids with cerebral palsy

Before Cincinnati Children’s started using the Lokomat, if therapists wanted to show a child with severe cerebral palsy what it felt like to walk, it would take a crew of therapists.

Therapists would hoist the child in a sling over a treadmill and support the child’s trunk. Two or three other therapists would get on each side to manipulate the child’s legs and feet at just the right time.

It was labor-intensive and not particularly safe for the therapists. So it was a huge advancement for Cincinnati Children’s to become one of the first pediatric hospitals in the country to adopt the high-tech Lokomat robotic treadmill that makes gait training a more practical and precise intervention.

For kids with cerebral palsy who don’t walk independently, this is the closest thing they have to experience typical gait, says Jilda Vargus-Adams, MD, MSc, who specializes in caring for children with cerebral palsy in our Division of Physical Medicine and Rehabilitation.

“The evidence suggests that it helps them develop their skills in terms of walking more and walking better,” she says.

The Lokomat works by suspending a child over a treadmill. Its robotic legs fit around the child’s legs. A therapist at the computer controls the movements and how much body weight the child must support without assistance from the machine.

“With this technology, we can do the same things, but in a better way,” says Jenny Schmit, DPT, PhD, who works with patients on the Lokomat and directs the neurodevelopmental research program in the Division of Occupational Therapy and Physical Therapy at Cincinnati Children’s. 

Inching closer to a new approach

Having the technology is just the first step, Vargus-Adams says. She and Schmit are now studying how promising new technologies like the Lokomat, along with electrical stimulation, might advance treatment for kids with cerebral palsy.

They, along with colleagues here and at Case Western Reserve University in Cleveland, are using a grant from the Cerebral Palsy International Research Foundation to evaluate the combination of functional electrical stimulation and robotic gait training.

“One of the things we realized is you could use electrical stimulation, which is a way to produce muscle activation, while you’re in the Lokomat,” Schmit says. “You still get the precise kinematic stepping, but you’re also getting muscle activation, and you’re getting it at the right times.”

Functional electrical stimulation involves using mild electrical current carried on wires to pads that are stuck on the skin. The shocks cause muscles to contract in specific patterns for specific activities. Functional electrical stimulation on major muscle groups in the legs create hip and knee movement during walking activities.

Both electronic stimulation and robotic gait training have been shown to help children with cerebral palsy with walking tasks, but this is the first time they are being tried together for children, Vargus-Adams says.

Her team will study the best ways to provide electronic stimulation to children while they are using robotic gait training. Researchers will measure the combined effects on walking, strength, other motor activity, and even the participants’ quality of life and ability to take part in other activities.

Advanced motion analysis 

Other new technologies that could help kids with cerebral palsy move better, including an upper extremity electronic arm device called an ArmeoSpring, are part of an expanding Center for Advanced Technology at Cincinnati Children’s.

Cincinnati Children’s is the first pediatric hospital in the country to use the ArmeoSpring robotic arm, another way doctors are testing whether they can rewire the brain and help kids with motor impairment move better.

Advances like this, as well as a new motion analysis lab slated to open later this year, will help the cerebral palsy program in both clinical and research applications, Vargus-Adams says. It will provide gait analysis data that can inform decisions about medical, therapeutic and surgical interventions, she says, and it will give researchers a way to establish specific effects of robotic technology.