Gross Motor Function Measure (GMFM) and Robotic-Assisted Gait Training
“Effect of Robot-Assisted Gait Training on Motor Functions in Adolescent and Young Adult Patients with Bilateral Spastic Cerebral Palsy: A Randomized Controlled Trial”
Article Summary
The purpose of this study was to determine the effect of robot-assisted gait training (RAGT) on gross motor function in individuals with bilateral spastic cerebral palsy compared to conventional physical therapy, and to determine if the RAGT effects continue over a 3-4 month period of time. This prospective, randomized controlled trial enrolled 47 adolescent and adult patients living with bilateral spastic cerebral palsy (CP), and the participants were broken up into two groups in two separate outpatient clinics: an experimental group and a control group. The first group consisted of 21 patients who received RAGT, and the second group consisted of 26 patients who received conventional physical therapy in a clinic where RAGT was unavailable.
The RAGT, which is considered a safe option for pediatric neurorehabilitation, utilized a treadmill with a body weight support system and electronically controlled lower extremity orthoses. The experimental group completed RAGT 3-5 times per week for 4-6 weeks, for a total of 20 therapeutic units (1 therapeutic unit = 55 minutes). This duration included set-up and break-down of equipment, with approximately 30 minutes of gait training during a session. The gait training took place in a virtual reality-based environment. The control group received physical therapy 2-3 times per week for 30-45 minutes per session, and typically consisted of therapeutic exercises to improve motor control, sitting and standing stability, gait and ADLs.
Prior to participation, all participants were classified using the Gross Motor Function Classification System (GMFCS) and participants within GMFCS levels I-IV were included in the study. Gross motor function was assessed using the Gross Motor Function Measure (GMFM-88), which is a standardized outcome measure used to evaluate changes in gross motor function over time in patients with CP. All evaluations were completed within 24 hours prior to the start of therapy and within 24 hours after the last session. The GMFM evaluates motor functions of five categories: lying and rolling; sitting; crawling and kneeling; standing; and walking, running, and jumping.
The RAGT group GMFM scores increased from a pre-test mean of 45.79±26.05 to a post-test mean of 55.23±26.70. The control group improved GMFM scores from 50.27±27.01 to 51.07±27.26, which was a statistically non-significant change in the evaluation of motor function. When comparing the experimental group to the control group, there was a statistically significant difference of each category of the GMFM as well as the overall score, with the significant improvement seen in the RAGT group. Overall, the RAGT group showed a statistically significant increase in motor function using the GMFM, while the control group did not. Follow-up 3-4 months later with the RAGT group yielded a decreased sample size of 16 participants due to participants not attending the follow-up visit. Upon completion of the RAGT, participants continued with conventional physical therapy 1-3 times per week, and a comparison of GMFM scores upon completion of the RAGT to 3-4 months after showed that the benefits gained from completing the RAGT persisted.
Strengths of this study included the sample size, and the inclusion of a variety of individuals with CP at different GMFCS levels of motor function. I believe the variety may lead to greater generalizability of the study. Weakness of this study included the use of multiple clinics and physical therapists completing the interventions, and a lack of the complete sample size present at the 3-4 month follow-up session. Also, the control group received conventional physical therapy which could have included a wide variety of interventions conducted by multiple physical therapists which may have impacted the results.
This study concluded that utilization of a robot-assisted gait training program significantly improves gross motor functions in adolescent and adult patients with cerebral palsy. It also concluded that the results from the RAGT were still present 3-4 months after completion of the regimen, which may indicate that conventional physical therapy can maintain the significant gain in motor function from the RAGT program.
References
- Klobucká S, Klobucký R, Kollár B. Effect of robot-assisted gait training on motor functions in adolescent and young adult patients with bilateral spastic cerebral palsy: A randomized controlled trial. NeuroRehabilitation. 2020;47(4):495-508. doi:10.3233/NRE-203102
2 responses to “Gross Motor Function Measure (GMFM) and Robotic-Assisted Gait Training”
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That is very interesting that results from RAGT remained present 3-4 months following the completion of the intervention. It would be interesting to continue to follow these individuals and collect more long term data and see how long these results persist. Furthermore, it would be interesting to see if continued use of RAGT, greater than the 4-6 weeks, would have profound effects or last even longer after intervention.
It is interesting to see the different variables used to gain improvements in gross motor function for patients with cerebral palsy. I read an article about the use of virtual reality with treadmill training to gain increases on GMFM scores. Similar to your study, virtual reality was also found to have a great influence on improving GMFM scores. It makes me curious to see what other avenues researchers will go down in an attempt to improve GMFM scores to a greater extent than they have already. Overall, great summary and I really enjoyed reading over your summary of the article you chose.