Robotic exoskeleton Remotion in outpatient gait rehabilitation for young adult patients with cerebral palsy

Background. Although a significant number of studies have focused on the rehabilitation of children patients with cerebral palsy (CP), the use of restorative treatment in the adult population with this pathology remains understudied. High-technology robot-assisted rehabilitation using exoskeleton systems for gait restoration has proven effective in various neurological disorders, including the rehabilitation of children with CP. However, questions concerning the application of these methods in adult patients require further clarification.

Aim. To investigate the effect of robot-assisted gait training in an exoskeleton in an outpatient setting on mobility, gait speed, and gait biomechanics in adult patients with CP (students of an inclusive university), and to determine the feasibility and effectiveness (i.e., the appropriateness) of outpatient motor rehabilitation using such training for this patient population.

Materials and methods. The study included 11 patients with spastic CP (spastic diplegia), classified as Gross Motor Function Classification System levels II–III. All patients underwent 10 training sessions on the Remotion robotic exoskeleton system (JSC "Volzhsky Electromechanical Plant", Russian Federation) once a day, 5 days a week. Clinical assessment included the timed up and go test and the 10-meter walk test. To objectify the clinical assessment data, biomechanical analysis of cyclic walking was performed using the Biomekhanika Nevrokor system (LLC Nevrokor, Russian Federation).

Results. The study demonstrated a clinically significant improvement in mobility as assessed by the timed up and go test (p < 0.05) and in fast walking speed measured by the 10-meter walk test (p < 0.05). Based on the gait biomechanics analysis, the patients were divided into two groups: a symmetric gait group (n = 5) and an asymmetric gait group (n = 5). In the asymmetric gait group, a statistically significant improvement in step phase symmetry was observed after the rehabilitation course using the Remotion exoskeleton system. These changes occurred due to a reduction in compensatory movements at the hip joint and normalization of the phase characteristics of the flexion/extension angles of the lower limb joints.

Conclusion. The present study confirmed that outpatient motor rehabilitation using robot-assisted therapy with an exoskeleton system is feasible, appropriate, and effective in adult patients with a previously established diagnosis of CP who are continuing their higher education.