Evaluation of the effectiveness of Lokomat ® robot-assisted gait training in children with cerebral palsy: A systematic review

Background Children with cerebral palsy (CP) may present motor and gait impairment. Objective This systematic review aims to assess the potential of robot-assisted gait training (RAGT) with Lokomat ® exoskeleton to improve gait in children with CP. Methods The search was conducted and repoted according to PRISMA guidelines on PubMed, Scopus, Cochrane Library and PEDro databases. All randomised controlled trials (RCT) including children with CP who underwent RAGT with Lokomat ® were considered eligible. Risk of bias was assessed with the Rob2 tool by two blinded reviewers. The review was previously registered on the PROSPERO database (CRD42023488699). Results 948 articles were found, and 9 studies involving 403 children with CP met the inclusion criteria. We found a heterogeneity in the RAGT protocol and a higher risk of bias for two included studies. Seven out nine studies reported a statistically significant improvement ( p < 0.05) on gait, balance, or global functions with respect to control groups. Specifically, walking speed and stride length were improved after RAGT. Conclusions Children with CP can benefit from the add-on therapy with RAGT through Lokomat ® to improve walking and balance function. There is a need for RCTs with better patient stratification and with less heterogeneity in outcomes to improve the quality of the pooled evidence.