Effects of Exoskeleton-Assisted Rehabilitation in Children with Cerebral Palsy According to Ambulatory Status

Aims To examine the effects of exoskeleton-assisted rehabilitation in children with spastic cerebral palsy (CP) and explore whether outcomes differ by ambulatory status.Methods This exploratory longitudinal study included 20 children with spastic CP (aged 10–13 years; GMFCS I–IV) who completed a 10-week exoskeleton-assisted program (20 sessions, 30 min/session). Participants were classified as independent ambulators (GMFCS I–II, n = 11) or non-independent ambulators (GMFCS III–IV, n = 9). Outcomes were assessed at baseline and post-intervention, with 4-week follow-up in a subset. Measures included the Gross Motor Function Measure-88 (GMFM-88), Pediatric Balance Scale (PBS), 10-Meter Walk Test, and 1-Minute Walk Test (1MWT). Longitudinal changes were analyzed using mixed-effects models.Results Main effects of time were observed for GMFM-88 (p = 0.001), PBS (p < 0.001), and 1MWT (p < 0.001). A time × group interaction was identified only for PBS (p = 0.034). The non-independent group showed baseline-to-post improvements in GMFM-88 and PBS, whereas the independent group showed an improvement in 10MWT.Conclusions Exoskeleton-assisted rehabilitation may be associated with differential changes by ambulatory status in children with CP, particularly in balance outcomes, but subgroup and longer-term findings should be interpreted cautiously. Trial registration: Clinical Research Information Service (CRIS: KCT0010892).