Benefits and limitations of robotic gait exoskeletons in functional rehabilitation of children with cerebral palsy: an umbrella review

PURPOSE: Cerebral palsy (CP) is a group of non-progressive brain disorders affecting posture and movement. Children show locomotor impairments, including slow, asymmetric, and unstable gait, limiting daily mobility. Robot-Assisted Gait Training (RAGT) is used in CP rehabilitation, but its effectiveness remains heterogeneous. MATERIALS AND METHODS: Spatiotemporal gait parameters (walking speed, step length) were analyzed with GMFM-88 functional outcomes (dimensions D and E). No other clinical, kinematic, kinetic, or EMG measures were reported. Effects were expressed as standardized mean differences with 95% confidence intervals; significance was based on whether intervals crossed zero. RESULTS: RAGT improves overall motor function, especially GMFM D and E, supporting its complementary role. Effects on gait parameters are limited, with no consistent advantage over treadmill or physiotherapy. GMFM-88 dimension D gains were limited and heterogeneous, whereas dimension E showed more consistent improvements, particularly with RAGT alone or versus conventional therapy. CONCLUSIONS: These findings highlight RAGT's role in enhancing gross motor function in children with CP, while improvements in spatiotemporal gait parameters remain inconsistent. Overall, RAGT can be considered a valuable adjunct to conventional rehabilitation, emphasizing the need for tailored interventions and further research to optimize gait outcomes in pediatric CP populations.