Patient‐specific determinants of responsiveness to robot‐enhanced treadmill therapy in children and adolescents with cerebral palsy. (25th August 2014)

• Record Type: Journal Article
• Authors: Schroeder, Andreas Sebastian; Von Kries, Rüdiger; Riedel, Christina; Homburg, Maria; Auffermann, Helene; Blaschek, Astrid; Jahn, Klaus; Heinen, Florian; Borggraefe, Ingo; Berweck, Steffen
• Is Part Of: Developmental medicine & child neurology. Volume 56:Number 12(2014:Dec.)
• Page Start: 1172
• Page End: 1179
• Publication Date: 2014-08-25
• Subjects: Child development -- Periodicals; Pediatric neurology -- Periodicals; 616.8
• DOI: 10.1111/dmcn.12564
• Languages: English
• ISSNs: 0012-1622

Abstract

Abstract : Aim: The aim of the study was to evaluate patient‐specific determinants of responsiveness to robot‐enhanced repetitive treadmill therapy (ROBERT) in patients with early‐developed movement disorders. Method: Patients were treated over 12 sessions during a 3‐week period. Gross Motor Function Measure‐66 (GMFM‐66) scores 1 day before ROBERT were compared with scores recorded 1 day after ROBERT. The association of GMFM‐66 baseline score, age, sex, aetiology, and add‐on botulinum toxin therapy to response to treatment was assessed. Results: Eighty‐three patients aged between 4 and 18 years (48 males, 35 females; mean age 10y 8mo, SD 6y 1mo; Gross Motor Function Classification System level I [ n =12], II [ n =21], III [ n =35], IV [ n =10], and V [ n =1]) were each treated for a total of 7.2 (SD 1.9) treadmill walking hours. Aetiology was bilateral spastic cerebral palsy (BS‐CP; n =69), unilateral CP ( n =3), ataxic CP ( n =3), hereditary spastic paraparesis ( n =6), and genetic syndrome including spasticity ( n =2). Meaningful improvements were observed in GMFM‐66 (+2.5; 95% CI 2.0–3.0), GMFM‐D (+5.2; 95% CI 3.6–6.8), and GMFM‐E (+4.0; 95% CI 2.8–5.3). There was a high inter‐individual variability in treatment response. After multivariable adjustment, the improvements in GMFM‐66 and GMFM‐E scores were positively associated with the GMFM‐66 baseline score. The effect on GMFM‐D improvement was inversely associated with age. Interpretation: Gross motor abilities at baseline and age were identified as relevant determinants for the high degree of interpersonal variability in response to ROBERT. What this paper adds: A high interpersonal variability in the response to ROBERT was confirmed. Gross motor function at baseline was identified as an independent determinant of improvement in GMFM‐66 total score and GMFM‐E score. Age seems to have an inverse effect on the improvement of standing abilities (GMFM‐D). GMFM‐66 baseline score is a candidate for prognostic studies to identify the best predictor for response to ROBERT. This article is commented on by Kurz and Reelfs on pages1137–1138 of this issue.