Christa M. Diot

Purpose: To explore how 12-weeks of robotic walking impacts physical function and sequelae of inactivity for individuals with pediatric-onset neuromotor impairments. Methods: A single-arm mixed-methods interventional study examined robotic walking for 12-weeks in home and community settings, with 12-week follow-up. Outcomes included family goals (Goal Attainment Scale (GAS)) and perspectives (Interviews), postural control (Early Clinical Assessment of Balance), physical activity (Actigraphy, Habitual Activity Estimation Scale, Patient Reported Outcome Measurement Information System (PROMIS) Physical Activity) and sequelae of inactivity (PROMIS Sleep Disturbances, Bowel Function Diary). GAS was collected pre-training, post-training, and 12-week follow-up. All other quantitative outcomes were collected every 4-weeks. Quantitative data are described with median (25 ^th -75 ^th percentile) and analyzed using a Skillings-Mack test with post-hoc Wilcoxon Signed-Rank. Qualitative interviews were conducted before and after training and analyzed thematically. Results: 15 participants aged 4-23 completed this study. Participants had cerebral palsy (10/15) or rare genetic conditions (5/15), and most used a wheelchair in community settings. Postural control improved (test-statistic = 23.0, p 50) after training. Exploratory analyses suggest improvements in sleep disturbance immediately after training (p=0.025) and 4-weeks after (p=0.047). All measures of physical activity did not improve. Parents reported improvements in walking, activities of daily living, and sequelae of inactivity (i.e., bowel function, appetite, and sleep). Conclusions: Improvements were seen across a range of measures and notably postural control improvements were maintained at the follow-up. Parents perceived improvements in physical function and activities of daily living. Future research is warranted to further understand the impacts of robotic walking for children and small adults with mobility impairments.

Background: Children with significant mobility impairments have few options for upright mobility, impacting health outcomes. Robotic walking facilitates upright movement and has demonstrated health benefits, but barriers to access exist. Implementation of robotic walking in schools may be promising for improving access. Objective: We aimed to evaluate school implementation of robotic walking for children who can’t walk independently. Participants & Methods: 8 participants (5 females, mean age 4.9 ±0.7 years) used a robotic walking device at school for 5 weeks. A hospital-based research group lent robotic walking devices and evaluated outcomes. A type 3 hybrid effectiveness-implementation design was used. Outcomes were assessed before and after the 5-week intervention of robotic walking. Feasibility was captured by device usage (steps, minutes and sessions/week) and training logs describing challenges. Effectiveness was assessed using Canadian Occupational Performance Measure (COPM) change scores and Wilcoxon signed rank was used to test statistical significance. Sustainability was evaluated by identifying barriers and facilitators to implementing robotic walking, which were mapped to strategies from the Expert Recommendations for Implementing Change (ERIC) framework. Results: Over the 5-week training phase median usage/week was 2.7 (2.4-3.2) days for 74.4 (70.4-80.5) minutes and 2,610 (2,260-2,886) steps. COPM performance and satisfaction increased by 2.5 (1.7-4.1), p=0.012 and 3.3 (2.3-4.2), p=0.012, respectively. 7 barriers and 15 facilitators were identified and mapped to 14 ERIC strategies. Conclusions: Implementation of regular robotic walking in a school setting was feasible and effective. The strategies identified support sustainable implementation and may serve as a model for other schools.

To evaluate the feasibility, impacts, and perspectives of a family-led robotic walking intervention. This single-arm interventional study recruited participants aged ≥4 years with neuromotor impairments. Participants were lent a robotic walker and recommended to use at least 150 min/week for 12-weeks. Robotic walking use, acceptability, practicality and adverse events were tracked. Family goals were measured before and after training period using Canadian Occupational Performance Measure (COPM). Quality of life was examined using EQ-5D-Y, Carer-QoL, and CP-CHILD. Quantitative data were analyzed using descriptive statistics (median (25^th-75^th percentile)) and Wilcoxon signed-rank tests. Qualitative interviews captured family perspectives and were analyzed using thematic analysis. 15 participants aged 4-23 completed this study. Participants trained 5 (3.5-6) times for 150(82-181) minutes and took 7,544(4,640-9,575) steps each week. Adverse events occurred in p ≤ 0.001) and satisfaction (3.3(3.0-5.0), p ≤ 0.001) of goals increased. Parents described positive changes in social experiences and family interactions and difficulties with the logistics of robotic walking. This family-led robotic walking intervention resulted in improvements in individual goals, though families did struggle with some logistics of robotic walking.

Purpose: To evaluate the feasibility, impacts, and perspectives of a family-led robotic walking intervention. Materials & Methods: This single-arm interventional study recruited participants aged ≥4 years with pediatric-onset neuromotor disorders. Participants were lent a robotic walker and recommended to use at least 150min/week for 12-weeks. Robotic walking use, acceptability, practicality and adverse events were tracked. Family goals were measured before and after training period using Canadian Occupational Performance Measure (COPM). Quality of life was examined using EQ-5D-Y, Carer-QoL, and CP-CHILD. Quantitative data were analyzed using descriptive statistics (median (25 ^th -75 ^th percentile)) and Wilcoxon signed-rank tests. Qualitative interviews captured family perspectives and were analyzed using thematic analysis. Results: 15 participants aged 4-23 completed this study. Participants trained 5 (3.5-6) times for 150(82-181) minutes and took 7,544(4,640 – 9,575) steps each week. Adverse events occurred in <1% (16 minor, 1 moderate) of robotic walking sessions. Performance (3.5 (1.9-4.5), p=<0.001) and satisfaction (3.3(3.0-5.0), p=<0.001) of goals increased. Parents described positive changes in social experiences and family interactions and difficulties with the logistics of robotic walking. Conclusions: This family-led robotic walking intervention resulted in improvements in individual goals, though families did struggle with some logistics of robotic walking, such as; transport and difficulties with the device.

Robotic gait training has the potential to improve secondary health conditions for people with severe neurological impairment. The purpose of this study was to describe who is using the Trexo robotic gait trainer, how much training is achieved in the home and community, and what impacts are observed after the initial month of use. In this prospective observational single-cohort study, parent-reported questionnaires were collected pre- and post-training. Of the 70 participants, the median age was 7 years (range 2 to 24), 83% had CP, and 95% did not walk for mobility. Users trained 2–5 times/week. After the initial month, families reported a significant reduction in sleep disturbance (p = 0.0066). Changes in bowel function, positive affect, and physical activity were not statistically significant. These findings suggest that families with children who have significant mobility impairments can use a robotic gait trainer frequently in a community setting and that sleep significantly improves within the first month of use. This intervention holds promise as a novel strategy to impact multi-modal impairments for this population. Future work should include an experimental study design over a longer training period to begin to understand the relationship between training volume and its full potential.