Benjamin M. Norman

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.

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.

Background: Physical activity has many benefits but can be hard to achieve for people living with severe mobility impairments. Robotic walking may be an effective way for these individuals to achieve physical activity. Objective: The aim of this study is to characterize the physical activity performed by children and small adults with severe mobility impairments during a single session of robotic walking. Methods: We conducted a series of single-session assessments to evaluate the heart rate response experienced by children and small adults with severe mobility impairments during overground walking with an untethered robotic walking aid designed for children (Trexo). Outcomes evaluating physical activity were the average percent heart rate reserve (%HRR) throughout the training session, the most intense minute of training, and the total time spent physically active (at >20% HRR). Nonparametric descriptive statistics are presented as median (25th–75th percentiles). Results: Fifteen individuals (aged 5–24) unable to walk independently participated in this study. Participants using the robotic walker had an average %HRR during training of 30% (21%–35%) and reached 40% (30%–50%) HRR in the highest minute of training. Participants spent a median of 17 (10–27) minutes and 99% (57%–100%) of the robotic walking time physically active. Conclusion: This study demonstrates that robotic walking can facilitate at least light physical activity for children and small adults with severe mobility impairments. The results of this study can be used to inform future providers on the physical activity benefits of robotic walking.