Effectiveness of robotic exoskeletons for improving gait in children with cerebral palsy: a systematic review

Journal article


Hunt, M., Everaert, L., Brown, M., Muraru, L., Hatzidimitriadou, E. and Desloovere, K. 2022. Effectiveness of robotic exoskeletons for improving gait in children with cerebral palsy: a systematic review . Gait & Posture. 98, pp. 343-354. https://doi.org/10.1016/j.gaitpost.2022.09.082
AuthorsHunt, M., Everaert, L., Brown, M., Muraru, L., Hatzidimitriadou, E. and Desloovere, K.
Abstract

Abstract
Background: Robotic exoskeletons have been developed to assist locomotion and address gait abnormalities in children with cerebral palsy (CP). These wearable assistive devices provide powered assistance to the lower-extremity joints, as well as support and stability.

Research Question: Does exoskeleton-assisted walking improve gait in children with CP?

Methods: The PRISMA guidelines were used to conduct this systematic review. Articles were obtained in a search of the following electronic databases: Embase, CINAHL Complete, PubMed, Web of Science and MEDLINE. Studies investigating spatiotemporal, kinematic, kinetic, muscle activity and/or physiological parameters during exoskeleton-assisted walking in children with CP were included. All articles were assessed for methodological quality using an adapted version of the Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group, provided by NIH.

Results: Thirteen studies were included. They involved the use of the following exoskeletons: tethered knee exoskeleton, pediatric knee exoskeleton (P.REX), untethered ankle exoskeleton, WAKE-Up ankle module, WAKE-Up ankle & knee module and unilateral ankle exosuit. Methodological quality varied, with key limitations in sample size and allocated time to adapt to the exoskeleton. There was a consensus that robotic exoskeletons improve gait given careful optimisation of exoskeleton torque and sufficient exoskeleton practice time for each participant. Improvements in gait included reduced metabolic cost of walking, increased walking speed, and increased knee and hip extension during stance. Furthermore, exoskeletons with an actuated ankle module were shown to promote normal ankle rocker function.

Significance: Robotic exoskeletons have the potential to improve the mobility of CP children and may therefore increase community participation and improve quality of life. Future work should involve larger controlled intervention studies utilising robotic exoskeletons to improve gait in children with CP. These studies should ensure sufficient exoskeleton practice time for each participant.

KeywordsRobotic exoskeletons; Gait; Cerebral palsy; Assistive devices ; Powered orthosis; Biomechanics
Year2022
JournalGait & Posture
Journal citation98, pp. 343-354
PublisherElsevier
ISSN0966-6362
Digital Object Identifier (DOI)https://doi.org/10.1016/j.gaitpost.2022.09.082
Official URLhttps://www.sciencedirect.com/science/article/pii/S0966636222005914
Funder2 Seas Interreg
Publication dates
Online25 Oct 2022
Publication process dates
Accepted19 Sep 2022
Deposited31 Oct 2022
Publisher's version
License
File Access Level
Open
Output statusPublished
References

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Neuromuscular responses to consecutive day military load carriage
Scales, J., Brown, M. and Coleman, D. 2017. Neuromuscular responses to consecutive day military load carriage.
Coping strategies of Turkish migrant women in the UK
Cakir, S. and Hatzidimitriadou, E. 2012. Coping strategies of Turkish migrant women in the UK.
Continuing to care: the needs and roles of older carers of people with dementia
Milne, A., Hatzidimitriadou, E. and Chryssanthopoulou, C. 2005. Continuing to care: the needs and roles of older carers of people with dementia.
Forgone healthcare and intimate partner violence: a study in six European urban centres
Costa, D., Hatzidimitriadou, E., Ioannidi-Kapolou, E., Lindert, J., Soares, J., Sundin, O., Toth, O. and Barros, H. 2014. Forgone healthcare and intimate partner violence: a study in six European urban centres.
A systematic review and meta-analysis of the potential local economic impact of tourism and leisure cycling and the development of an evidence-based market segmentation
Weed, M., Bull, C., Brown, M., Dowse, S., Lovell, J., Mansfield, L. and Wellard, I. 2014. A systematic review and meta-analysis of the potential local economic impact of tourism and leisure cycling and the development of an evidence-based market segmentation. Tourism Review International. 18 (1-2), pp. 37-55. https://doi.org/10.3727/154427214X13990420684482
Notational analysis of sprint kayaking: differentiating between ability level
Brown, M., Lauder, M. and Dyson, R. 2011. Notational analysis of sprint kayaking: differentiating between ability level. International Journal of Performance Analysis in Sport. 11 (1), pp. 171-183.
A qualitative analysis of migrant social workers’ work experiences and perceived prejudice from an empowering acculturative integration approach
Hatzidimitriadou, E. and Psoinos, M. 2017. A qualitative analysis of migrant social workers’ work experiences and perceived prejudice from an empowering acculturative integration approach. European Journal of Social Work. https://doi.org/10.1080/13691457.2017.1366299
Screening for falls risk in the older person with haemophilia - a pilot study
Stephensen, D., Brown, M., Digby-Bowl, C., Swaine, I. and Evans, G. 2016. Screening for falls risk in the older person with haemophilia - a pilot study. Haemophilia. 22 (S4), pp. 105-105. https://doi.org/10.1111/hae.12980
Exploring the significance of falls in the everyday lives of the older person with haemophilia
Stephensen, D., Brown, M., Digby-Bowl, C., Swaine, I. and Evans, G. 2016. Exploring the significance of falls in the everyday lives of the older person with haemophilia.
Screening for falls risk in the older person with haemophilia – a pilot study
Stephensen, D., Brown, M., Digby-Bowl, C., Swaine, I. and Evans, G. 2016. Screening for falls risk in the older person with haemophilia – a pilot study. Blackwell.
Post-migration wellbeing, community activism and empowerment: the case of Turkish-speaking women in London
Hatzidimitriadou, E. and Cakir, S. 2013. Post-migration wellbeing, community activism and empowerment: the case of Turkish-speaking women in London. in: Gideon, J. and Thomas, F. (ed.) Migration, Health and Inequality London Zed Books. pp. 180-197
Managing equality and diversity in health care: the case of ethnic monitoring at St George's NHS Trust
Butler, C., Hatzidimitriadou, E. and Psoinos, M. 2010. Managing equality and diversity in health care: the case of ethnic monitoring at St George's NHS Trust.
Socioeconomic inequalities in victims of intimate partner violence in Europe
Costa, D., Soares, J., Lindert, J., Hatzidimitriadou, E., Sundin, O., Toth, O., Ioannidi-Kapolou, E., Degomme, O., Cervilla, J. and Barros, H. 2013. Socioeconomic inequalities in victims of intimate partner violence in Europe. European Journal of Public Health. 23 (1), p. 120. https://doi.org/10.1093/eurpub/ckt126.296
Continuing carers: developing a conceptual framework to explore their status & identity
Milne, A. and Hatzidimitriadou, E. 2014. Continuing carers: developing a conceptual framework to explore their status & identity.
‘Care for me at home’ A qualitative exploration of experiences of people receiving domiciliary (home) care in the London Borough of Bexley.
Palmer, D., Williams, L., Hatzidimitriadou, E., Hossain, R., Ball, C., Rigby, N., Hackett, L. and Hinds-Murray, A. 2015. ‘Care for me at home’ A qualitative exploration of experiences of people receiving domiciliary (home) care in the London Borough of Bexley. Bexley London Borough of Bexley.
Cultural capital and professional development experiences of migrant health and social care professionals
Hatzidimitriadou, E. and Psoinos, M. 2010. Cultural capital and professional development experiences of migrant health and social care professionals.
Review of domestic violence policies in England & Wales
Matczak, A., Hatzidimitriadou, E. and Lindsay, J. 2011. Review of domestic violence policies in England & Wales. London, U.K. Kingston University and St George's, University of London.
An exploration of cultural capital, labour market position and work experiences of migrant and refugee doctors in the UK
Hatzidimitriadou, E. and Psoinos, M. 2011. An exploration of cultural capital, labour market position and work experiences of migrant and refugee doctors in the UK.
Ethnic monitoring in healthcare services in the UK as a mechanism to address health disparities: a narrative review
Psoinos, M., Hatzidimitriadou, E., Butler, C. and Barn, R. 2011. Ethnic monitoring in healthcare services in the UK as a mechanism to address health disparities: a narrative review. London Swan IPI.
Informing the development of cultural and ethical competence in social work education
Gupta, A., Fook, J., Bhatti-Sinclair, K., Hatzidimitriadou, E. and Lee, Y. 2011. Informing the development of cultural and ethical competence in social work education. London, U.K. Social Policy and Social Work Subject Centre (SWAP).
Exploring how to optimise the professional contribution and enhance the psychosocial well-being of migrant and refugee healthcare professionals in the UK
Hatzidimitriadou, E. and Psoinos, M. 2012. Exploring how to optimise the professional contribution and enhance the psychosocial well-being of migrant and refugee healthcare professionals in the UK.
Transferability of locally collected research results: employing theoretical triangulation in a study on migrant social workers in the UK
Hatzidimitriadou, E. and Psoinos, M. 2012. Transferability of locally collected research results: employing theoretical triangulation in a study on migrant social workers in the UK.
Evidence of a gender effect in the impact of Intimate Partner Violence victimisation on health-related quality of life
Costa, D., Soares, J., Lindert, J., Hatzidimitriadou, E., Sundin, O., Toth, O., Ioannidi-Kapolou, E., Degomme, O., Cervilla, J. and Barros, H. 2012. Evidence of a gender effect in the impact of Intimate Partner Violence victimisation on health-related quality of life.
"Hero Imagery" - Are there performance advantages associated with imagining yourself as your favourite athlete?
Uphill, M., Balsdon, A., Brown, M., Digby-Bowl, C., Southam, M. and Swain, J. 2015. "Hero Imagery" - Are there performance advantages associated with imagining yourself as your favourite athlete?
Evaluation of the totally touchable arts intervention project for sight impaired adults
Manship, S. and Hatzidimitriadou, E. 2015. Evaluation of the totally touchable arts intervention project for sight impaired adults. Canterbury Christ Church University.
Exploring the significance of falls in the everyday lives of the older person with haemophilia
Stephensen, D., Brown, M., Digby-Bowl, C., Swaine, I. and Evans, G. 2016. Exploring the significance of falls in the everyday lives of the older person with haemophilia. Haemophilia. 22 (S2), pp. 45-46. https://doi.org/10.1111/hae.1_12882
Cultural capital during migration: findings from narrative interviews with academically and vocationally skilled adults with immigrant background in the UK - final report
Hatzidimitriadou, E. 2008. Cultural capital during migration: findings from narrative interviews with academically and vocationally skilled adults with immigrant background in the UK - final report. Canterbury European Centre for the Study of Migration and Social Care, University of Kent.
Cultural capital of second generation migrant women in the UK: reconstructing gendered experiences through biographical narratives
Hatzidimitriadou, E. 2008. Cultural capital of second generation migrant women in the UK: reconstructing gendered experiences through biographical narratives.
Domestic violence in Europe: study on determinants and characteristics of domestic violence in England
Lindsay, J. and Hatzidimitriadou, E. 2012. Domestic violence in Europe: study on determinants and characteristics of domestic violence in England.
Male and female physical intimate partner violence and socioeconomic position: a cross-sectional international multicentre study in Europe
Costa, D., Hatzidimitriadou, E., Ioannidi-Kapolou, E., Lindert, J., Soares, J., Sundin, O., Toth, O. and Barros, H. 2016. Male and female physical intimate partner violence and socioeconomic position: a cross-sectional international multicentre study in Europe. Public Health. 139, pp. 44-52. https://doi.org/10.1016/j.puhe.2016.05.001
A qualitative evaluation of psychosocial outcomes of the Creative Communications pilot project for people with dementia
Manship, S. and Hatzidimitriadou, E. 2015. A qualitative evaluation of psychosocial outcomes of the Creative Communications pilot project for people with dementia.
Editorial: User involvement and empowerment in health care practices with ethnic minority and migrant groups: a community approach
Garcia-Ramirez, M. and Hatzidimitriadou, E. 2009. Editorial: User involvement and empowerment in health care practices with ethnic minority and migrant groups: a community approach. International Journal of Migration, Health and Social Care. 5 (1), pp. 2-4. https://doi.org/10.1108/17479894200900001
'No one knows like we do' - the narratives of mental health service users trained as researchers
Palmer, D., Williams, L., White, S., Chenga, C., Calabria, V., Branch, D., Arundal, S., Storer, L., Ash, C., Cuthill, C., Bezuayehu, H. and Hatzidimitriadou, E. 2009. 'No one knows like we do' - the narratives of mental health service users trained as researchers. Journal of Public Mental Health. 8 (4), pp. 18-28. https://doi.org/10.1108/17465729200900024
Sozialraumliche Koordinaten beruflicher Orientierung. Hochqualifizierte der zweiten Generation in Deutschland und Grossbritannien
Schittenhelm, K. and Hatzidimitriadou, E. 2010. Sozialraumliche Koordinaten beruflicher Orientierung. Hochqualifizierte der zweiten Generation in Deutschland und Grossbritannien. in: Nohl, A., Schittenhelm, K., Schmidtke, O. and Weiss, A. (ed.) Kulturelles Kapital in der Migration: Hochqualifizierte Einwanderer und Einwanderinnen auf dem Arbeitsmarkt Wiesbaden, Germany VS Verlag. pp. 301-314
"Isn't he wonderful?" Exploring the contribution and conceptualization of older husbands as carers
Milne, A. and Hatzidimitriadou, E. 2003. "Isn't he wonderful?" Exploring the contribution and conceptualization of older husbands as carers. Ageing International. 28 (4), pp. 389-407. https://doi.org/10.1007/s12126-003-1011-y
Carers of older relatives in long term care: support needs and services
Milne, A., Hatzidimitriadou, E. and Chryssanthopoulou, C. 2004. Carers of older relatives in long term care: support needs and services. Generations Review. 14 (3), pp. 4-9.
Carers of older relatives in long term care: support needs and services
Milne, A., Hatzidimitriadou, E. and Chryssanthopoulou, C. 2004. Carers of older relatives in long term care: support needs and services. Generations Review.
Planning ahead: meeting the needs of older people with intellectual disabilities in the United Kingdom
Hatzidimitriadou, E. and Milne, A. 2005. Planning ahead: meeting the needs of older people with intellectual disabilities in the United Kingdom. Dementia: The International Journal for Social Research and Practice. 4 (3), pp. 341-359. https://doi.org/10.1177/1471301205055027
GP attitudes to early diagnosis of dementia: evidence of improvement
Hatzidimitriadou, E., Milne, A. and Hamilton-West, K. 2005. GP attitudes to early diagnosis of dementia: evidence of improvement. Aging & Mental Health. 9 (5), pp. 449-455. https://doi.org/10.1080/13607860500142762
Providing care for older people with learning disabilities
Hatzidimitriadou, E. and Milne, A. 2006. Providing care for older people with learning disabilities. in: Carnaby, S. (ed.) Intimate and Personal Care for People with Learning Disabilties London Jessica Kingsley. pp. 160-180
Learning in the real world? Exploring widening participation student views concerning the 'fit' between knowledge learnt and work practices
Forrester-Jones, R. and Hatzidimitriadou, E. 2007. Learning in the real world? Exploring widening participation student views concerning the 'fit' between knowledge learnt and work practices. Assessment & Evaluation in Higher Education. 31 (6), pp. 611-624. https://doi.org/10.1080/02602930600760181
Migrant women and welfare issues: diversity of experiences, challenges and opportunities
Hatzidimitriadou, E. 2007. Migrant women and welfare issues: diversity of experiences, challenges and opportunities. International Journal of Migration, Health and Social Care. 3 (3), pp. 2-5. https://doi.org/10.1108/17479894200700014
Community activism and empowerment of Turkish-speaking migrant women in London
Hatzidimitriadou, E. and Cakir, S. 2009. Community activism and empowerment of Turkish-speaking migrant women in London. International Journal of Migration, Health and Social Care. 5 (1), pp. 34-46. https://doi.org/10.1108/17479894200900005
Migration and ageing: settlement experiences and emerging care needs of older refugees in developed countries
Hatzidimitriadou, E. 2010. Migration and ageing: settlement experiences and emerging care needs of older refugees in developed countries. Hellenic Journal of Psychology. 7 (1), pp. 1-20.
Intimate partner violence in Europe: design and methods of a multinational study
Costa, D., Soares, J., Lindert, J., Hatzidimitriadou, E., Karlsson, A., Sundin, O., Toth, O., Ioannidi-Kapolou, E., Degomme, O., Cervilla, J. and Barros, H. 2013. Intimate partner violence in Europe: design and methods of a multinational study. Gaceta Sanitaria. 27 (6), pp. 558-561. https://doi.org/10.1016/j.gaceta.2013.03.001
From the asylum to the community: a longitudinal study of staff involved in the transition from Tone Vale Hospital to community-based services
Carpenter, J., Ring, C., Sangster, A., Cambridge, P. and Hatzidimitriadou, E. 2000. From the asylum to the community: a longitudinal study of staff involved in the transition from Tone Vale Hospital to community-based services. Journal of Mental Health. 9 (2), pp. 211-230. https://doi.org/10.1080/09638230050009203
Early diagnosis of dementia by GPs: an exploratory study of attitudes
Milne, A., Woolford, H., Mason, J. and Hatzidimitriadou, E. 2000. Early diagnosis of dementia by GPs: an exploratory study of attitudes. Aging & Mental Health. 4 (4), pp. 292-300. https://doi.org/10.1080/713649958
Caring in later life: reviewing the role of older carers
Milne, A., Hatzidimitriadou, E., Chryssanthopoulou, C. and Owen, T. 2001. Caring in later life: reviewing the role of older carers. London Help the Aged.
Political ideology, helping mechanisms and empowerment of mental health self-help/mutual aid groups
Hatzidimitriadou, E. 2002. Political ideology, helping mechanisms and empowerment of mental health self-help/mutual aid groups. Journal of Community & Applied Social Psychology. 12 (4), pp. 271-285. https://doi.org/10.1002/casp.681
The caring in later life report: a secondary analysis of the 1995 General Household Survey
Milne, A. and Hatzidimitriadou, E. 2002. The caring in later life report: a secondary analysis of the 1995 General Household Survey. Quality in Ageing and Older Adults. 3 (3), pp. 3-15. https://doi.org/10.1108/14717794200200017
Gaining access to and working with self-help groups in mental health
Hatzidimitriadou, E. 2003. Gaining access to and working with self-help groups in mental health. in: Cochrane, S. (ed.) Where You Stand Affects Your Point of View: Emancipatory Approaches to Mental Health Research: Notes from SPN Study Day 12 June 2003 UK Social Perspectives Network.
Intimate partner violence and health-related quality of life in European men and women: findings from the DOVE study
Costa, D., Hatzidimitriadou, E., Ioannidi-Kapolou, E., Lindert, J., Soares, J., Sundin, O., Toth, O. and Barros, H. 2015. Intimate partner violence and health-related quality of life in European men and women: findings from the DOVE study. Quality of Life Research. 24 (2), pp. 463-471.
Physical intimate partner violence in Europe: results from a population-based multi-center study in six countries
Costa, D., Hatzidimitriadou, E., Ioannidi-Kapolou, E., Lindert, J., Soares, J., Sundin, O., Toth, O. and Barros, H. 2015. Physical intimate partner violence in Europe: results from a population-based multi-center study in six countries. International Journal of Epidemiology. 44 (S1), p. 264. https://doi.org/10.1093/ije/dyv096.500
A laboratory and field comparison of gross efficiency at an absolute, relative and performance intensity
Saunders, S., Brown, M. and Coleman, D. 2014. A laboratory and field comparison of gross efficiency at an absolute, relative and performance intensity.
The relationship between cycle tourism and sustainable transport in the UK
Weed, M., Bull, C., Brown, M., Dowse, S., Lovell, J., Mansfield, L. and Wellard, I. 2014. The relationship between cycle tourism and sustainable transport in the UK. Tourism Review International. https://doi.org/10.3727/154427214X13990420684644
"Tangled wires in the head": older migrant Chinese's perception of mental illness in Britain
Li, S., Hatzidimitriadou, E. and Psoinos, M. 2014. "Tangled wires in the head": older migrant Chinese's perception of mental illness in Britain. Journal of Aging Studies. 30 (1), pp. 73-86. https://doi.org/10.1016/j.jaging.2014.04.001
Cultural health capital and professional experiences of overseas doctors and nurses in the UK
Hatzidimitriadou, E. and Psoinos, M. 2014. Cultural health capital and professional experiences of overseas doctors and nurses in the UK. Diversity and Equality in Health and Care. 11 (1), pp. 35-47.
The effect of short-term calorie restriction on exercise performance and efficiency in cyclists
Saunders, S., Coleman, D. and Brown, M. 2013. The effect of short-term calorie restriction on exercise performance and efficiency in cyclists.
Evaluation of co-production processes in a community-based mental health project in Wandsworth
Hatzidimitriadou, E., Mantovani, N. and Keating, F. 2012. Evaluation of co-production processes in a community-based mental health project in Wandsworth. Kingston upon Thames Kingston University and St George's, University of London.
Ageing in the English countryside: is it good for your health?
Milne, A., Hatzidimitriadou, E. and Wiseman, J. 2004. Ageing in the English countryside: is it good for your health?
Activation and contribution of trunk and leg musculature to force production during on-water sprint kayak performance
Brown, M., Lauder, M. and Dyson, R. 2010. Activation and contribution of trunk and leg musculature to force production during on-water sprint kayak performance.
Health and quality of life among older people in rural England: exploring the impact and efficacy of policy
Milne, A., Hatzidimitriadou, E. and Wiseman, J. 2007. Health and quality of life among older people in rural England: exploring the impact and efficacy of policy. Journal of Social Policy. 36 (3), pp. 477-495. https://doi.org/10.1017/S0047279407001055