Pediatric Lower Limb Rehabilitation Training System with Soft Exosuit and Quantitative Partial Body Weight Support

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Lines 27-29: That phrase is ambiguous, please refine it to provide clear information. (especially important since it is in the abstract)
75-76: Maybe some verb is missing here, the phrase doesn't make sense.
81-83: please refine the writing
128-129: what are the transducers' types? All 7 are the same, if yes what are they measuring?
Fig.2: Only 3 transducers were identified, where are the other 4?
143...160, Fig.3: What is the scientific rationale behind selecting the exosuit's particular shape - in terms of pneumatic actuation? (there are many ways to build this suit type; why like this?)
How were the internal volumes defined (inflated/deflated) and what is  the pressure limit supported by the textile chamber?
How was the overall size of the suit determined, and what age (or weight) group will it cover?
164: What is the "angle rotary guide"? It looks like a commercial stepper-based positioning unit; if yes, please add the model and manufacturer.
169: How was the 100kPa pressure limit selected?
171: "angle rotary" is missing "guide"
178: "the pneumatic model of the exosuit" should be presented in the paper
191: form Eqs.(1)...(3) a minimum and maximum w and r should result, to comply with the desired torque limits. These values are not presented.
197-201: Theoretical predictions (Fig. 6) cannot be trusted, since w and r are not defined as values.
When publishing, please consider the ability of other researchers to duplicate the work in order to validate principles, models and results.
Fig.7 is showing a sequence of inflate-hold-deflate-hole responses, but the response time (eg. the time it takes to inflate or deflate from 0 kPa to xx kPa) cannot be observed.
226-242: Fig. 8 is not referenced in text.
247: Table 1 is superfluous, the data already exists in the text body
253: says "age between 2 and 15 years", while Table 2 shows 2-5 years. Please correct the text.
270: The text refers to a standardized baseline and calibration protocol. It should also be stated the number/identification of the standard used.
References:
3, 34, 35: Please use the correct names for the authors (not just initials)
22, 25, 28, 33: The authors are missing

Comments on the Quality of English Language

A professional English editing service is highly recommended, some paragraphs are quite difficult to understand (missing verbs etc.).

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

 

This article innovatively develops a quantitative partial body weight support (PBWS) training system integrated with a soft pneumatic exosuit. Targeting crouch gait in children with cerebral palsy (CP), it assists knee extension during the stance phase of the gait cycle via a "torque-on-demand" model and quantifies the children’s reliance on external support. Preliminary tests show significant improvements in knee extension angle and range of motion, as well as increased lower limb weight-bearing ratio, providing a personalized and quantifiable solution for pediatric rehabilitation.

 

Technical Questions

 

1. The current system only assists the knee joint and does not involve the ankle or hip joints. How to optimize the structure to coordinate multi-joint movement and address concurrent issues such as equinus gait and hip internal rotation?

2. The existing control strategy triggers inflation and deflation based on fixed thresholds. Can an adaptive algorithm be developed to dynamically adjust the assistive torque according to the child’s real-time gait changes?

3. The trial only included 5 children with GMFCS Level II-III. How to verify the adaptability and safety of the system for children with GMFCS Level I (mild) and Level IV (severe) impairments?

4. The soft exosuit uses textile materials, whose fatigue resistance and airtightness may decrease after long-term use. How to optimize material selection or structural design to enhance durability?

5. The system does not consider shear force data during gait. How to add a shear force monitoring module to more comprehensively evaluate lower limb force distribution and gait stability in children?

6. The existing system is relatively large and only suitable for fixed scenarios. How to achieve miniaturization and portability to meet the needs of home-based rehabilitation training for children?

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The paper presents an important issue in the field of pediatric rehabilitation by combining a partial body weight support system with a pneumatic exosuit.

However, I have a few comments about the paper.

• I believe that testing on a small number of participants reduces the relevance of the obtained results. Since expanding the sample size in a short period of time is difficult, I recommend that the authors include a sentence in the paper explaining the extent to which the observed results are due to the proposed system and not other factors. They should also explain how they believe the results could be extrapolated to a larger population. It would also be useful to compare the test group with a similar group that received conventional therapy to highlight the value of the proposed system, despite the small sample size.
• the statements regarding improved motor function are not supported by statistical tests. To validate the pre- and post-intervention results, I recommend that the authors apply statistical tests or integrate international validation tools, such as the Gross Motor Function Measure (GMFM), the Pediatric Evaluation of Disability Inventory (PEDI), or the SCALE, which quantify patient progress and allow for comparison with other studies in the field.

- the paper mentions the control architecture of the exosuit, but the authors do not provide sufficient data on the system's real-time behavior. At least one sentence could be added regarding real-time performance, control errors, signal stability, etc.

- the bibliography includes titles that are more than five or even ten years old. I suggest that the authors include sources published within the last three years that address similar topics.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

All comments were addressed.