Search Results (245)

The Gross Motor Function Measure-66 (GMFM-66, range of values: 0 to 100 points) is one of the most widely used clinical tests to quantify motor function in children with cerebral palsy (CP). A disadvantage of the GMFM-66 is that it can take up to one hour to complete. The aim of the study was to evaluate whether the GMFM-66 can be predicted with sufficient accuracy by the results of an instrumental gait analysis (IGA) in ambulant children with CP. A retrospective analysis was conducted on n = 256 ambulant children with CP enrolled in a rehabilitation program between 2018 and 2023. The sample consisted of 97 females and 159 males, with a mean age of 9.0 years (SD 3.6 years). The IGA was performed with a Zebris FDM pressure plate. For the prediction of the GMFM-66, different statistical models were used (multiple linear regression and machine learning algorithms). Among the models considered, the XGBoost model had the best predictive performance (mean absolute error 6.32 (95%CI 5.35–7.28)). Agreement between results from gait analyses by the Zebris FDM pressure plate and GMFM-66 is not yet sufficient to predict the GMFM-66 score with acceptable accuracy for clinical purposes. Full article

Background and Objectives: Dual-task training (DTT) is an innovative therapeutic approach that involves the simultaneous application of two tasks, which can be motor, cognitive, or a combination of both. Children with cerebral palsy (CP) often exhibit impairments in balance, motor skills, and gait, conditions that may be amenable to improvement through DTT. The aim of this study was to determine the effectiveness of DTT in enhancing balance, walking speed, and gross motor function-related balance in children with CP. Materials and Methods: In accordance with PRISMA guidelines, a comprehensive systematic review with meta-analysis (SRMA) was conducted. Electronic databases like PubMed Medline, Scopus, Web of Science, CINAHL, and PEDro were searched up to March 2025, with no language or publication date restrictions. Only randomized controlled trials (RCTs) examining the effectiveness of DTT on balance, gross motor function, and walking speed in children with CP were included. The methodological quality and risk of bias of the included RCTs were assessed using the PEDro scale. Pooled effects were calculated using Cohen’s standardized mean difference (SMD) and its 95% confidence interval (95% CI) within random-effects models. Results: Eight RCTs, providing data from 216 children, were included. Meta-analyses suggested that DTT was more effective than conventional therapies for increasing functional (SMD = 0.65; 95% CI 0.18 to 1.13), dynamic (SMD = 0.61; 95% CI 0.15 to 1.1), and static balance (SMD = 0.46; 95% CI 0.02 to 0.9), as well as standing (SMD = 0.75; 95% CI 0.31 to 1.18; p = 0.001) and locomotion dimensions (SMD = 0.65; 95% CI 0.22 to 1.08) of the Gross Motor Function Measure (GMFM) and walking speed (SMD = 0.46; 95% CI 0.06 to 0.87). Subgroup analyses revealed that a motor–cognitive dual task is better than a motor single task for functional, dynamic, and static balance and standing and locomotion dimensions for the GMFM. Conclusions: This SRMA, including the major number of RCTs to date, suggests that DTT is effective in increasing balance, walking and gross motor function-related balance in children with CP. Full article

Rehabilitation devices such as actuated lower-limb exoskeletons can provide essential mobility assistance for pediatric patients with gait impairments. Enhancing their control systems under conditions of user variability and dynamic disturbances remains a significant challenge, particularly in active-assist modes. This study presents a human-in-the-loop control architecture for a pediatric lower-limb exoskeleton, combining outer-loop admittance control with robust inner-loop trajectory tracking via a non-singular terminal sliding-mode (NSTSM) controller. Designed for active-assist gait rehabilitation in children aged 8–12 years, the exoskeleton dynamically responds to user interaction forces while ensuring finite-time convergence under system uncertainties. To enhance adaptability, we augment the inner-loop control with a twin delayed deep deterministic policy gradient (TD3) reinforcement learning framework. The actor–critic RL agent tunes NSTSM gains in real-time, enabling personalized model-free adaptation to subject-specific gait dynamics and external disturbances. The numerical simulations show improved trajectory tracking, with RMSE reductions of 27.82% (hip) and 5.43% (knee), and IAE improvements of 40.85% and 10.20%, respectively, over the baseline NSTSM controller. The proposed approach also reduced the peak interaction torques across all the joints, suggesting more compliant and comfortable assistance for users. While minor degradation is observed at the ankle joint, the TD3-NSTSM controller demonstrates improved responsiveness and stability, particularly in high-load joints. This research contributes to advancing pediatric gait rehabilitation using RL-enhanced control, offering improved mobility support and adaptive rehabilitation outcomes. Full article

Background: Aquatic therapy (AT), immersion in hot water, and supported standing are frequently used to manage spasticity, contractures, and joint retractions in children with cerebral palsy (CP). Recently, the use of exoskeletons has been offering a new treatment option for severe CP. This study aimed to compare the post-immediate effects of four treatments on spasticity, range of motion, and the heart rate of children with severe CP. Methods: Three children with spastic CP (levels IV and V GMFCS) received a single 30-min session in consecutive weeks of robot-assisted gait training (RAGT), AT, supported standing, and immersion in hot water. Post-immediate assessments included knee flexor spasticity (modified Ashworth scale, MAS, and modified Tardieu scale, MTS); knee range of motion (ROM, in degrees (°)); and heart rate (HR). Results: AT and supported standing induced greater reductions in spasticity based on MAS scores. RAGT demonstrated superior spasticity reduction using MTS and yielded the greatest improvement in popliteal angle (mean increase: 27°). AT and RAGT induced a 14 beats-per-minute change in HR, indicating moderate cardiovascular engagement. Conclusions: RAGT appears particularly effective in improving spasticity and ROM in children with severe CP. Nonetheless, conventional treatments still offer an effective option when addressing spasticity. Full article

Weakness, spasticity, and muscle shortening are common in children with cerebral palsy (CP), leading to deficits in gross motor, gait, and selective motor functions. While traditional assessments, such as the Gross Motor Function Measure (GMFM-66), instrumented gait analysis, and the Selective Control Assessment of the Lower Extremity (SCALE), are widely used, they are often limited by the resource-intensive nature of hospital-based evaluations. We employed cyclogram-based analysis, utilizing simple hip and knee joint kinematics to assess clinical measures, including GMFM-66, normalized gait speed, the gait deviation index (GDI), and the gait profile score (GPS). Principal component analysis was used to quantify the cyclogram shape characteristics. A total of 144 children with ambulatory spastic CP were included in the study. All the cyclogram parameters were significantly correlated with GMFM-66, gait speed, the GDI, and the sagittal plane subscore of the GPS for the hip and knee, with the swing phase area showing the strongest correlation. Regression models based on the swing phase area were used to estimate the GMFM-66 (R² = 0.301) and gait speed (R² = 0.484). The PC1/PC2 ratio showed a moderate correlation with selective motor control, as measured by the SCALE (R² = 0.320). These findings highlight the potential of hip–knee cyclogram parameters to be used as accessible digital biomarkers for evaluating motor control and gait function in children with bilateral spastic CP. Further prospective studies using wearable sensors, such as inertial measurement units, are warranted to validate and build upon these results. Full article

Background: Marker-based motion capture is the current gold standard for three-dimensional (3D) gait analysis. This is a highly technical analysis that is time-consuming, and marker application can trigger anxiety in children. One potential solution is to use markerless camera systems instead. The objective of this study was to compare 3D lower limb gait kinematics in children using both marker-based and markerless motion capture methods. Methods: Ten typically developing children (age 6–13 yrs) completed five barefoot walks at a self-selected speed. A 10-camera marker-based system (Oqus, Qualisys) and a 7-camera markerless system (Miqus, Qualisys) captured synchronised gait data at 85 Hz. Generalised Additive Mixed Models were fitted to the data to identify the random effects of measurement systems, age, and time across the gait cycle. The root-mean-square difference (RMSD) was used to compare the differences between systems. Results: Significant interactions and differences were observed between the marker-based and markerless systems for most joint angles and planes of motion, particularly with regard to time and age. Conclusions: Despite differences across all kinematic profiles, the RMSD in this study was comparable to previously published results. Alternative model definitions and kinematic crosstalk in both systems likely explain the differences. Age differences were not consistent across joint levels, suggesting a larger sample size is required to determine how maturation may affect markerless tracking. Further investigation is required to understand the deviations and differences between systems before implementing markerless technology in a clinical setting. Full article

The use of gait analysis to differentiate among paediatric populations with neurological and developmental conditions such as idiopathic toe walking (ITW), cerebral palsy (CP), and hereditary spastic paraplegia (HSP) remains challenging due to the insufficient precision of current diagnostic approaches, leading in some cases to misdiagnosis. Existing methods often isolate the analysis of gait variables, overlooking the whole complexity of biomechanical patterns and variations in motor control strategies. While previous studies have explored the use of statistical physics principles for the analysis of impaired gait patterns, gaps remain in integrating both kinematic and kinetic information or benchmarking these approaches against Deep Learning models. This study evaluates the robustness of statistical physics metrics in differentiating between normal and abnormal gait patterns and quantifies how the data source affects model performance. The analysis was conducted using gait data sets from two research institutions in Madrid and Dublin, with a total of 81 children with ITW, 300 with CP, 20 with HSP, and 127 typically developing children as controls. From each kinematic and kinetic time series, Shannon’s entropy, permutation entropy, weighted permutation entropy, and time irreversibility metrics were derived and used with Random Forest models. The classification accuracy of these features was compared to a ResNet Deep Learning model. Further analyses explored the effects of inter-laboratory comparisons and the spatiotemporal resolution of time series on classification performance and evaluated the impact of age and walking speed with linear mixed models. The results revealed that statistical physics metrics were able to differentiate among impaired gait patterns, achieving classification scores comparable to ResNet. The effects of walking speed and age on gait predictability and temporal organisation were observed as disease-specific patterns. However, performance differences across laboratories limit the generalisation of the trained models. These findings highlight the value of statistical physics metrics in the classification of children with different toe walking conditions and point towards the need of multimetric integration to improve diagnostic accuracy and gain a more comprehensive understanding of gait disorders. Full article

School-aged children are routinely exposed to additional physical stress due to carrying school backpacks. These backpacks often exceed recommended limits and can contain not only books and notebooks but also laptops, water bottles, and other personal items. The present study aimed to evaluate the impact of different backpack loads (10%, 15%, and 20% of body weight) on dynamic gait parameters in 7-year-old girls and boys. Twenty-six children (13 girls, 13 boys) participated in the study. Gait analysis was performed using the Footscan® system (RSscan International, Olen, Belgium; 2 m × 0.4 m × 0.02 m, 16,384 sensors) equipped with Footscan software version 7 (Gait 2nd generation), examining peak force (FMAX), peak pressure (PMAX), contact area (CA), and time to peak force (Time to FMAX) across five anatomical foot zones. The study revealed significant changes in all parameters, particularly at loads of 15% and 20% of body weight. Increases in plantar pressure, contact area, and asymmetry were observed, along with delays in time to peak force. These findings support the recommendation that children’s backpack loads should not exceed 10% of their body weight to prevent potential adverse effects on postural and musculoskeletal development. Full article

Neuromuscular gait deficits in children with autism spectrum disorder (ASD) are often overlooked. High-intensity training protocols may improve running performance, but their efficacy in pediatric populations is underexplored. This study evaluates the impact of a high-intensity running protocol on locomotor performance in neurotypical and neurodivergent children (children with ASD). Spatiotemporal gait characteristics (speed, stride frequency, stride length, and duty factor), gait symmetry (symmetry ratio), and kinematics were assessed for ten neurodivergent children (10–15 years old) during a 15 m sprint. Locomotor costs (cost of locomotion, transport, and locomotion per stride) were analyzed in six neurodivergent participants (11–14 years old) via open-flow respirometry during treadmill running. Participants completed a 5–12 week, twice-weekly program; neurotypical participants served as a control group. Neurodivergent and neurotypical children exhibited baseline differences in spatiotemporal variables. Following training, neurodivergent participants demonstrated statistically significant improvements in spatiotemporal metrics and locomotor costs. Differences in symmetry between the two groups were not present pre- or post-program. These findings highlight the efficacy of high-intensity running programs in improving sensorimotor function and coordination in children with ASD. This program provides valuable insights into gross motor rehabilitation for neurodivergent children, supporting its potential as an effective intervention. Full article

Background and Objectives: Children with cerebral palsy (CP) improve walking abilities through partial body weight-supported treadmill training (PBWSTT) and loaded treadmill training (LTT), but there is no consensus on the most effective method. This study aimed to evaluate the effects of PBWSTT and LTT on spatiotemporal gait parameters in children with CP. Materials and Methods: A randomized clinical trial involved 25 children aged 12+ with spastic diplegic CP from various outpatient clinics in Taif and Makkah between January 2024 and January 2025. Participants were randomly assigned to PBWSTT (30% body weight support, n = 12) or LTT (60% lower limb weight loading, n = 13) with 45 min sessions three times per week for eight weeks, including conventional therapy. Results: The spatiotemporal gait parameters (such as gait speed, cadence, stride length, swing phase, and swing width) significantly improved within the PBWSTT and LTT groups, but no significant difference was found between the groups. The gross motor function measure, dimension E (for walking, running, and jumping), showed significantly higher improvement in the PBWSTT group compared to the LTT group (p = 0.047). Conclusions: This study indicates that PBWSTT and LTT can improve gait parameters in children with CP, with PBWSTT promoting postural control and LTT improving mobility. These findings suggest that the proposed rehabilitation strategies can significantly improve the functional outcomes of pediatric cerebral palsy patients. Full article

Background: Music therapy and music-based interventions are increasingly recognized as valuable adjuncts in pediatric neurorehabilitation, leveraging rhythm, singing, instrument playing, and improvisation to support children with neurological disabilities. Objective/Method: This narrative review synthesizes evidence from studies published between 2000 and 2025, focusing on children aged 3 to 18 years receiving neurorehabilitation. Results: The literature demonstrates that music therapy and music-based interventions can improve motor function—particularly gait and upper limb coordination—as well as speech production, while also reducing anxiety and enhancing participation. Techniques such as rhythmic auditory stimulation and melodic intonation therapy have shown promise in targeting movement and communication deficits. Music therapy is further associated with positive effects on vital signs and emotional well-being, supporting its role in holistic care. Neurobiological findings suggest that music-based interventions may promote neuroplasticity and strengthen brain connectivity, though high-quality mechanistic studies remain limited. Conclusions: Despite methodological heterogeneity and small sample sizes in the current literature, the overall evidence supports music therapy and music-based interventions as accessible, cost-effective, and child-centered complements to standard neurorehabilitation. Future research should prioritize rigorous clinical trials and neurobiological investigations to clarify mechanisms and optimize therapeutic protocols. Full article

Background/Objectives: Children with diplegic spastic cerebral palsy (CP) often present with impaired postural control, poor balance, and gait abnormalities that negatively affect their functional mobility and independence. Core stability, which is the ability to control the position and movement of the trunk, is considered a critical component in maintaining postural alignment and improving gross motor function. This study aimed to investigate the impact of a structured core stability exercise program on the standing ability, functional balance, and gait parameters of children diagnosed with diplegic spastic CP. Methods: Forty children (28 males, 12 females) aged 4–10 years with a clinical diagnosis of diplegic spastic cerebral palsy were randomly allocated into two groups (n = 20 each). The study group underwent a 12-week core stability exercise program in addition to a standardized physiotherapy regimen, which was conducted three times per week. The control group received the physiotherapy program alone. Functional outcomes were assessed pre- and post-intervention using the Gross Motor Function Classification System (GMFCS), Pediatric Balance Scale, and Kinovea software for gait analysis. Results: Both groups demonstrated statistically significant improvements in all measured variables after the intervention. However, the study group showed significantly greater improvements in standing ability (9%), balance (9%), and gait parameters (p < 0.05), particularly in knee flexion, ankle dorsiflexion, and plantar flexion, during gait cycles. Conclusions: Core stability training resulted in superior enhancements in balance, standing, and gait performance compared with physiotherapy alone in children with diplegic spastic cerebral palsy. Full article

Objectives: Different types of exercises that aim in the development of balance, motor function, and gait are necessary for patients with motor disorders. Equine-assisted therapy could play an important role in the rehabilitation of these participants. Methods: The purpose of this study was to examine the effects that equine-assisted therapy can exert on balance, motor function, spasticity, posture and gait, as well as quality of life on individuals with motor disorders. Clinical trials, published up to 20 April 2022, comparing equine-assisted therapy with conventional rehabilitation were systematically searched. Two independent reviewers performed data extraction and assessed the quality of studies using the Downs and Black quality assessment tool. Results: Out of 27 studies that satisfied the inclusion criteria for systematic review, 15 included appropriate data for further comparative meta-analysis. Statistically significant differences were found in Dimension E (walking, running, jumping) of Gross Motor Function Measure in children with CP (0.009) and in Time Up and Go in Elderly and post-stroke participants (p = 0.006). Specifically, children with CP improved in walking, running, and jumping, as well as improved mobility in the elderly. The systematic review showed that the intervention had positive results, as well as in other domains, even though these were not statistically significant. Conclusions: Equine-assisted therapy is beneficial for individuals with impairments in balance, gross motor function, gait, spasticity, and coordination. Full article

Accurate estimation of gait characteristics, including step length, step velocity, and travel distance, is critical for assessing mobility in toddlers, children, and teens with Duchenne muscular dystrophy (DMD) and typically developing (TD) peers. This study introduces a novel method leveraging Fast Fourier Transform (FFT)-derived step frequency from a single waist-worn consumer-grade accelerometer to predict gait parameters efficiently. The proposed FFT-based step frequency detection approach, combined with regression-derived stride length estimation, enables precise measurement of temporospatial gait features across various walking and running speeds. Our model, developed from a diverse cohort of children aged 3–16, demonstrated high accuracy in step length estimation ($R^2=0.92$, $RMSE=0.06$ m) using only step frequency and height as inputs. Comparative analysis with ground-truth observations and AI-driven Walk4Me models validated the FFT-based method, showing strong agreement across step count, step frequency, step length, step velocity, and travel distance metrics. The results highlight the feasibility of using widely available mobile devices for gait assessment in real-world settings, offering a scalable solution for monitoring disease progression and mobility changes in individuals with DMD. Future work will focus on refining model performance and expanding applicability to additional movement disorders. Full article

This block-randomized crossover study investigated how a speed-modulated aquatic treadmill (AT) impacts the walking biomechanics of pediatric gait. Eight cerebral palsy (CP) and fifteen typically developing (TD) children walked at normal, slow, and fast treadmill speeds in AT and dry treadmill (DT) conditions. The joint angles of participants were calculated from inertial measurement units to derive sample entropy (SE) measures that quantified the regularity or complexity of motion. A hierarchical statistical model revealed that the CP group had lower SE values for the hip, knee, and ankle joints in the AT and at slower than faster treadmill speeds. Only the SE values of the knee and ankle joints were impacted for the TD group. The lower SE values suggest improved regularity for participants at slower speeds and in the AT environment. This study highlights the potential of AT to improve the walking biomechanics of children with CP in acute exposure, but further work is needed to investigate the AT condition as a gait rehabilitation environment. Full article