Robotic Knee Orthosis-assisted Walking in CP

A Pilot Study to Examine the Effect of a Powered Knee Orthosis on Crouch Gait in Cerebral Palsy

Robotic exoskeletons are becoming increasingly accepted to provide upright mobility in individuals with neurological disorders. These devices can assist in overcoming gravitational forces and reduce energy consumption. Agilik is one such device intended for individuals with neurological disorders. However, Agilik is relatively new, and its efficacy in individuals with CP is unknown. Therefore, this study aims to assess the effectiveness of Agilik as an assistive device for individuals with CP and crouch gait. In this pilot study, ten individuals with CP, GMFCS levels I and II, and crouch gait will walk with Agilik under the supervision of a physical therapist. Assessments of walking with shoes or AFO and Agilik will evaluate the efficacy of the device. The pilot study will assess if Agilik decreases crouch and improves gait characteristics in individuals with CP.

Robotic knee orthosis (RKO) can assist with voluntary knee extension and potentially reduce crouch/flexed-knee gait, but the effectiveness of this technology in individuals with CP is unknown. This study aims to assess the efficacy of Agilik as an assistive device for individuals with CP. Ten individuals with CP, ages 8 to 65 years, and at GMFCS levels I and II, will be recruited for this pilot study. Each individual will participate in a maximum of four sessions/ visits. The first three sessions will include RKO device fitting and tuning, followed by RKO-assisted walking practice to help with device acclimation. These sessions will last up to 60 minutes. A two-minute walk test (2MWT) will also be conducted at the first visit, which will serve as a reference to assess any shift in endurance from device-tuning/ practice. The final visit will include 2MWT and 3D motion capture in shod (shoes or shoes+AFO) and RKO-assisted (shoes+RKO or shoes+AFO+RKO) conditions, and may take up to 3 to 4 hours.

Inclusion Criteria:

• Diagnosed with cerebral palsy at GMFCS levels I and II
• Exhibits crouch gait
• Between 8 to 65 years of age
• Hip flexion contracture less than 10 degrees
• Knee flexion contracture less than 20 degrees when measured in prone with hips extended
• Thigh-foot angle is between 15 degrees (internal) to 30 degrees (external) in prone
• Can walk a minimum distance of 10 meters without stopping

Exclusion Criteria:

• No other neurological, musculoskeletal, or cardiorespiratory health conditions or injuries
• The presence of any cognitive impairment that could limit the ability to understand, follow simple directions, and inform when in pain
• Inability to participate in the study because of recent orthopedic surgery (within twelve months)