Study Aims to Compare the Effect of Robotic-assisted Gait Training and Conventional Treadmill Training on Postural Stability in Ambulatory Children With Cerebral Palsy.

The aim of this study is to explore the impact of gait training with a robotic device versus treadmill training on enhancing postural stability and walking capabilities in children with cerebral palsy (CP). The main questions to answer are children with CP who receive Robotic gait training will improve more in their postural stability compared with children with CP who received gait training on Treadmill? Are children with CP who receive Robotic gait training will improve more in their gross motor functions compared with children with CP who received gait training on Treadmill Are children with CP who receive Robotic gait training will improve more in their walking distance compared with children with CP who received gait training on Treadmill? Researchers will compare Group A to Group B to see if Robotic gait training has more effect on their outcomes than treadmill. Participants will be randomly allocated to one of two group and will receive gait training for 3 times per week for eight weeks. Outcome measures will be assessed in the base line before starting intervention and after completing intervention. Study Design A randomized control trial (RCT) Participants and Recruitment The trial will be conducted in Pediatric Out-Patient Rehabilitation Services (Clinic 750) at king Abdullah Specialized Children Hospital (KASCH), National Guard Hospital (NGH) in Riyadh, Saudi Arabia. The study populations are ambulatory children who have been diagnosed to have Spastic CP and who are referred and treated in rehabilitation department at KASCH in NGH in Riyadh. Recruitment will be through their medical record number. Inclusion Criteria are Spastic CP diagnosed from a pediatrician's (Neurology clinic) to have Diplegia, Hemiplegia, or Quadriparesis, Both gender with their age ranged from 5-14 years, independently able to stand and walk or walk with assistance, GMFCS Level I and II, with walking limitations, but able to ambulate without the gait device for most distances and with GMFCS Level III, who have a greater degree of walking limitation and able to use wheelchairs or walkers for short to long distances, Ability to follow instructions, Ability to accurately signal pain and discomfort using verbal or non-verbal signals, Ability to be participated in \> 45 minutes of active Physical Therapy treatment, Hip's and knee's passive range of motion (ROM) within the minimum range requirement for robotic device (≤10° for hip and knee flexion contracture). Exclusion Criteria are Botox injection in lower limb during the last 6 months, Surgical intervention in lower limb within a 1-year period prior to the examination date (including tendon release, muscle lengthening and bone surgery), Active drug for resisting epilepsy, Anatomical leg length differences larger than 2 cm (due to the limitations of robotic device), Bone-articular instability (joint dislocation), Fixed joint contractures; bone and joint deformities of lower extremities, Baclofen therapy by using an implanted infusion pump, Inhibiting casts for lower limb during 6 months prior to the program, Significant visual and hearing loss, Skin inflammation and open skin lesions around the lower limb or trunk, Any significant impairments in endurance due to limitation in cardiovascular system based on the patient's history, Cognition (higher mental functions) disorders resulted in lack of patient cooperation, Lack of consent from the parent or guardian. Procedure We will send the invitation letter to the parents of participants. If interested, we will provide their parents with the informed consent (written). We will obtain the Assent from children who are unable to provide independent consent. Then, the participants will complete a basic screening session. If the participant met the eligibility criteria of the screening, he/ she will have a robotic device fitting assessment session to confirm there are no concerns with the participation in the study and to use the robotic device. If the participant met these the fitting criteria, the therapist would review the findings and will confirm (with the family) whether the child is eligible for the study based on their findings. The participants will be divided randomly to enter on of the two treatment groups (robotic or treadmill). Each participant will have a baseline assessment during the first two weeks prior to the beginning of the treatment, treatment program for eight weeks, and post treatment assessment at the last two weeks after completing the program. The duration of the whole program is twelve weeks. All participants will be assessed for their balance and walking parameters.