A novel sensorized shoe system to classify gait severity in children with cerebral palsy.

The clinical management of children with Cerebral Palsy (CP) relies upon periodic assessments of changes in the severity of gait deviations in response to clinical interventions. Current clinical practice is limited to sporadic assessments in a clinical environment and hence it is limited in its ability to estimate the impact of CP-related gait deviations in real-life conditions. Frequent home-based quantitative assessments of the severity of gait deviations would be extremely useful in scheduling clinical visits and gathering feedback about the effectiveness of intervention strategies. The use of a wearable system would allow clinicians to gather information about the severity of gait deviations in the home setting. In this paper, we present ActiveGait, a novel sensorized shoe-based system for monitoring gait deviations. The ActiveGait system was used to gather data, under supervised and unsupervised conditions, from a group of 11 children with various levels of CP-related gait deviation severities. We present a methodology to derive severity measures based on features extracted from Center of Pressure (CoP) trajectories. Results show that a Random Forest classifier is able to estimate severity scores based on the Edinburgh Visual Scale with a level of accuracy >80% adequate for clinical use.

Enhancing robotic gait training via augmented feedback.

Recent work has examined the feasibility of robotic-assisted gait training in pediatric patients, including children with cerebral palsy (CP). Herein we present a case series describing clinical outcomes in four children with CP who underwent gait training using a robotic driven gait orthosis (DGO) (Pediatric Lokomat©). Children had a diagnosis of spastic diplegia due to CP. They were paired based on functional abilities and observed gait characteristics. Two children had a GMFCS of III and showed excessive ankle plantarflexion during stance. The other two children had a GMFCS of II and displayed a crouch gait pattern. Each subject participated in a 6-week intervention of robotic-assisted gait training that involved three 30-minute sessions per week. Pre-and post-training evaluations were performed including clinical tests of standing and walking function, walking speed, and walking endurance. Clinical gait analysis was also performed using a motion capture system to assess changes in gait mechanics. All subjects showed an improvement in locomotor function. For lower functioning children, this may be mediated by improved trunk control. The use of augmented feedback was associated with larger. However, these results have to be considered with caution because of the limited sample size of the study.

Robotic gait training in an adult with cerebral palsy: a case report.

Improved treatments and rehabilitation for cerebral palsy (CP) have led to an increased number of children with CP surviving into adulthood. Adults with CP show an increased prevalence of pain, fatigue, and musculoskeletal dysfunction, leading to a decrease in ambulatory function. Recent work has demonstrated the potential benefits of intensive task-specific gait training, including the use of robotic-driven gait orthoses, on motor recovery in children with CP. In contrast, reports of interventions aimed at improving motor function in adults with CP are lacking. This case study reports on the outcomes of a 6-week intervention of robotic-assisted gait training administered to a 52-year-old woman with right hemiplegia attributable to CP. Improvements were noted in balance, walking speed, and time to negotiate stairs at posttraining and follow-up. Gait analysis showed an increase in step length and a reduction in the period of double support. In conclusion, robotic-assisted gait training may be beneficial in enhancing locomotor function in adults with CP.

Assessing the feasibility of classifying toe-walking severity in children with cerebral palsy using a sensorized shoe.

The clinical management of children with cerebral palsy (CP) relies on monitoring changes in the severity of gait abnormalities and on planning appropriate clinical interventions. Currently available technology does not make it possible to perform clinical gait evaluations as often as it would be desirable from a clinical standpoint. The use of wearable technology (e.g. a sensorized shoe) could provide an effective means to monitor changes in the severity of gait abnormalities in children with CP. In this paper, we studied a group of children with CP who showed an equinus (i.e. toe-walking) gait pattern, a gait abnormality often observed in children with CP. The aim of the study was to determine the feasibility of relying upon a sensorized shoe to assess changes in the severity of toe-walking. We demonstrated that it is possible to use features extracted from the center of pressure trajectory and ankle kinematics to predict the severity of toe-walking. Our results motivate the development and clinical testing of a sensorized shoe to assess changes in gait patterns that accompany the development, and the response to clinical interventions, of children with CP.