The improvements achieved in therapy with the Innowalk Pro were greater than for treadmill intervention. Both the 10-meter walk test, the 6-minutes walk test, the fun and effort factors suggest that the Innowalk Pro outshines treadmill training.
Malte Stahl, a physiotherapist from Hamburg, has just completed his Master thesis from the University in Krems (Austria). Since 2012 he has worked at a school for students with motor development disorders in Hamburg. Previously, he worked in a clinic with children, adolescents and adults with a wide range of diagnosis. It was here he first came across robotic devices in rehabilitation and saw the advantages of repetitive movements.
We asked Malte Stahl to share his experience with the Innowalk Pro and the findings of his pilot study (Master thesis).
What was the reason for conducting a pilot study on the Innowalk Pro for your master thesis?
First time I saw the Innowalk Pro I was fascinated about the movement possibilities in a motion therapy device taking up so little space of a room! This is a nice advantage and makes it possible to perform this type of therapy in a school setting. Another reason for choosing to focus on the Innowalk Pro was the possibility of mobilising the hip area of children with CP.
What was the aim of the pilot study?
The aim was to gain the acceptance and the feasibility of a subsequent clinical trial, determining the effectiveness of the motion therapy device Innowalk Pro in children with CP (GMFCS level II & III), compared to a body-weight-supported treadmill training with special reference to mobility.
What method did you choose and what were the reasons?
I chose a randomized cross-over-design study and included 6 children with CP, GMFCS level II and III, aged 12-15 years. The participants completed a four-week intervention period with the Innowalk Pro and a four-week intervention period with treadmill training. Each intervention period contained a total of twelve training sessions.
The subjects were randomized and received a two-week wash-out period between the treatment blocks. Primary outcome was “walking speed”, and following test was used to measure outcomes:
- 10-meter walk test
- 6-minute walk test
- Timed up-and-go test
The measurements were conducted before and after each treatment block (4 weeks).
Secondary outcome was “total steps in everyday life” and was measured with a stepping sensory test.
During each training session the following elements were registered:
- Fun effort factors
- Eventualities and difficulties
The parents of the children participating in the pilot received a questionnaire after each four-week intervention period. In addition, the children conducted a questionnaire at the end of the study period.
I chose a cross-over design because I find this method fair for the children participating, as everyone gets the opportunity to do both training methods, in this case Innowalk Pro and treadmill training.
In addition, the study design requires fewer subjects because each subject is his own control group. This was an important consideration, as the study was to be conducted in a school setting with few subjects available and few resources.
What was the theoretic background for choice of method and patient group?
Cerebral palsy (CP) is the most common motor disorder in children, in many cases leading to compensatory movement patterns. The main reason for the loss of mobility is identified to be muscle weakness. Robotic gait therapy and motion therapy devices offer an opportunity to conduct repetitive task-oriented therapy while walking. The proof of effectiveness of this therapy is still very vague and more studies is needed.
What was the results from the study?
Apart from the stepping sensory test, the choice of interventions, implementation of the interventions and tests seem to be suitable and practical to conduct in an everyday school life.
Apart from the treadmill 10-meter test, improvements were achieved on average in all three tests. Comparison of the Innowalk Pro to treadmill intervention:
- Timed up-and-go test: 12.9 % to 5.8 %
- 10-meter walk test: 7 % to - 1 %.
- 6-minute walk test: 16 % to 9 %.
The survey of the children showed a higher fun factor (4.6 to 4.2) and lower effort factor (12.2 to 13.8) in favour of the Innowalk Pro.
So, the results from the pilot showed that with less effort and more fun, a higher benefit can be achieved with the Innowalk Pro compared to a body-weight-supported treadmill training. Nevertheless, to confirm and generalise these findings, there is a need for a larger clinical study.
What clinical implication do you think your findings might have for you as a clinician?
Through my pilot study I found that it is feasible to conduct research in an everyday school life setting. Recruitment of participants is possible, because it demands no extra effort from the family.
Interventions using robotics seem to be fun for the children and can be a supplement to standard therapy. The correction of the gait pattern in the Innowalk Pro device, especially for children with crouch gait, seems to make sense to achieve muscle strength.
In general, I believe, we should evaluate each child and adapted an appropriate treatment program that fits that child and the family’s goals and needs.