Serebral Palsi'de Robot Destekli Yürüme Eğitimi
Özet
Serebral Palsi (SP)’de görülen yürüyüş bozukluğu veya yürüyememe bireyin günlük yaşam aktivitelerini, sosyal etkileşimini, yaşam kalitesini ve hayata katılımını doğrudan etkileyen önemli bir fonksiyon kaybıdır. Bu nedenle SP yönetiminin tüm aşamalarında yürüme becerisinin korunması ve geliştirilmesi ana hedeflerdendir. Robot destekli yürüyüş eğitimi (RDYE) postüral kontrolü, dengeyi ve yürümeyi iyileştirmek amacıyla sıklıkla tercih edilen uygulamalardandır. RDYE aynı algoritmayla tekrarlayan, yoğun egzersizler ve hastanın aktif katılımını içeren motor öğrenme prensipleri aracılığıyla beyin nöroplastisitesini uyarır ve fonksiyonel durumda iyileşmeye yol açar. RDYE'nin SP’li bireylerin eklem hareket açıklığında, kas tonusunda, kas gücünde, dengede ve özellikle yürüyüş hızında iyileşmeler sağladığı gösterilmektedir. Alt ekstremite kinematiğinin iyileştirilmesine ek olarak üst vücudun kontrolünün uyumlandığı yeni dinamik yürüyüş stratejilerini desteklediği, SP’li çocukların ayakta durma ve yürüme becerilerinde iyileşme sağladığı, giyilebilir robotların hem statik hem dinamik dengeyi ve yürümeyi iyileştirdiği bildirilmektedir. Destekli olarak yüksek yürüyüş hızlarında verilen RDYE’nin, esnekliği artırabileceği, kaba motor fonksiyonda, yürüyüş kinematiğinde, metabolik maliyette azalma ve enduransta iyileşmeler sağlayabileceği gösterilmektedir. RDYE'nin konvansiyonel rehabilitasyon ile kombine kullanımı özellikle zorlu ergenlik dönemindeki SP'li çocukların postüral ve lokomotor fonksiyonların iyileştirilmesinde olumlu bir etki oluşturmaktadır. Diğer taraftan SP’li çocukların fonksiyonel seviyelerinin dikkate alındığı, kullanım sıklığı ve şiddeti ile ilgili fikir birliğiyle oluşturulmuş bir uygulama protokolünün geliştirilmesine ihtiyaç duyulduğu ortaya konmaktadır.
Referanslar
Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: The definition and classification of cerebral palsy April 2006. Dev Med Child Neurol. 2007;49(109):8–14.
Vitrikas K, Dalton H, Breish D. Cerebral palsy: an overview. Am Fam Physician. 2020;101(4):213–20.
Patel DR, Neelakantan M, Pandher K, Merrick J. Cerebral palsy in children: a clinical overview. Translational pediatrics, 9 (Suppl 1), S125–S135. 2020.
Monica S, Nayak A, Joshua AM, Mithra P, Amaravadi SK, Misri Z, et al. Relationship between Trunk Position Sense and Trunk Control in Children with Spastic Cerebral Palsy: A Cross‐Sectional Study. Rehabil Res Pract. 2021;2021(1):9758640.
Nashner LM, Shumway-Cook A, Marin O. Stance posture control in select groups of children with cerebral palsy: deficits in sensory organization and muscular coordination. Exp Brain Res. 1983;49(3):393–409.
Woollacott MH, Shumway-Cook A. Postural dysfunction during standing and walking in children with cerebral palsy: what are the underlying problems and what new therapies might improve balance? Neural Plast. 2005;12(2–3):211–9.
Sarajchi M, Al-Hares MK, Sirlantzis K. Wearable lower-limb exoskeleton for children with cerebral palsy: A systematic review of mechanical design, actuation type, control strategy, and clinical evaluation. IEEE Transactions on Neural Systems and Rehabilitation Engineering. 2021;29:2695–720.
Wren TAL, Rethlefsen S, Kay RM. Prevalence of specific gait abnormalities in children with cerebral palsy: influence of cerebral palsy subtype, age, and previous surgery. Journal of Pediatric Orthopaedics. 2005;25(1):79–83.
Jin L, Zhao C, Dou B, Dong J, He P. Influence of Robotic Interventions on Gait Improvement in Children with Cerebral Palsy. In: Cerebral Palsy - Epidemiology, Etiology, Clinical Presentation, Treatments, and Outcomes [Working Title]. IntechOpen; 2025.
Choi JY, Jin LH, Jeon MS, Kim MH, Yang S, Sohn MK. Training intensity of robot‐assisted gait training in children with cerebral palsy. Dev Med Child Neurol. 2024;66(8):1096–105.
Perry J. Normal Gait. Clin Orthop. 2011;1–17.
Waters RL, Mulroy S. The energy expenditure of normal and pathologic gait. Vol. 9, Gait and Posture. 1999. p. 207–31.
Schwartz M. Kinematics of Normal Gait. In: Treatment of Gait Problems in Cerebral Palsy. 2004. p. 99–119.
Bayón C, Raya R, Lara SL, Ramírez Ó, J IS, Rocon E. Robotic Therapies for Children with Cerebral Palsy: A Systematic Review. Transl Biomed [Internet]. 2016;7(1):1–10. Available from: http://www.transbiomedicine.com/translational-biomedicine/robotic-therapies-for-children-with-cerebral-palsy-a-systematic-review.php?aid=8788
Juenger H, Kuhnke N, Braun C, Ummenhofer F, Wilke M, Walther M, et al. Two types of exercise‐induced neuroplasticity in congenital hemiparesis: a transcranial magnetic stimulation, functional MRI, and magnetoencephalography study. Dev Med Child Neurol. 2013;55(10):941–51.
Gage JR. An essential tool in the treatment of cerebral palsy. Clin Orthop Relat Res. 1993;288:126–34.
Bonanno M, Militi A, La Fauci Belponer F, De Luca R, Leonetti D, Quartarone A, et al. Rehabilitation of Gait and Balance in Cerebral Palsy: A Scoping Review on the Use of Robotics with Biomechanical Implications. Vol. 12, Journal of Clinical Medicine. Multidisciplinary Digital Publishing Institute (MDPI); 2023.
Ma Y, Liang Y, Kang X, Shao M, Siemelink L, Zhang Y. Gait characteristics of children with spastic cerebral palsy during inclined treadmill walking under a virtual reality environment. Appl Bionics Biomech. 2019;2019(1):8049156.
Kim SK, Park D, Yoo B, Shim D, Choi JO, Choi TY, et al. Overground robot-assisted gait training for pediatric cerebral palsy. Sensors. 2021;21(6):2087.
Bayón C, Martín-Lorenzo T, Moral-Saiz B, Ramírez Ó, Pérez-Somarriba Á, Lerma-Lara S, et al. A robot-based gait training therapy for pediatric population with cerebral palsy: Goal setting, proposal and preliminary clinical implementation. J Neuroeng Rehabil. 2018 Jul 27;15(1).
Molteni F, Gasperini G, Cannaviello G, Guanziroli E. Exoskeleton and end-effector robots for upper and lower limbs rehabilitation: narrative review. PM&R. 2018;10(9):S174–88.
Colombo G, Joerg M, Schreier R, Dietz V. Treadmill training of paraplegic patients using a robotic orthosis. J Rehabil Res Dev. 2000;37(6):693–700.
Conner BC, Remec NM, Lerner ZF. Is robotic gait training effective for individuals with cerebral palsy? A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil. 2022 Jul 1;36(7):873–82.
Ding Y, Wang Z, Yang P, Yu S. ChMER: an exoskeleton robot with active body weight support walker based on compliant actuation for children with cerebral palsy. Front Bioeng Biotechnol. 2025;13.
Bayon C, Ramírez O, Serrano JI, Del Castillo MD, Pérez-Somarriba A, Belda-Lois JM, et al. Development and evaluation of a novel robotic platform for gait rehabilitation in patients with Cerebral Palsy: CPWalker. Rob Auton Syst. 2017;91:101–14.
Bayón C, Lerma S, Ramírez O, Serrano JI, Del Castillo MD, Raya R, et al. Locomotor training through a novel robotic platform for gait rehabilitation in pediatric population. J Neuroeng Rehabil. 2016;13(1):98.
Grodon C, Bassett P, Shannon H. The ‘heROIC’trial: Does the use of a robotic rehabilitation trainer change quality of life, range of movement and function in children with cerebral palsy? Child Care Health Dev. 2023;49(5):914–24.
Kitatani R, Ohata K, Takahashi H, Shibuta S, Hashiguchi Y, Yamakami N. Reduction in energy expenditure during walking using an automated stride assistance device in healthy young adults. Arch Phys Med Rehabil. 2014;95(11):2128–33.
Cumplido-Trasmonte C, Barquín-Santos E, Aneiros-Tarancón F, Plaza-Flores A, Espinosa-García S, Fernández R, et al. Usability and Safety of the ATLAS 2030 Robotic Gait Device in Children with Cerebral Palsy and Spinal Muscular Atrophy. Children. 2024;11(12):1500.
Cho C, Hwang W, Hwang S, Chung Y. Treadmill training with virtual reality improves gait, balance, and muscle strength in children with cerebral palsy. Tohoku J Exp Med. 2016;238(3):213–8.
Manikowska F, Brazevic S, Krzyżańska A, Jóźwiak M. Effects of robot-assisted therapy on gait parameters in pediatric patients with spastic cerebral palsy. Front Neurol. 2021;12:724009.
Li Z, Li J, Zhao S, Yuan Y, Kang Y, Chen CLP. Adaptive neural control of a kinematically redundant exoskeleton robot using brain–machine interfaces. IEEE Trans Neural Netw Learn Syst. 2018;30(12):3558–71.
McCrum C, Bhatt TS, Gerards MHG, Karamanidis K, Rogers MW, Lord SR, et al. Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice. Front Sports Act Living. 2022;4:1015394.
Yazıcı M, Livanelioğlu A, Gücüyener K, Tekin L, Sümer E, Yakut Y. Effects of robotic rehabilitation on walking and balance in pediatric patients with hemiparetic cerebral palsy. Gait Posture. 2019;70.
Baronchelli F, Zucchella C, Serrao M, Intiso D, Bartolo M. The effect of robotic assisted gait training with Lokomat® on balance control after stroke: systematic review and meta-analysis. Front Neurol. 2021;12:661815.
Jung YG, Chang HJ, Jo ES, Kim DH. The effect of a horse-riding simulator with virtual reality on gross motor function and body composition of children with cerebral palsy: preliminary study. Sensors. 2022;22(8):2903.
Curtis DJ, Woollacott M, Bencke J, Lauridsen HB, Saavedra S, Bandholm T, et al. The functional effect of segmental trunk and head control training in moderate-to-severe cerebral palsy: A randomized controlled trial. Dev Neurorehabil. 2018;21(2):91–100.
Santamaria V, Khan M, Luna T, Kang J, Dutkowsky J, Gordon AM, et al. Promoting functional and independent sitting in children with cerebral palsy using the robotic trunk support trainer. IEEE Transactions on Neural Systems and Rehabilitation Engineering. 2020;28(12):2995–3004.
Abidin N, Ünlü Akyüz E, Cankurtaran D, Karaahmet ÖZ, Tezel N. The effect of robotic rehabilitation on posture and trunk control in non-ambulatory cerebral palsy. Assistive Technology. 2024;36(6):422–8.
Rasooli AH, Birgani PM, Azizi S, Shahrokhi A, Mirbagheri MM. Therapeutic effects of an anti-gravity locomotor training (AlterG) on postural balance and cerebellum structure in children with Cerebral Palsy. In: 2017 International Conference on Rehabilitation Robotics (ICORR). IEEE; 2017. p. 101–5.
Zadnikar M, Kastrin A. Effects of hippotherapy and therapeutic horseback riding on postural control or balance in children with cerebral palsy: a meta‐analysis. Dev Med Child Neurol. 2011;53(8):684–91.
Dominguez-Romero JG, Molina-Aroca A, Moral-Munoz JA, Luque-Moreno C, Lucena-Anton D. Effectiveness of mechanical horse-riding simulators on postural balance in neurological rehabilitation: Systematic review and meta-analysis. Int J Environ Res Public Health. 2020;17(1):165.
Yoo J, Kim S, Lee M, Jin J, Hong J, Choi Y, et al. The effect of horse simulator riding on visual analogue scale, body composition and trunk strength in the patients with chronic low back pain. Int J Clin Pract. 2014;68(8):941–9.
Choi HJ, Kim KJ, Nam KW. The effects of a horseback riding simulation exercise on the spinal alignment of children with cerebral palsy. Journal of Korean Physical Therapy. 2014;26(3):209–15.
Sung YH, Kim CJ, Yu BK, Kim KM. A hippotherapy simulator is effective to shift weight bearing toward the affected side during gait in patients with stroke. NeuroRehabilitation. 2013;33(3):407–12.
Park JH, You J (Sung) H. Innovative robotic hippotherapy improves postural muscle size and postural stability during the quiet stance and gait initiation in a child with cerebral palsy: A single case study. NeuroRehabilitation. 2018;42(2):247–53.
Hemachithra C, Meena N, Ramanathan R, Felix AJW. Immediate effect of horse riding simulator on adductor spasticity in children with cerebral palsy: A randomized controlled trial. Physiotherapy Research International. 2020;25(1):e1809.
Tsitlakidis S, Horsch A, Schaefer F, Westhauser F, Goetze M, Hagmann S, et al. Gait classification in unilateral cerebral palsy. J Clin Med. 2019;8(10):1652.
Carvalho I, Pinto SM, das Virgens Chagas D, Dos Santos JLP, de Sousa Oliveira T, Batista LA. Robotic gait training for individuals with cerebral palsy: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2017;98(11):2332–44.
Lefmann S, Russo R, Hillier S. The effectiveness of robotic-assisted gait training for paediatric gait disorders: systematic review. J Neuroeng Rehabil. 2017;14(1):1.
Hidler JM, Wall AE. Alterations in muscle activation patterns during robotic-assisted walking. Clinical Biomechanics. 2005;20(2):184–93.
Wessels M, Lucas C, Eriks-Hoogland I, De Groot S. Body weight-supported gait training for restoration of walking in people with an incomplete spinal cord injury: A systematic review. In: Assistive Technology Research Series. 2010. p. 297–9.
Mehrholz J, Kugler J, Pohl M, Elsner B. Electromechanical‐assisted training for walking after stroke. Cochrane database of systematic reviews. 2025;(5).
Borggraefe I, Schaefer JS, Klaiber M, Dabrowski E, Ammann-Reiffer C, Knecht B, et al. Robotic-assisted treadmill therapy improves walking and standing performance in children and adolescents with cerebral palsy. european journal of paediatric neurology. 2010;14(6):496–502.
Algabbani MF, Fagehi JM, Aljosh M, Bawazeer M, Aldaihan MM, Abdulrahman TA, et al. Effect of robotic-assisted gait training program on spatiotemporal gait parameters for ambulatory children with cerebral palsy: A randomized control trial. NeuroRehabilitation. 2024;55(1):127–36.
Lerner ZF, Damiano DL, Park HS, Gravunder AJ, Bulea TC. A robotic exoskeleton for treatment of crouch gait in children with cerebral palsy: Design and initial application. IEEE Transactions on Neural Systems and Rehabilitation Engineering. 2016;25(6):650–9.
Delgado E, Cumplido C, Ramos J, Garcés E, Puyuelo G, Plaza A, et al. ATLAS2030 pediatric gait exoskeleton: changes on range of motion, strength and spasticity in children with cerebral palsy. A case series study. Front Pediatr. 2021;9:753226.
Wallard L, Dietrich G, Kerlirzin Y, Bredin J. Effect of robotic-assisted gait rehabilitation on dynamic equilibrium control in the gait of children with cerebral palsy. Gait Posture. 2018;60:55–60.
Sucuoglu H. Effects of robot-assisted gait training alongside conventional therapy on the development of walking in children with cerebral palsy. J Pediatr Rehabil Med. 2020;13(2):127–35.
Baud R, Manzoori AR, Ijspeert A, Bouri M. Review of control strategies for lower-limb exoskeletons to assist gait. J Neuroeng Rehabil. 2021;18(1):119.
Hunt M, Everaert L, Brown M, Muraru L, Hatzidimitriadou E, Desloovere K. Effectiveness of robotic exoskeletons for improving gait in children with cerebral palsy: A systematic review. Gait Posture. 2022;98:343–54.
Hong J, Lee J, Choi T, Choi W, Kim T, Kwak K, et al. Feasibility of overground gait training using a joint-torque-assisting wearable exoskeletal robot in children with static brain injury. Sensors. 2022;22(10):3870.
Kawasaki S, Ohata K, Yoshida T, Yokoyama A, Yamada S. Gait improvements by assisting hip movements with the robot in children with cerebral palsy: a pilot randomized controlled trial. J Neuroeng Rehabil. 2020;17(1):87.
Cherni Y, Ballaz L, Lemaire J, Dal Maso F, Begon M. Effect of low dose robotic-gait training on walking capacity in children and adolescents with cerebral palsy. Neurophysiologie Clinique. 2020;50(6):507–19.
Chen J, Hochstein J, Kim C, Tucker L, Hammel LE, Damiano DL, et al. A pediatric knee exoskeleton with real-time adaptive control for overground walking in ambulatory individuals with cerebral palsy. Front Robot AI. 2021;8:702137.
Lerner ZF, Gasparri GM, Bair MO, Lawson JL, Luque J, Harvey TA, et al. An untethered ankle exoskeleton improves walking economy in a pilot study of individuals with cerebral palsy. IEEE Transactions on Neural Systems and Rehabilitation Engineering. 2018;26(10):1985–93.
Fu WS, Song YC, Wu BA, Qu CH, Zhao JF. Virtual reality combined with robot-assisted gait training to improve walking ability of children with cerebral palsy: A randomized controlled trial. Technology and Health Care. 2022;30(6):1525–33.
Lee J, Chun MH, Seo YJ, Lee A, Choi J, Son C. Effects of a lower limb rehabilitation robot with various training modes in patients with stroke: A randomized controlled trial. Medicine. 2022;101(44):e31590.
Marchal-Crespo L, Riener R. Robot-assisted gait training. In: Rehabilitation Robotics. Elsevier; 2018. p. 227–40.
Vostrý M, Lanková B, Zilcher L, Jelinková J. The Effect of Individual Combination Therapy on Children with Motor Deficits from the Perspective of Comprehensive Rehabilitation. Applied Sciences. 2022;12(9):4270.
Bulea TC, Kim J, Damiano DL, Stanley CJ, Park HS. Prefrontal, posterior parietal and sensorimotor network activity underlying speed control during walking. Front Hum Neurosci. 2015;9(May):247.
Miyai I, Suzuki M, Hatakenaka M, Kubota K. Effect of body weight support on cortical activation during gait in patients with stroke. Exp Brain Res. 2006;169(1):85–91.
Poldrack R, Sabb F, Foerde K, Tom S, Asarnow R, Bookheimer S, et al. The Neural Correlates of Motor Skill Automaticity. Journal of Neuroscience. 2005;25(22):5356–64.
Fonseca ST, Holt KG, Fetters L, Saltzman E. Dynamic resources used in ambulation by children with spastic hemiplegic cerebral palsy: relationship to kinematics, energetics, and asymmetries. Phys Ther. 2004;84(4):344–54; discussion 355-358.
Tardieu G, Huet de la Tour E, Bret MD TC. Muscle hypoextensibility in children with cerebral palsy, I: clinical and experimental observations. Arch Phys Med Rehabil. 1982;63:97–102.
McMahon TA, Valiant G FEC. Groucho running. J Appl Physiol. 1987;62:2326–2337.
Jin P, Wang Y. The impact of botulinum toxin combined with robot-assisted gait training on spasticity and gross motor function on children with spastic cerebral palsy. Dev Neurorehabil. 2024;27(5–6):155–60.
Kawamura K, Murayama K, Takamura J, Minegishi S. Effect of a weekly functional independence measure scale on the recovery of patient with acute stroke: A retrospective study. Medicine. 2022;101(11):e28974.
Mak MKY. Repetitive transcranial magnetic stimulation combined with treadmill training can modulate corticomotor inhibition and improve walking performance in people with Parkinson’s disease. J Physiother. 2013;59(2):128.
Duarte N de AC, Grecco LAC, Galli M, Fregni F, Oliveira CS. Effect of transcranial direct-current stimulation combined with treadmill training on balance and functional performance in children with cerebral palsy: a double-blind randomized controlled trial. PLoS One. 2014;9(8):e105777.
Hu C, Wang X, Pan T. Effect of acupuncture combined with lower limb gait rehabilitation robot on improving walking function in stroke patients with hemiplegia. NeuroRehabilitation. 2024;54(2):309–17.
DeVol CR, Shrivastav SR, Landrum VM, Bjornson KF, Roge D, Moritz CT, et al. Effects of spinal stimulation and short-burst treadmill training on gait biomechanics in children with cerebral palsy. Gait Posture. 2025;118:25–32.
Shepherd H, Reeves J, Stewart C. Evaluating the use of electromyography in UK and European gait laboratories for the assessment of cerebral palsy and other neurological and musculoskeletal conditions. Gait Posture. 2025;117:143–52.
Shin J, An H, Yang S, Park C, Lee Y, You S (Joshua) H. Comparative effects of passive and active mode robot-assisted gait training on brain and muscular activities in sub-acute and chronic stroke. NeuroRehabilitation. 2022;51(1):51–63.
Youssofzadeh V, Zanotto D, Wong-Lin K, Agrawal SK, Prasad G. Directed functional connectivity in fronto-centroparietal circuit correlates with motor adaptation in gait training. IEEE Transactions on Neural Systems and Rehabilitation Engineering. 2016;24(11):1265–75.
Kim DH, Kang CS, Kyeong S. Robot-assisted gait training promotes brain reorganization after stroke: A randomized controlled pilot study. NeuroRehabilitation. 2020;46(4):483–9.
Kim HY, Yang SP, Park GL, Kim EJ, You J (Sung) H. Best facilitated cortical activation during different stepping, treadmill, and robot-assisted walking training paradigms and speeds: a functional near-infrared spectroscopy neuroimaging study. NeuroRehabilitation. 2016;38(2):171–8.
Tang Z, Zhao Y, Sun X, Liu Y, Su W, Liu T, et al. Evidence that robot-assisted gait training modulates neuroplasticity after stroke: an fMRI pilot study based on graph theory analysis. Brain Res. 2024;1842:149113.
Çağlar Okur S, Uğur M, Şenel K. Effects of botulinum toxin A injection on ambulation capacity in patients with cerebral palsy. Dev Neurorehabil. 2019;22(4):288–91.
Leister KR, Rosenberg J, Servais A, Leeds R. Neuromuscular contributions to disability in children with cerebral palsy and the impact of dynamic stretching orthoses and therapeutic exercise interventions: a narrative review. Transl Pediatr. 2024;13(5):803.
Reid LB, Rose SE, Boyd RN. Rehabilitation and neuroplasticity in children with unilateral cerebral palsy. Nat Rev Neurol. 2015;11(7):390–400.
Yang JF, Gorassini M. Spinal and brain control of human walking: implications for retraining of walking. The Neuroscientist. 2006;12(5):379–89.
Wu M, Kim J, Gaebler-Spira DJ, Schmit BD, Arora P. Robotic resistance treadmill training improves locomotor function in children with cerebral palsy: a randomized controlled pilot study. Arch Phys Med Rehabil. 2017;98(11):2126–33.
Beck S, Taube W, Gruber M, Amtage F, Gollhofer A, Schubert M. Task-specific changes in motor evoked potentials of lower limb muscles after different training interventions. Brain Res. 2007;1179:51–60.
Kurz, M.J., Wilson, T.W., and Arpin DJ. Stride-timevariabilityand sensorimotorcorticalactivationduringwalking. Neuroimage. 2012;59:1602–1607.
Miyai I, Suzuki M, Hatakenaka M, Kubota K. Effect of body weight support on cortical activation during gait in patients with stroke. Exp Brain Res. 2006;169(1):85–91.
Kim J, Park HS, Damiano DL. An interactive treadmill under a novel control scheme for simulating overground walking by reducing anomalous force. In: IEEE/ASME Transactions on Mechatronics. Institute of Electrical and Electronics Engineers; 2015. p. 1491–6.
Yoon J, Park HS, Damiano DL. A novel walking speed estimation scheme and its application to treadmill control for gait rehabilitation. J Neuroeng Rehabil. 2012;9(1):62.
Bekius A, Bach MM, Van der Krogt MM, De Vries R, Buizer AI, Dominici N. Muscle synergies during walking in children with cerebral palsy: a systematic review. Front Physiol. 2020;11:632.
Hashiguchi Y, Ohata K, Osako S, Kitatani R, Aga Y, Masaki M, et al. Number of synergies is dependent on spasticity and gait kinetics in children with cerebral palsy. Pediatric physical therapy. 2018;30(1):34–8.
Tang L, Li F, Cao S, Zhang X, Wu D, Chen X. Muscle synergy analysis in children with cerebral palsy. J Neural Eng. 2015;12(4):046017.
Steele KM, Rozumalski A, Schwartz MH. Muscle synergies and complexity of neuromuscular control during gait in cerebral palsy. Dev Med Child Neurol. 2015;57(12):1176–82.
Schwartz MH, Rozumalski A, Steele KM. Dynamic motor control is associated with treatment outcomes for children with cerebral palsy. Dev Med Child Neurol. 2016;58(11):1139–45.
Barbeau H. Locomotor training in neurorehabilitation: emerging rehabilitation concepts. Neurorehabil Neural Repair. 2003;17(1):3–11.
