Robotic exoskeletons have been developed to assist locomotion and address gait abnormalities in children with cerebral palsy (CP). These wearable assistive devices provide powered assistance to the lower-extremity joints, as well as support and stability. Does exoskeleton-assisted walking improve gait in children with CP? The PRISMA guidelines were used to conduct this systematic review. Articles were obtained in a search of the following electronic databases: Embase, CINAHL Complete, PubMed, Web of Science and MEDLINE. Studies investigating spatiotemporal, kinematic, kinetic, muscle activity and/or physiological parameters during exoskeleton-assisted walking in children with CP were included. All articles were assessed for methodological quality using an adapted version of the Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group, provided by the National Institutes of Health (NIH). Thirteen studies were included. They involved the use of the following exoskeletons: tethered knee exoskeleton, pediatric knee exoskeleton (P.REX), untethered ankle exoskeleton, WAKE-Up ankle module, WAKE-Up ankle & knee module and unilateral ankle exosuit. Methodological quality varied, with key limitations in sample size and allocated time to adapt to the exoskeleton. There was a consensus that robotic exoskeletons improve gait given careful optimisation of exoskeleton torque and sufficient exoskeleton practice time for each participant. Improvements in gait included reduced metabolic cost of walking, increased walking speed, and increased knee and hip extension during stance. Furthermore, exoskeletons with an actuated ankle module were shown to promote normal ankle rocker function. Robotic exoskeletons have the potential to improve the mobility of CP children and may therefore increase community participation and improve quality of life. Future work should involve larger controlled intervention studies utilising robotic exoskeletons to improve gait in children with CP. These studies should ensure sufficient exoskeleton practice time for each participant.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Living labs in the health and wellbeing domain have become increasingly common over the past decade but vary in available infrastructure, implemented study designs and outcome measures. Increased transnational collaboration and harmonization can further improve research quality. The Horizon 2020 Project ‘Virtual Health and Wellbeing Living Lab Infrastructure’ (VITALISE) unites 19 partners across 11 countries. VITALISE aims to harmonize Living Lab procedures and open Living Lab Infrastructures to facilitate and promote research activities in the health and wellbeing domain in Europe and beyond. To do so, the VITALISE consortium will conduct joint research activities (JRAs) in the fields included in the care pathway of patients: rehabilitation, transitional care and everyday living environments for the elderly. In line with the expertise of the involved Living Labs, the current protocol will describe the design of the rehabilitation JRA, focusing on the use of innovative technology both for rehabilitation interventions and data collection in a rehabilitation context. Objective: With this JRA, we primarily aim to gain insight in each Living Lab’s infrastructure and procedures in order to harmonize health and wellbeing Living Lab procedures and infrastructures in Europe and beyond, in particular in the context of rehabilitation. Secondly, we aim to investigate the potential of innovative technologies for rehabilitation through Living Lab methodologies. Methods: The study has a mixed-methods design comprising multiple phases. There are two main phases of data collection, co-creation (phase 1) and small-scale pilots (phase 2), which are preceded by a preliminary harmonization of procedures between the different international Living Labs. An intermediate phase further allows to implement minor adjustments to the intervention or protocol depending on the input that was obtained in the co-creation phase. Six small-scale pilots using innovative technologies for intervention or data collection will be performed across four countries. A third and final phase involves Delphi procedures to reach consensus on harmonized procedures and protocols. Results: Phase 1 data collection will begin in March 2022 and phase 2 data collection will begin in June 2022. Results will include output of the co-creation sessions, small-scale pilots and advice on harmonizing procedures and protocols for health and wellbeing Living Labs focusing on rehabilitation. Conclusions: The knowledge gained by the execution of this research will lead to harmonized procedures and protocols in a rehabilitation context for health and wellbeing Living Labs in Europe and beyond. In addition to the harmonized procedures and protocols in rehabilitation, we will also be able to provide new insights for improving implementation of innovative technologies in rehabilitation.

Ankle–foot orthoses (AFOs) are commonly prescribed to children with cerebral palsy (CP). The conventional AFO successfully controls the first and second ankle rocker, but it fails to correct the third ankle rocker, which negatively effects push-off power. The current study evaluated a new powered AFO (PAFO) design, developed to address the shortcomings of the conventional AFO. Eight children with spastic CP (12.4 ± 3.4 years; GMFCS I-III; 4/4-♂/♀; 3/5-bi/unilateral) were included. Sagittal kinematic and kinetic data were collected from 20 steps during barefoot walking, with conventional AFOs and PAFOs. In the PAFO-condition, an actuation unit was attached to a hinged AFO and through push–pull cables to a backpack that was carried by the child and provided patient-specific assistance-as-needed. SnPM-analysis indicated gait cycle sections that differed significantly between conditions. For the total group, differences between the three conditions were found in ankle kinematics (49.6–66.1%, p = 0.006; 88.0–100%, p = 0.011) and angular velocity (0.0–6.0%, p = 0.001; 45.1–51.1%, p = 0.006; 62.2–73.0%, p = 0.001; 81.2–93.0%, p = 0.001). Individual SnPM-analysis revealed a greater number of significant gait cycle sections for kinematics and kinetics of the ankle, knee, and hip. These individual results were heterogeneous and specific per gait pattern. In conclusion, the new PAFO improved the ankle range-of-motion, angular velocity, and power during push-off in comparison to the conventional AFO.