Children with cerebral palsy (CP) suffer deficits in their motor, sensory, and cognitive abilities, as well as in their visuospatial competences. In the last years, several authors have tried to correlate the visuospatial abilities with the navigational ones. Given their importance in everyday functions, navigation skills have been deeply studied using increasingly cutting-edge techniques such as virtual reality (VR). However, to our knowledge, there are no studies focused on training using immersive VR (IVR) in children with movement disorders. For this reason, we proposed an IVR training to 35 young participants with CP and conceived to improve their navigation skills in a “simil-real” environment while playing on a dynamic platform. A subgroup performed a part of the training which was specifically dedicated to the use of the allocentric strategy (i.e., looking for landmarks) to navigate the virtual environment. We then compared the children’s navigation and spatial skills pre- and post-intervention. All the children improved their visual–spatial abilities; particularly, if the IVR activities specifically trained their ability to look for landmarks and use them to navigate. The results of this work highlight the potential of an IVR training program to increase the navigation abilities of patients with CPs.

Background: In 2020, a multiprofessional panel was set up in collaboration with the Italian FightTheStroke Foundation family association to produce evidence-based recommendations for the management and neuromotor rehabilitation of persons with cerebral palsy aged 2–18 years to implement in clinical practice in Italy. Methods: The recommendations of these care pathways were developed according to the American Academy for Cerebral Palsy and Developmental Medicine guidelines for Care Pathways Development and the Grading of Recommendations Assessment Development and Evaluation working group for adoption, adaptation, or de novo development of recommendations from high-quality guidelines (GRADE-ADOLOPMENT). Results: Four strong positive recommendations were developed regarding comprehensive management, and twenty-four addressed neuromotor treatment. Conclusions: A holistic, individualized approach was affirmed in terms of both multidimensional patient profile and interdisciplinary management in a network with the school where children and adolescents are integrated. It was defined that all motor rehabilitation approaches must be individually tailored considering age and developmentally appropriate activities as interventions and goals, in light of the reference curves addressing prognosis for Gross Motor Function and Manual Ability Classification Systems. Intervention must be structured with adaptations of the task and/or of the context (objects and environment) based on the analysis of the child’s skills to support motivation and avoid frustration.

Gait training in a virtual reality (VR) environment is promising for children affected by different disorders. However, the efficacy of VR therapy is still under debate, and more research is needed to clarify its effects on clinical conditions. The combination of VR with neuroimaging methods, such as the electroencephalography (EEG), might help in answering this need. The aim of the present work was to set up and test a system for the multimodal analysis of the gait pattern during VR gait training of pediatric populations by analyzing the EEG correlates as well as the kinematic and kinetic parameters of the gait. An EEG system was integrated with the Gait Real-time Analysis Interactive Lab (GRAIL). We developed and validated, with healthy adults (n = 5) and children (n = 4, healthy or affected by cerebral palsy (CP)), the hardware and software integration of the two systems, which allowed the synchronization of the acquired signals and a reliable identification of the initial contact (IC) of each gait cycle, showing good sensitivity and critical success index values. Moreover, we tested the multimodal acquisition by successfully analyzing EEG data and kinematic and kinetic parameters of one healthy child and one child with CP. This system gives the possibility of monitoring the effect of the VR therapy and studying the neural correlates of gait.

Background: Cerebral palsy (CP) is the most common cause of disability in developmental age, affecting motor and postural skills. With growth, lower-limb orthopedic surgery often becomes necessary. Post-surgical walking rehabilitation programs generally involve conventional therapy with only limited evidence on the use of robot-assisted gait training (RAGT). The aim of the present pilot study is to assess the feasibility and the preliminary functional outcomes of an intensive 3-week rehabilitation of 15 sessions with Lokomat combined with 15 sessions of conventional physiotherapy. Methods: In total, 27 patients with diplegic cerebral palsy who underwent orthopedic surgery were recruited. Outcomes collected: the 6 min walking test (primary outcome), the Gross Motor Function Measure-88, the Gillette Functional Assessment Questionnaire, 3D gait analysis, and spasticity and force metrics of the lower limbs. Paired statistical tests were used to assess pre–post changes. Results: A pre–post statistically significant improvement was observed in gait endurance in the 6MWT (Δ = 28.56 ± 34.28 m; p < 0.001) and in gross motor functional skills. Gait parameters showed some functional and structural improvements, and joint stiffness was reduced in some measures. Conclusions: This combined rehabilitative approach seems to be promising in postoperative patients with CP. Future studies, involving a control group and larger sample size, are needed to generalize our results.

Background: Cerebral palsy (CP) is the most common neuromotor disability in children and often results in spastic diplegia, which can lead to crouch gait. This gait pattern, resulting from weakness predominantly in the extensor muscles and spasticity mainly affecting the flexors, is characterized by excessive knee flexion, insufficient hip extension, and excessive ankle dorsiflexion, which together can progressively impair walking. The Agilik powered knee-ankle-foot orthosis is designed to enhance knee extension and potentially improve gait in children with CP. Here we present the protocol of a study that aims to evaluate the clinical effectiveness of Agilik in a domiciliary setting. Methods: According to this protocol, the multicentre randomized controlled trial will enrol 40 children with CP (aged 5–17 years) exhibiting crouch gait. Participants will be randomly assigned to either the Intervention Group, which will receive training with the Agilik device, or the Control Group, which will maintain their standard routines and therapies. All participants will undergo physical examination and baseline assessments. Then, while the Control Group continues the usual care, the Intervention Group will begin the Agilik program, including three device fitting visits, 4/5 weeks of hospital training, and two months of home-based sessions. Both groups will be evaluated at three time points: baseline, after the intervention, and at a one-month follow-up. Primary endpoints include the 6-Minute Walking Test and Knee Extension in Mid-Stance computed during gait analysis. Secondary endpoints assess gross-motor abilities, gait speed, 3D gait analysis with electromyography, joint range of motion, muscle length, self-perceived performance, spasticity, and balance. Additionally, the Intervention Group will provide feedback on the usability and acceptability of the device, and on cognitive, behavioural and affective engagement. Discussion: This trial will provide valuable insights into the effectiveness of the Agilik device in children with CP and crouch gait. It will help emphasizing the potential benefits of the device on daily living activities and gait performance. The findings could influence clinical practice and guide future interventions for managing crouch gait in CP, potentially leading to enhanced quality of life for these children. Trial registration: The trial has been registered the 30 ^th September 2024 on ClinicalTrials.gov with the identifier NCT06622655.