Cerebral palsy is a group of persistent central motor and postural developmental disorders, limited mobility syndroms, which are caused by non-progressive damage to the brain of the developing fetus or infant. Motor disorders in cerebral palsy are often associated with sensory, perceptual, cognitive, communication, and behavioral disorders as well as epilepsy and secondary musculoskeletal problems.

Diagnostic criteria

1. Prerequisites 4

(1) Central dyskinesia persists;

(2) Abnormal motor and postural development;

(3) Abnormal muscle tone and strength;

(4) Abnormal reflex development.

2. 2 reference conditions

(1) There is an etiological basis for cerebral palsy;

(2) Evidence from magnetic resonance imaging (MRI) of the head.

The diagnosis of cerebral palsy should have the above 4 necessary conditions, and the reference conditions can help find the cause.

  Rehabilitation principle

  The principles of cerebral palsy rehabilitation include early intervention, comprehensive rehabilitation and team intervention, goal-oriented rehabilitation, rehabilitation training that makes the child happy and motivated, child and parent as decision makers, family intervention, combination of specific tasks and assistive technology, ICF as guidance, and EBM principles. Conventional rehabilitation therapy is mainly targeted at the condition, without considering the physiological, psychological and other factors of the children. Although it can inhibit the deterioration of the symptoms of the children and improve the motor function to a certain extent, it has certain psychological damage to the children. At the same time, due to the different types of symptoms and severity of the disease, the therapeutic effect is not ideal. The use of rehabilitation AIDS for rehabilitation training is to combine a variety of training methods according to the physiological and psychological characteristics of the children, conduct targeted training on the tissue and function of the children, and promote the recovery of the physical movement ability of the children. Besides, the use of auxiliary AIDS such as standing frame, crawling frame and walker can play a gradual role in the movement ability of the children, which is more reasonable than the conventional training methods.

Application of assistive devices

  The AIDS recommended in the China Cerebral Palsy Rehabilitation Guide (2022) include eating AIDS, communication AIDS, postural control AIDS, and transfer AIDS; Orthoses include foot orthoses, ankle-foot orthosis (AFO), and knee-ankle-foot orthosis (knee-ankle-foot orthosis). KAFO), hip adduction and abduction control orthotics, international college of biomechanics (ICB) orthopedic insole, etc. Among them, the ICB orthopedic insole is customized according to the biomechanical characteristics of the foot and ankle of children with cerebral palsy, which can help children with cerebral palsy achieve relatively normal foot weight status, correct abnormal biological force lines, improve the standing and dynamic balance ability of children with cerebral palsy, improve the gross motor function and improve their walking ability and ADL ability, so it is recommended as A grade.

  In addition, assistive treatment methods combined with specific tasks include suspension training, all-round intensive motor training, kinesio taping (KT), rehabilitation robots, etc. As a new type of assistive technology, rehabilitation robot is the research hotspot and development direction of rehabilitation medicine. B grade recommendation was given to rehabilitation robot for relieving muscle spasm in children with cerebral palsy, correcting abnormal posture and gait, and improving movement and balance coordination. A grade recommendation is given to improve the cognitive function and ADL ability of children with cerebral palsy by combining tele-rehabilitation robot with motion observation therapy and other rehabilitation techniques.

  At present, there is no cure for malformed gait caused by cerebral palsy. Typical medical methods such as surgery, physical therapy, and intramuscular drug injection can enhance the walking ability of children with cerebral palsy, but the lower limb joint ability decline is still common or easy to relapse after treatment. Technology-driven gait rehabilitation has led to new treatment options, and treadmetre-based weight-supported exercise training and robot-assisted gait training have shown some effectiveness in children with cerebral palsy. However, treadmill based gait rehabilitation is limited to hospitals or research institutions, limiting the frequency and duration of rehabilitation for children with cerebral palsy. Therefore, the rehabilitation assisted exoskeleton robot for children with cerebral palsy, which is suitable for family use and easy to carry, has become an important research direction.

  Rehabilitation assisted exoskeleton for children with cerebral palsy is of great significance to individuals, families and society. At the individual level of children with cerebral palsy, rehabilitation of exoskeleton for children with cerebral palsy can improve their walking gait in the long term, reduce joint pain and other complications caused by deformed gait, reduce the cost of walking energy metabolism, alleviate the negative emotion caused by walking difficulty in children with cerebral palsy, and promote the maintenance of long-term exercise ability. At the level of families of children with cerebral palsy, the maintenance and improvement of motor ability of children with cerebral palsy means more parent-child interaction and lower care burden, which increases the happiness index of families with cerebral palsy children; For the society, the rehabilitation aid exoskeleton for children with cerebral palsy provides an intelligent rehabilitation treatment means for such patients, which can reduce the human burden of rehabilitation therapists and promote the development of intelligent rehabilitation equipment industry.

  From different perspectives, the exoskeleton of rehabilitation aid for children with cerebral palsy can be classified in a variety of ways. According to the materials used in the parts, the children with cerebral palsy rehabilitation aid exoskeleton can be divided into rigid exoskeleton and flexible exoskeleton. According to the ability to provide external active torque to the human lower limb joints, children with cerebral palsy exoskeletons can usually be divided into dynamic (active) and undynamic (passive) types. According to the number of lower limb joints driven, children with cerebral palsy rehabilitation aid exoskeleton can be divided into single joint and multi-joint drive lower limb exoskeleton.

Summary and prospect

  Although the current research on exoskeleton for rehabilitation assistance of children with cerebral palsy has some problems, such as unclear joint assist mechanism, too single assisting joint, only laboratory assisting scene, non-personalized assisting trajectory, control parameters cannot be automatically adjusted with children's growth and development, gait improvement and unsatisfactory assisting effect, etc. However, it also proves that the lower limb exoskeleton of children with cerebral palsy has definite effect and good application prospect in improving gait and walking efficiency. 

  The exoskeleton rehabilitation robot technology for lower limbs is a product formed by the integration of various high and new technologies, which can help the patients with motor dysfunction to carry out rehabilitation training and improve the physical function. At present, the lower limb exoskeleton rehabilitation robot and ankle rehabilitation robot are more in clinical application, and the clinical application research of the knee and hip rehabilitation robot is less. Although the lower limb exoskeleton rehabilitation robot can not completely replace the traditional rehabilitation treatment method, its unique advantages will become the protagonist in the rehabilitation medical process in the future.