Wearable robotic exoskeleton improves walking posture in children with cerebral palsy



The most common movement disorder in children, cerebral palsy (CP), can cause serious problems with walking, including crouch gait, in which children walk with their leg joints bent. Children who walk with a crouch gait pattern frequently experience a decline in function as they age because their strength and coordination cannot keep up with the extra demands this walking pattern places on their muscles. Traditional treatments for crouch gait, which include braces, physical therapy, Botox injections, and surgery, have mixed outcomes, and about half of all children with crouch gait due to CP lose walking ability at some point in early adulthood. Thus, there is a clear need for more effective and sustainable treatments for crouch gait in CP.


NIH researchers led by IRP staff scientist Thomas C. Bulea, Ph.D., and IRP senior investigator Diane L. Damiano, Ph.D., developed the first robotic exoskeleton to alleviate crouch gait in children. Unlike existing exoskeletons that guide users’ limbs through predefined movements, their device provides precisely timed bursts of assistance to extend the limb, but then turns these off, forcing the user to maintain and adjust their muscle activity while using the exoskeleton. A study of seven children with CP showed that the children were not only able to use the exoskeleton to walk, but also that their ability to walk using the exoskeleton improved with practice. By the final visit of the study, the children’s crouch gait had noticeably improved with the exoskeleton and their step length and walking speed had also increased.


The results of this study show that a responsive, user-driven exoskeleton can alter the user’s posture and muscle activity without disrupting walking. Thus, the study shows that wearable exoskeletons have the potential to act simultaneously as both assistive and exercise devices. Future work can leverage this new approach to provide exoskeleton-mediated walking training on a daily basis, even in home or community environments, with the ultimate goal of eventually attaining an improved manner of walking even when the user is not wearing the device. This approach can also be extended to other pediatric movement disorders, including spina bifida and muscular dystrophy.


Lerner ZF, Damiano DL, Bulea TC. (2017). A lower-extremity exoskeleton improves knee extension in children with crouch gait from cerebral palsy. Sci Transl Med. Aug 23;9(404):eaam9145. doi:10.1126/scitranslmed.aam9145.

Lerner ZF, Damiano DL, Park HS, Gravunder AJ, Bulea TC. (2017). A robotic exoskeleton for treatment of crouch gait in children with cerebral palsy: design and initial application. IEEE Trans Neural Syst Rehabil Eng. Jun;25(6):650-659. doi:10.1109/TNSRE.2016.2595501.

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This page was last updated on Tuesday, June 13, 2023