The ability to walk contributes considerably to physical health and overall well-being, particularly in children with motor disability, and is therefore prioritized as a rehabilitation goal. However, half of ambulatory children with cerebral palsy (CP), the most prevalent childhood movement disorder, cease to walk in adulthood. Robotic gait trainers have shown positive outcomes in initial studies, but these clinic-based systems are limited to short-term programs of insufficient length to maintain improved function in a lifelong disability such as CP. Sophisticated wearable exoskeletons are now available, but their utility in treating childhood movement disorders remains unknown. We evaluated an exoskeleton for the treatment of crouch (or flexed-knee) gait, one of the most debilitating pathologies in CP. We show that the exoskeleton reduced crouch in a cohort of ambulatory children with CP during overground walking. The exoskeleton was safe and well tolerated, and all children were able to walk independently with the device. Rather than guiding the lower limbs, the exoskeleton dynamically changed the posture by introducing bursts of knee extension assistance during discrete portions of the walking cycle, a perturbation that resulted in maintained or increased knee extensor muscle activity during exoskeleton use. Six of seven participants exhibited postural improvements equivalent to outcomes reported from invasive orthopedic surgery. We also demonstrate that improvements in crouch increased over the course of our multiweek exploratory trial. Together, these results provide evidence supporting the use of wearable exoskeletons as a treatment strategy to improve walking in children with CP.

行走能力对身体健康和整体幸福感有很大贡献，特别是对于有运动障碍的儿童，因此被优先作为康复目标。然而，半数患有脑瘫 (CP) 的走动儿童（最常见的儿童运动障碍）在成年后停止行走。机器人步态训练器在初步研究中显示出积极的结果，但这些基于临床的系统仅限于长度不足的短期计划，无法维持 CP 等终身残疾的改善功能。现在可以使用复杂的可穿戴外骨骼，但它们在治疗儿童运动障碍方面的作用仍然未知。我们评估了用于治疗蹲伏（或屈膝）步态的外骨骼，这是 CP 中最令人衰弱的病症之一。我们表明，外骨骼减少了一组患有 CP 的门诊儿童在地面行走期间的蹲伏。外骨骼安全且耐受性良好，所有儿童都能够使用该设备独立行走。外骨骼不是引导下肢，而是通过在步行周期的离散部分引入膝关节伸展辅助来动态改变姿势，这种扰动导致在外骨骼使用期间维持或增加膝关节伸肌活动。七名参与者中有六名表现出与侵入性骨科手术报告的结果相当的姿势改善。我们还证明，在我们为期数周的探索性试验过程中，蹲伏的改善有所增加。一起，