Exoskeleton‐assisted physiotherapy in school and outpatient contexts for minimally ambulant children with cerebral palsy

AIM: To assess the clinical feasibility of lower-limb pediatric exoskeleton-assisted (Trexo Plus) physiotherapy for minimally ambulatory children at an outpatient center and a primary school. Secondary aims were to assess associated functional and goal-based outcomes before and after Trexo-based physiotherapy. METHOD: Ten children with cerebral palsy participated (five males; mean age 5 years 9 months; Gross Motor Function Classification System level IV). Trexo intervention (twice weekly for 6 weeks) was provided in school (gym class/individual physiotherapy) and outpatient (individual physiotherapy) settings by a physiotherapist two-person team. Independent physiotherapy (motor/functional) assessments occurred pre-intervention, 1-week post-intervention, and 5-weeks post-intervention. RESULTS: Fifteen of 16 clinical feasibility indicators were met. Every participant completed the intervention and Trexo use was found to be safe (two adverse skin events in one child). Children reported high enjoyment and comfort during Trexo-facilitated activities, and exercise-linked fatigue. Canadian Occupational Performance Measure and Goal Attainment Scale functional goals were achieved overall, but there was no meaningful increase in Gross Motor Function Measure (88 items; mean change +1.0). Gait assessments showed no increase in 1-minute walk distance but did show enhanced gait maneuverability and reduced physiotherapist assistance when children used their supported-stepping walker. INTERPRETATION: Exoskeleton-based therapy was safe, feasible, and associated with achieving Trexo intervention-focused goals in school and outpatient settings with physiotherapist team support.