Effectiveness of emerging technology-assisted rehabilitation in children with cerebral palsy: a systematic review and meta-analysis.

INTRODUCTION: Robot-assisted gait training (RAGT), virtual reality (VR), and other emerging technology-assisted interventions are increasingly used in pediatric neurorehabilitation, but their effects across functional domains and follow-up periods in children with cerebral palsy (CP) remain unclear. METHODS: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to February 23, 2026. Randomized controlled trials (RCTs) comparing these interventions with conventional rehabilitation in children with CP were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the revised Cochrane Risk of Bias tool (RoB 2). Random-effects meta-analyses generated mean differences (MDs) with 95% confidence intervals (CIs). Subgroup analyses examined technology type and follow-up duration. The certainty of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Forty-six RCTs involving 1,812 children were included. Emerging technology-assisted interventions improved performance on the 10-Meter Walk Test (10MWT; MD = -2.83, 95% CI -4.39 to -1.27), 6-Minute Walk Test (6MWT; MD = 43.56, 95% CI 25.55 to 61.57), Timed Up and Go Test (TUG; MD = -2.17, 95% CI -3.60 to -0.75), Pediatric Balance Scale (PBS; MD = 5.21, 95% CI 4.06 to 6.37), Gross Motor Function Measure (GMFM) dimension D (MD = 3.99, 95% CI 1.61 to 6.37), and GMFM dimension E (MD = 8.90, 95% CI 5.18 to 12.62). RAGT favored gait outcomes, whereas VR favored balance outcomes. Upper-limb spasticity measured by the Modified Ashworth Scale (MAS) decreased (MD = -0.40, 95% CI -0.59 to -0.21). ABILHAND-Kids questionnaire scores showed no immediate improvement (MD = 2.00, 95% CI -1.01 to 5.01) but improved at ≥6 weeks (MD = 2.54, 95% CI 0.41 to 4.66). Most gains were immediate; only balance and manual ability remained significant at longer follow-up. CONCLUSION: Emerging technology-assisted rehabilitation improves gait, mobility, balance, gross motor function, and upper-limb outcomes in children with CP. RAGT and VR show domain-specific advantages. Evidence certainty ranged from high to very low, and further high-quality RCTs with extended follow-up are needed. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251157757, Identifier CRD420251157757.