Community-based RoboGym training improves gross motor function in ambulatory children with cerebral palsy

Children with cerebral palsy (CP) require sustained, intensive, task-specific rehabilitation, yet conventional community-based rehabilitation (CBR) is often limited by insufficient training dose and lack of assistive technologies. In this pragmatic randomized controlled trial, 60 children with CP (mean age 10.4 ± 1.4 years; Gross Motor Function Classification System levels II–III) were allocated 1:1 to a community-based RoboGym (CRG) integrating five robotic modalities in a task-oriented circuit, or to conventional CBR. Both groups received 90-min sessions twice weekly for 6 months.

The primary outcome was the Gross Motor Function Measure-66 (GMFM-66); secondary outcomes were the Pediatric Balance Scale (PBS), Functional Independence Measure (FIM), and Pediatric Quality of Life Inventory (PedsQL). Significant Time × Group interactions favored CRG for GMFM-66 (p = 0.048), PBS (p = 0.048), and the PedsQL emotional (p = 0.039) and social functioning (p = 0.015) domains; differences in FIM (p = 0.065) and PedsQL physical functioning (p = 0.076) also favored CRG but were not statistically significant. The CRG mean GMFM-66 percentile advanced from the 36th to the 48th (individual effect size (iES) = 1.14, large), whereas CBR remained near baseline (iES = 0.29).

A higher proportion of CRG participants exceeded the minimal detectable change threshold (37–63% vs. 17–27%), a difference that was statistically significant for GMFM-66, PBS, and FIM. Multi-modal robotic circuit training may offer a scalable community-based approach to CP management, although confirmation in larger multicenter trials is required. Clinical Research Information Service, KCT0006417, registered [03 August 2021].

Gross Motor Function Classification System International Classification of Functioning, Disability and Health Minimal detectable change at the 95% confidence level Robotic-assisted reciprocal upper- and lower-limb gait trainer We thank all participating children and their families, as well as the clinical and technical staff of the Yonsei Goodwellness Center. This research was supported by the National Research Foundation of Korea (NRF) grant, funded by the Korean government (MSIT) (RS-2025-24534569). This research was supported by the Assistive Technology Commercialize R&D Project for Independent Living for People with Disability and Older People by the Ministry of Health & Welfare, Republic of Korea (grant number : RS-2025-02634726).

This research was supported by the ANCHOR program through the Gangwon ANCHOR Center, funded by the Ministry of Education (MOE) and the Gangwon State (G.S.), Republic of Korea (2026-ANCHOR-10-000). This research was also supported by the MFF program of Yonsei University Mirae Campus. Department of Physical Therapy, Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Yonsei University, Wonju, 26493, Republic of Korea Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA Burke Rehabilitation Hospital, White Plains, NY, USA Human Motor Control Section, National Institutes of Health, Bethesda, MD, USA School of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea Department of Biomedical Engineering, Yonsei University, Wonju, Republic of Korea The authors declare no competing interests.

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