{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:24:23Z","timestamp":1789518263026,"version":"build-2803163510"},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2024,3,29]],"date-time":"2024-03-29T00:00:00Z","timestamp":1711670400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec>\n            <jats:title>Purpose:<\/jats:title>\n            <jats:p>To describe the implementation of an exoskeleton program in a rehabilitation setting using a Design Thinking framework.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>This is a retrospective case series of 3 randomly selected children who participated in skilled physical therapy using a pediatric exoskeleton that occurred on our journey to walking 1 000 000 steps in the exoskeleton devices. Participants ranged in age from 3 to 5 years, and all had neurologic disorders.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>All participants improved toward achieving their therapy goals, tolerated the exoskeleton well, and had an increased number of steps taken over time.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion:<\/jats:title>\n            <jats:p>The implementation of new technology into pediatric care and an established outpatient therapy clinic is described. The Design Thinking process applies to health care professionals and improves clinical care. Exoskeletons are effective tools for use in pediatric physical therapy.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pep.0000000000001097","type":"journal-article","created":{"date-parts":[[2024,2,13]],"date-time":"2024-02-13T17:00:48Z","timestamp":1707843648000},"page":"285-293","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Journey to 1 Million Steps: A Retrospective Case Series Analyzing the Implementation of Robotic-Assisted Gait Training Into an Outpatient Pediatric Clinic"],"prefix":"10.1097","volume":"36","author":[{"given":"Brittany","family":"Dierwechter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie A.","family":"Kolakowsky-Hayner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,3,29]]},"reference":[{"issue":"11","key":"R1-20250525","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.2522\/ptj.20060116","article-title":"Promotion of physical fitness and prevention of secondary conditions for children with cerebral palsy: section on pediatrics research summit proceedings","volume":"87","author":"Fowler","year":"2007","journal-title":"Phys Ther"},{"issue":"1","key":"R2-20250525","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1097\/PEP.0b013e31818f57f2","article-title":"Contribution of stepping while standing to function and secondary conditions among children with cerebral palsy","volume":"21","author":"Eisenberg","year":"2009","journal-title":"Pediatr Phys Ther"},{"issue":"1","key":"R3-20250525","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1093\/ptj\/72.1.35","article-title":"Considerations related to weight-bearing programs in children with developmental disabilities","volume":"72","author":"Stuberg","year":"1992","journal-title":"Phys Ther"},{"key":"R4-20250525","first-page":"1087","article-title":"Exergaming with a pediatric exoskeleton: facilitating rehabilitation and research in children with cerebral palsy","volume":"2017","author":"Bulea","year":"2017","journal-title":"IEEE Int Conf Rehabil Robot"},{"issue":"404","key":"R5-20250525","doi-asserted-by":"crossref","first-page":"eaam9145","DOI":"10.1126\/scitranslmed.aam9145","article-title":"A lower-extremity exoskeleton improves knee extension in children with crouch gait from cerebral palsy","volume":"9","author":"Lerner","year":"2017","journal-title":"Sci Transl Med"},{"issue":"2","key":"R6-20250525","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1109\/TMRB.2020.2989321","article-title":"A hinge-free, non-restrictive, lightweight tethered exosuit for knee extension assistance during walking","volume":"2","author":"Park","year":"2020","journal-title":"IEEE Trans Med Robot Bionics"},{"issue":"1","key":"R7-20250525","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1186\/s12984-020-00738-7","article-title":"Toward a hybrid exoskeleton for crouch gait in children with cerebral palsy: neuromuscular electrical stimulation for improved knee extension","volume":"17","author":"Shideler","year":"2020","journal-title":"J Neuroeng Rehabil"},{"key":"R8-20250525","first-page":"1","article-title":"Improving ankle muscle recruitment via plantar pressure biofeedback during robot resisted gait training in cerebral palsy","volume":"2022","author":"Conner","year":"2022","journal-title":"IEEE Int Conf Rehabil Robot"},{"issue":"4","key":"R9-20250525","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1007\/s10439-020-02454-8","article-title":"Adaptive ankle resistance from a wearable robotic device to improve muscle recruitment in cerebral palsy","volume":"48","author":"Conner","year":"2020","journal-title":"Ann Biomed Eng"},{"issue":"7","key":"R10-20250525","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.1109\/TBME.2021.3137447","article-title":"Improving the energy cost of incline walking and stair ascent with ankle exoskeleton assistance in cerebral palsy","volume":"69","author":"Fang","year":"2022","journal-title":"IEEE Trans Biomed Eng"},{"key":"R11-20250525","doi-asserted-by":"crossref","first-page":"110601","DOI":"10.1016\/j.jbiomech.2021.110601","article-title":"Pilot evaluation of changes in motor control after wearable robotic resistance training in children with cerebral palsy","volume":"126","author":"Conner","year":"2021","journal-title":"J Biomech"},{"key":"R12-20250525","first-page":"343","article-title":"A platform for rehabilitation of finger individuation in children with hemiplegic cerebral palsy","volume":"2019","author":"McCall","year":"2019","journal-title":"IEEE Int Conf Rehabil Robot"},{"key":"R13-20250525","first-page":"108","article-title":"PEXO\u2014a pediatric whole hand exoskeleton for grasping assistance in task-oriented training","volume":"2019","author":"Butzer","year":"2019","journal-title":"IEEE Int Conf Rehabil Robot"},{"key":"R14-20250525","first-page":"1","article-title":"Design of a compliant, stabilizing wrist mechanism for a pediatric hand exoskeleton","volume":"2022","author":"Dittli","year":"2022","journal-title":"IEEE Int Conf Rehabil Robot"},{"issue":"2","key":"R15-20250525","doi-asserted-by":"crossref","first-page":"237","DOI":"10.23736\/S1973-9087.20.05926-2","article-title":"Robotic-assisted hand therapy for improvement of hand function in children with cerebral palsy: a case series study","volume":"56","author":"Kuo","year":"2020","journal-title":"Eur J Phys Rehabil Med"},{"issue":"1","key":"R16-20250525","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s12984-022-00994-9","article-title":"Clinical utility of a pediatric hand exoskeleton: identifying users, practicability, and acceptance, and recommendations for design improvement","volume":"19","author":"Lieber","year":"2022","journal-title":"J Neuroeng Rehabil"},{"issue":"2","key":"R17-20250525","first-page":"185","article-title":"Improvement of motor performance in children with cerebral palsy treated with exoskeleton robotic training: a retrospective explorative analysis","volume":"38","author":"Digiacomo","year":"2020","journal-title":"Restor Neurol Neurosci"},{"issue":"7","key":"R18-20250525","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1080\/17518423.2018.1527862","article-title":"Trunk control and gross motor outcomes after body weight supported treadmill training in young children with severe cerebral palsy: a non-experimental case series","volume":"22","author":"Flores","year":"2019","journal-title":"Dev Neurorehabil"},{"issue":"4","key":"R19-20250525","first-page":"495","article-title":"Effect of robot-assisted gait training on motor functions in adolescent and young adult children with bilateral spastic cerebral palsy: a randomized controlled trial","volume":"47","author":"Klobuck\u00e1","year":"2020","journal-title":"NeuroRehabilitation"},{"issue":"4","key":"R20-20250525","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.ejpn.2019.05.003","article-title":"Three by three weeks of robot-enhanced repetitive gait therapy within a global rehabilitation plan improves gross motor development in children with cerebral palsy\u2014a retrospective cohort study","volume":"23","author":"Weinberger","year":"2019","journal-title":"Eur J Paediatr Neurol"},{"issue":"7","key":"R21-20250525","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1080\/09638288.2019.1646814","article-title":"Intra- and inter-tester reliability of spasticity assessment in standing position in children and adolescents with cerebral palsy using a paediatric exoskeleton","volume":"43","author":"Cherni","year":"2021","journal-title":"Disabil Rehabil"},{"key":"R22-20250525","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.gaitpost.2016.09.016","article-title":"Feasibility and reliability of using an exoskeleton to emulate muscle contractures during walking","volume":"50","author":"Attias","year":"2016","journal-title":"Gait Posture"},{"issue":"1","key":"R23-20250525","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s12984-019-0485-0","article-title":"Evaluation of biomechanical gait parameters of children with cerebral palsy at 3 different levels of gait assistance using the CPWalker","volume":"16","author":"Aycardi","year":"2019","journal-title":"J Neuroeng Rehabil"},{"key":"R24-20250525","doi-asserted-by":"crossref","first-page":"702137","DOI":"10.3389\/frobt.2021.702137","article-title":"A pediatric knee exoskeleton with real-time adaptive control for overground walking in walking individuals with cerebral palsy","volume":"8","author":"Chen","year":"2021","journal-title":"Front Robot AI"},{"key":"R25-20250525","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1109\/OJEMB.2021.3135826","article-title":"Ankle exoskeleton assistance increases six-minute walk test performance in cerebral palsy","volume":"2","author":"Conner","year":"2021","journal-title":"IEEE Open J Eng Med Biol"},{"issue":"6","key":"R26-20250525","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1080\/10400435.2022.2121324","article-title":"Factors influencing neuromuscular responses to gait training with a robotic ankle exoskeleton in cerebral palsy","volume":"35","author":"Conner","year":"2023","journal-title":"Assist Technol"},{"key":"R27-20250525","doi-asserted-by":"crossref","first-page":"753226","DOI":"10.3389\/fped.2021.753226","article-title":"ATLAS2030 pediatric gait exoskeleton: changes on range of motion, strength and spasticity in children with cerebral palsy. a case series study","volume":"9","author":"Delgado","year":"2021","journal-title":"Front Pediatr"},{"key":"R28-20250525","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1109\/TNSRE.2021.3055796","article-title":"Feasibility of augmenting ankle exoskeleton walking performance with step length biofeedback in individuals with cerebral palsy","volume":"29","author":"Fang","year":"2021","journal-title":"IEEE Trans Neural Syst Rehabil Eng"},{"key":"R29-20250525","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.gaitpost.2020.11.005","article-title":"Adaptive ankle exoskeleton gait training demonstrates acute neuromuscular and spatiotemporal benefits for individuals with cerebral palsy: a pilot study","volume":"95","author":"Fang","year":"2022","journal-title":"Gait Posture"},{"issue":"9","key":"R30-20250525","doi-asserted-by":"crossref","first-page":"2522","DOI":"10.1007\/s10439-021-02822-y","article-title":"Does ankle exoskeleton assistance impair stability during walking in individuals with cerebral palsy?","volume":"49","author":"Harvey","year":"2021","journal-title":"Ann Biomed Eng"},{"issue":"1","key":"R31-20250525","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1186\/s12984-020-00712-3","article-title":"Gait improvements by assisting hip movements with the robot in children with cerebral palsy: a pilot randomized controlled trial","volume":"17","author":"Kawasaki","year":"2020","journal-title":"J Neuroeng Rehabil"},{"key":"R32-20250525","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.isatra.2021.08.027","article-title":"Designing a robust controller for a lower limb exoskeleton to treat an individual with crouch gait pattern in the presence of actuator saturation","volume":"126","author":"Khamar","year":"2022","journal-title":"ISA Trans"},{"issue":"6","key":"R33-20250525","doi-asserted-by":"crossref","first-page":"2087","DOI":"10.3390\/s21062087","article-title":"Overground robot-assisted gait training for pediatric cerebral palsy","volume":"21","author":"Kim","year":"2021","journal-title":"Sensors (Basel)"},{"issue":"6","key":"R34-20250525","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1016\/j.braindev.2019.12.009","article-title":"Robot-assisted gait training using a very small-sized Hybrid Assistive Limb\u00ae for pediatric cerebral palsy: a case report","volume":"42","author":"Kuroda","year":"2020","journal-title":"Brain Dev"},{"key":"R35-20250525","first-page":"2214","article-title":"A robotic exoskeleton to treat crouch gait from cerebral palsy: initial kinematic and neuromuscular evaluation","volume":"2016","author":"Lerner","year":"2016","journal-title":"Annu Int Conf IEEE Eng Med Biol Soc"},{"issue":"6","key":"R36-20250525","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1109\/TNSRE.2016.2595501","article-title":"A robotic exoskeleton for treatment of crouch gait in children with cerebral palsy: design and initial application","volume":"25","author":"Lerner","year":"2017","journal-title":"IEEE Trans Neural Syst Rehabil Eng"},{"issue":"10","key":"R37-20250525","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1109\/TNSRE.2018.2870756","article-title":"An untethered ankle exoskeleton improves walking economy in a pilot study of individuals with cerebral palsy","volume":"26","author":"Lerner","year":"2018","journal-title":"IEEE Trans Neural Syst Rehabil Eng"},{"issue":"6","key":"R38-20250525","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1007\/s10439-019-02237-w","article-title":"A battery-powered ankle exoskeleton improves gait mechanics in a feasibility study of individuals with cerebral palsy","volume":"47","author":"Lerner","year":"2019","journal-title":"Ann Biomed Eng"},{"issue":"1","key":"R39-20250525","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/s12984-021-00954-9","article-title":"Usability and performance validation of an ultra-lightweight and versatile untethered robotic ankle exoskeleton","volume":"18","author":"Orekhov","year":"2021","journal-title":"J Neuroeng Rehabil"},{"issue":"2","key":"R40-20250525","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1109\/TNSRE.2020.2965029","article-title":"Ankle exoskeleton assistance can improve over-ground walking economy in individuals with cerebral palsy","volume":"28","author":"Orekhov","year":"2020","journal-title":"IEEE Trans Neural Syst Rehabil Eng"},{"issue":"7","key":"R41-20250525","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1109\/TNSRE.2017.2651404","article-title":"WAKE-Up exoskeleton to assist children with cerebral palsy: design and preliminary evaluation in level walking","volume":"25","author":"Patane","year":"2017","journal-title":"IEEE Trans Neural Syst Rehabil Eng"},{"issue":"9","key":"R42-20250525","doi-asserted-by":"crossref","first-page":"e73139","DOI":"10.1371\/journal.pone.0073139","article-title":"Feasibility study of a wearable exoskeleton for children: is the gait altered by adding masses on lower limbs?","volume":"8","author":"Rossi","year":"2013","journal-title":"PLoS One"},{"key":"R43-20250525","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.jocn.2019.07.026","article-title":"Feasibility and safety of Robot Suit HAL treatment for adolescents and adults with cerebral palsy","volume":"68","author":"Ueno","year":"2019","journal-title":"J Clin Neurosci"},{"issue":"11","key":"R44-20250525","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1097\/PHM.0000000000000776","article-title":"Effects of the integration of dynamic weight shifting training into treadmill training on walking function of children with cerebral palsy: a randomized controlled study","volume":"96","author":"Wu","year":"2017","journal-title":"Am J Phys Med Rehabil"},{"issue":"5","key":"R45-20250525","doi-asserted-by":"crossref","first-page":"e0252193","DOI":"10.1371\/journal.pone.0252193","article-title":"Effectiveness of powered exoskeleton use on gait in individuals with cerebral palsy: a systematic review","volume":"16","author":"Bunge","year":"2021","journal-title":"PLoS One"},{"key":"R46-20250525","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1109\/OJEMB.2020.3035316","article-title":"Wearable adaptive resistance training improves ankle strength, walking efficiency and mobility in cerebral palsy: a pilot clinical trial","volume":"1","author":"Conner","year":"2020","journal-title":"IEEE Open J Eng Med Biol"},{"key":"R47-20250525","article-title":"What is design thinking & why is it important? HBS Online","author":"Han","year":"2022","journal-title":"Business Insights Blog"},{"key":"R48-20250525","doi-asserted-by":"crossref","first-page":"E117","DOI":"10.5888\/pcd15.180128","article-title":"Design thinking in health care","volume":"15","author":"Altman","year":"2018","journal-title":"Prev Chronic Dis"},{"issue":"4","key":"R49-20250525","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.ejpn.2014.04.012","article-title":"Prospective controlled cohort study to evaluate changes of function, activity and participation in children with bilateral spastic cerebral palsy after Robot-enhanced repetitive treadmill therapy","volume":"18","author":"Schroeder","year":"2014","journal-title":"Eur J Paediatr Neurol"},{"issue":"1","key":"R50-20250525","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12984-016-0214-x","article-title":"The effectiveness of robotic-assisted gait training for paediatric gait disorders: systematic review","volume":"14","author":"Lefmann","year":"2017","journal-title":"J Neuroeng Rehabil"}],"container-title":["Pediatric Physical Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/PEP.0000000000001097","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,25]],"date-time":"2025-05-25T01:00:28Z","timestamp":1748134828000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/PEP.0000000000001097"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,29]]},"references-count":50,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.1097\/pep.0000000000001097","relation":{},"ISSN":["0898-5669"],"issn-type":[{"value":"0898-5669","type":"print"}],"subject":[],"published":{"date-parts":[[2024,3,29]]}}}