{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:12:25Z","timestamp":1790143945729,"version":"4.0.1"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction\/Background<\/jats:title>\n                    <jats:p>Bone and muscle health is a significant concern among individuals with neuromotor impairments, especially those with the greatest functional limitations. This case series presents the bone and muscle adaptations in response to 13 to 14 weeks of robotic walking in children and adolescents with neuromotor impairments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      To ensure that the intervention targeted functionally meaningful outcomes, the Canadian Occupational Performance Measure (COPM) was used to capture family-centered goals and motivations for participating in robotic walking. Peripheral quantitative computed tomography (pQCT) scans of the tibia assessed bone and muscle health at three locations: the 3% (trabecular bone), 38% (cortical bone), and 66% (muscle) of tibia length. Scans were acquired before and following robotic walking in five participants with the greatest functional limitations [Gross Motor Function Classification System (GMFCS) levels III -V and Functional Assessment Questionnaire (FAQ): Functional Walking Scale levels 1 -5; aged 4 -12 years]. Bone and muscle outcomes were converted to age-, sex-, and ethnicity-matched\n                      <jats:italic>Z<\/jats:italic>\n                      -scores relative to a typically developing population, and the change in pre- and post-intervention\n                      <jats:italic>Z<\/jats:italic>\n                      -scores was assessed. The least significant change (LSC) was calculated for each participant in bone parameter units, and a clinically relevant change was defined as one that exceeded both the LSC and the expected growth from available reference data.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In some participants, clinically relevant improvements were observed in trabecular bone mineral density (BMD) (three participants), total bone mineral content (one participant), and cortical BMD (one participant) following robotic walking, suggesting promising bone adaptations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Results underscore the need for larger longitudinal studies to explore the impacts of robotic walking across various GMFCS and FAQ levels.<\/jats:p>\n    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