{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T09:06:14Z","timestamp":1788944774082,"version":"build-2803163510"},"reference-count":38,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Background: Gait disturbances are among the most disabling manifestations of cerebral palsy (CP) and substantially affect functional mobility and quality of life. Robot-assisted gait training (RAGT) has been introduced to improve gait performance; however, its effects on lower-limb kinematics remain inconsistent. The aim of this study was to evaluate changes in sagittal-plane gait kinematics in children with CP following a four-week gait rehabilitation program using the PRODROBOT robotic gait trainer. Methods: A prospective quasi-experimental pre\u2013post study with a reference group was conducted. Ten children with spastic cerebral palsy at GMFCS level III aged 8\u201313 years completed a four-week intervention comprising 20 sessions of robot-assisted gait training. Three-dimensional gait analysis (Vicon) was performed before (KF1) and within 72 h after the end of the intervention (KF2); for each participant, 15 gait cycles were averaged. Eighteen typically developing children aged 7\u201314 years constituted the normative reference group (CG) and were assessed once. Sagittal plane angular waveforms for the hip, knee, and ankle joints were compared using the difference factor (f1) and the similarity factor (f2). Results: The intervention produced selective changes in lower-limb kinematics. At the ankle joint, the range of motion deficit in the sagittal plane relative to the CG decreased from 4.5\u00b0 to 2.9\u00b0, and the difference modulus at 55\u201360% of the gait cycle decreased from 7.5% to 4.0%. At the knee joint, the difference factor relative to the CG decreased from f1 = 22.2% to f1 = 17.4%, with a reduction of the difference modulus by 2\u20133 percentage points during the loading response phase, terminal stance phase, and terminal swing phase. At the hip joint, the profiles before and after the intervention were respectively f1 = 2.0% and f2 = 95.6, and the deviation from the reference pattern remained at the level of f1 = 54.1% vs. 53.0%; f2 = 50.2 in both comparisons, with persistent flexion of approximately 10\u00b0 and a lack of extension in the terminal stance phase. Conclusions: Robot-assisted gait training with the PRODROBOT system produced selective improvements in sagittal-plane gait kinematics in children with cerebral palsy, with the most pronounced effects observed at the ankle joint and, to a lesser extent, the knee. The intervention did not restore a normal gait pattern, particularly at the hip joint. These findings suggest that robotic gait training may serve as a valuable component of comprehensive rehabilitation but should be combined with interventions targeting muscle strength, joint mobility and postural control. Larger randomized studies with long-term follow-up are needed to confirm the clinical effectiveness of this approach.<\/jats:p>","DOI":"10.3390\/s26185708","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T08:05:43Z","timestamp":1788941143000},"page":"5708","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessment of Gait Kinematics in the Sagittal Plane in Children with Cerebral Palsy Following Therapy with the PRODROBOT Gait Trainer"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8963-9083","authenticated-orcid":false,"given":"Katarzyna","family":"Fedejko-Kaflowska","sequence":"first","affiliation":[{"name":"Department of Applied Occupational, Therapy Institute of Applied Sciences, University of Physical Culture in Krak\u00f3w, 31-571 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"given":"Wies\u0142aw","family":"Chwa\u0142a","sequence":"additional","affiliation":[{"name":"Department of Biomechanics, University of Physical Culture in Krak\u00f3w, 31-571 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"funding-acquisition","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9231-8353","authenticated-orcid":false,"given":"Krzysztof","family":"Kasicki","sequence":"additional","affiliation":[{"name":"Department of Sport Theory and Motor Skills, Institute of Sports Sciences, University of Physical Culture in Krak\u00f3w, 31-571 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7956-7488","authenticated-orcid":false,"given":"\u0141ukasz","family":"Rydzik","sequence":"additional","affiliation":[{"name":"Department of Sport Theory and Motor Skills, Institute of Sports Sciences, University of Physical Culture in Krak\u00f3w, 31-571 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7361-9478","authenticated-orcid":false,"given":"Tadeusz","family":"Ambro\u017cy","sequence":"additional","affiliation":[{"name":"Department of Sport Theory and Motor Skills, Institute of Sports Sciences, University of Physical Culture in Krak\u00f3w, 31-571 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2439-5652","authenticated-orcid":false,"given":"S\u0142awomir","family":"Porada","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Psychology, Collegium Medicum, University of Rzesz\u00f3w, 35-959 Rzeszow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1017\/S001216220500112X","article-title":"Proposed Definition and Classification of Cerebral Palsy, April 2005","volume":"47","author":"Bax","year":"2005","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1469-8749.2007.tb12609.x","article-title":"Definition and Classification of Cerebral Palsy: A Historical Perspective","volume":"49","author":"Morris","year":"2007","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1111\/dmcn.15346","article-title":"Global Prevalence of Cerebral Palsy: A Systematic Analysis","volume":"64","author":"McIntyre","year":"2022","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1111\/j.1469-8749.1997.tb07414.x","article-title":"Development and Reliability of a System to Classify Gross Motor Function in Children with Cerebral Palsy","volume":"39","author":"Palisano","year":"1997","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1111\/j.1469-8749.2008.03089.x","article-title":"Content Validity of the Expanded and Revised Gross Motor Function Classification System","volume":"50","author":"Palisano","year":"2008","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1302\/2058-5241.1.000052","article-title":"Gait Analysis in Children with Cerebral Palsy","volume":"1","author":"Armand","year":"2016","journal-title":"EFORT Open Rev."},{"key":"ref_7","unstructured":"Canavese, F., and Deslandes, J. (2015). Kinematic Deviations in Children with Cerebral Palsy. Orthopedic Management of Children with Cerebral Palsy: A Comprehensive Approach, Nova Science Publishers Inc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1016\/S0021-9290(01)00105-1","article-title":"Contributions of the Individual Ankle Plantar Flexors to Support, Forward Progression and Swing Initiation during Walking","volume":"34","author":"Neptune","year":"2001","journal-title":"J. Biomech."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.jbiomech.2010.08.015","article-title":"Muscle Contributions to Whole-Body Sagittal Plane Angular Momentum during Walking","volume":"44","author":"Neptune","year":"2011","journal-title":"J. Biomech."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.gaitpost.2021.07.009","article-title":"Instrumented Gait Analysis for Management of Gait Disorders in Children with Cerebral Palsy: A Scoping Review","volume":"90","author":"States","year":"2021","journal-title":"Gait Posture"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.gaitpost.2008.05.001","article-title":"The Gait Deviation Index: A New Comprehensive Index of Gait Pathology","volume":"28","author":"Schwartz","year":"2008","journal-title":"Gait Posture"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S225","DOI":"10.1044\/1092-4388(2008\/018)","article-title":"Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation after Brain Damage","volume":"51","author":"Kleim","year":"2008","journal-title":"J. Speech Lang. Hear. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s11910-020-1022-z","article-title":"State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy","volume":"20","author":"Novak","year":"2020","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1111\/dmcn.12246","article-title":"A Systematic Review of Interventions for Children with Cerebral Palsy: State of the Evidence","volume":"55","author":"Novak","year":"2013","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3863","DOI":"10.1007\/s10072-023-06964-w","article-title":"Systematic Review and Network Meta-Analysis of Robot-Assisted Gait Training on Lower Limb Function in Patients with Cerebral Palsy","volume":"44","author":"Wang","year":"2023","journal-title":"Neurol. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"358","DOI":"10.2340\/16501977-1114","article-title":"Functional Effects of Robotic-Assisted Locomotor Treadmill Therapy in Children with Cerebral Palsy","volume":"45","author":"Druzbicki","year":"2013","journal-title":"J. Rehabil. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.apmr.2009.10.029","article-title":"Efficacy of Partial Body Weight\u2013Supported Treadmill Training Compared with Overground Walking Practice for Children with Cerebral Palsy: A Randomized Controlled Trial","volume":"91","author":"Willoughby","year":"2010","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1177\/0269215514566249","article-title":"Over Ground Walking and Body Weight Supported Walking Improve Mobility Equally in Cerebral Palsy: A Randomised Controlled Trial","volume":"29","author":"Swe","year":"2015","journal-title":"Clin. Rehabil."},{"key":"ref_19","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."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"0115","DOI":"10.34133\/cbsystems.0115","article-title":"Adaptive gait training of a lower limb rehabilitation robot based on human\u2013robot interaction force measurement","volume":"5","author":"Yu","year":"2024","journal-title":"Cyborg Bionic Syst."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"0250","DOI":"10.34133\/cbsystems.0250","article-title":"Lateral walking gait recognition and hip angle prediction using a dual-task learning framework","volume":"6","author":"Luo","year":"2025","journal-title":"Cyborg Bionic Syst."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Fedejko-Kaflowska, K., Kasicki, K., Rydzik, \u0141., Ambro\u017cy, T., Paleczny, \u0141., and Chwa\u0142a, W. (2026). Kinematic Similarity of Frontal and Transverse Plane Joint Profiles Before and After PRODROBOT Gait Training in Children with Neurological Disorders in Relation to Healthy Individuals. Appl. Sci., 16.","DOI":"10.3390\/app16157572"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1046\/j.1468-1331.2001.00042.x","article-title":"Classification of Gait Patterns in Spastic Hemiplegia and Spastic Diplegia: A Basis for a Management Algorithm","volume":"8","author":"Rodda","year":"2001","journal-title":"Eur. J. Neurol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1111\/j.1469-8749.2007.00751.x","article-title":"The Natural History of Gross Motor Development in Children with Cerebral Palsy Aged 1 to 15 Years","volume":"49","author":"Beckung","year":"2007","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_25","unstructured":"Milanowski, B. (2009). Zastosowanie STATISTICA Profile Uwalniania w Pracach Badawczych i Przemy\u015ble Farmaceutycznym, StatSoft Polska. (In Polish)."},{"key":"ref_26","first-page":"64","article-title":"Mathematical Comparison of Dissolution Profiles","volume":"20","author":"Moore","year":"1996","journal-title":"Pharm. Technol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Cort\u00e9s-P\u00e9rez, I., Gonz\u00e1lez-Gonz\u00e1lez, N., Peinado-Rubia, A.B., Nieto-Escamez, F.A., Obrero-Gait\u00e1n, E., and Garc\u00eda-L\u00f3pez, H. (2022). Efficacy of Robot-Assisted Gait Therapy Compared to Conventional Therapy or Treadmill Training in Children with Cerebral Palsy: A Systematic Review with Meta-Analysis. Sensors, 22.","DOI":"10.3390\/s22249910"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1177\/10538135241296010","article-title":"Evaluation of the Effectiveness of Lokomat\u00ae Robot-Assisted Gait Training in Children with Cerebral Palsy: A Systematic Review","volume":"55","author":"Ciancarelli","year":"2024","journal-title":"NeuroRehabilitation"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"92","DOI":"10.12965\/jer.2448186.093","article-title":"Effects of Robot Rehabilitation on the Motor Function and Gait in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis","volume":"20","author":"Lim","year":"2024","journal-title":"J. Exerc. Rehabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1589\/jpts.27.1337","article-title":"Effects of Trunk-Hip Strengthening on Standing in Children with Spastic Diplegia: A Comparative Pilot Study","volume":"27","author":"Kim","year":"2015","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Miller, F., Bachrach, S., Lennon, N., and O\u2019Neil, M. (2020). Hip and Pelvic Kinematic Pathology in Cerebral Palsy Gait. Cerebral Palsy, Springer International Publishing.","DOI":"10.1007\/978-3-319-50592-3"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.jbiomech.2017.06.036","article-title":"Crouch Severity Is a Poor Predictor of Elevated Oxygen Consumption in Cerebral Palsy","volume":"60","author":"Steele","year":"2017","journal-title":"J. Biomech."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2332","DOI":"10.1016\/j.apmr.2017.06.018","article-title":"Robotic Gait Training for Individuals With Cerebral Palsy: A Systematic Review and Meta-Analysis","volume":"98","author":"Carvalho","year":"2017","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e2422625","DOI":"10.1001\/jamanetworkopen.2024.22625","article-title":"Overground Gait Training With a Wearable Robot in Children With Cerebral Palsy","volume":"7","author":"Choi","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"11","DOI":"10.5604\/01.3001.0053.9679","article-title":"Robot-Assisted Targeted Gait Training","volume":"34","author":"Chambers","year":"2024","journal-title":"J. Kinesiol. Exerc. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1097\/PEP.0000000000001101","article-title":"Three-Dimensional Instrumented Gait Analysis for Children With Cerebral Palsy: An Evidence-Based Clinical Practice Guideline","volume":"36","author":"States","year":"2024","journal-title":"Pediatr. Phys. Ther."},{"key":"ref_37","first-page":"1","article-title":"Effects of Fascia-Oriented Training Program on Joint Position Sense, Force Sense and Postural Control of Dancers","volume":"35","author":"Chatzopoulos","year":"2025","journal-title":"J. Kinesiol. Exerc. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"437","DOI":"10.2106\/00004623-198769030-00016","article-title":"Gait Patterns in Spastic Hemiplegia in Children and Young Adults","volume":"69","author":"Winters","year":"1987","journal-title":"J. Bone Jt. Surg. Am."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/26\/18\/5708\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T08:07:36Z","timestamp":1788941256000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/26\/18\/5708"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":38,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["s26185708"],"URL":"https:\/\/doi.org\/10.3390\/s26185708","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]}}}