Physiological and Neurofunctional Adaptations to Robotic-Assisted Gait Therapy in Cerebral Palsy: A Double Case Study

Cerebral palsy (CP) is a permanent, non-degenerative neurological condition that often leads to motor impairments, balance disorders, and reduced functional mobility in children. Robotic-assisted gait training (RAGT) has shown promising results in enhancing motor function and gait performance in individuals with neurological conditions, including CP. Beyond motor improvements, therapy effectiveness is increasingly linked to patient engagement. In this case study, we investigated the impact of a four-week RAGT program on two children with CP classified as level 2 and level 5 on the Gross Motor Function Classification System (GMFCS) by analyzing both physiological and neurophysiological signals. The main aim of the study is to investigate the effects of RAGT on autonomic activity, brain plasticity, and therapy responsiveness in relation to individual functional levels. Heart rate variability (HRV), infrared thermography (IRT), and functional near-infrared spectroscopy (fNIRS) were used to monitor autonomic nervous system activity, emotional engagement, and cortical hemodynamics at three time points: first session (T0), sixth session (T1), and twelfth session (T2). The results demonstrated a higher level of efficacy in the subject with GMFCS 5 particularly in terms of cortical activation and physiological engagement. Moreover, the integration of multimodal monitoring techniques offers a comprehensive perspective on therapy outcomes, supporting the use of RAGT in personalized rehabilitation strategies.