Effects of robot-assisted gait training on walking capacity and gross motor function in children with central nervous system impairments: a systematic review and meta-analysis predominantly based on cerebral palsy studies

Abstract Background Children with cerebral palsy (CP) and other central nervous system (CNS) impairments often have limitations in walking capacity and gross motor function. Robot-assisted gait training (RAGT) is increasingly used in pediatric rehabilitation, but existing evidence remains inconsistent. Objective To evaluate the effects of RAGT versus conventional therapy for improving walking capacity and broader motor and functional outcomes in children with CP and other CNS impairments. Methods PubMed, Embase, Web of Science, the Cochrane Library, CINAHL, and ClinicalTrials.gov were searched from inception to April 1, 2026. Randomized controlled trials of children aged 2–18 years with CP or other CNS impairments were included. Risk of bias and methodological quality were assessed using the Cochrane Risk of Bias 2 tool and PEDro scale. Random-effects meta-analyses used mean differences (MDs) or standardized mean differences (SMDs), and certainty of evidence was assessed using GRADE. Results A total of 22 studies ( n = 718) were included, of which 20 focused on CP and two on spinal cord injury (SCI); no studies involving acquired brain injury (ABI) were identified. Compared with conventional therapy, RAGT was associated with greater improvements in walking speed (SMD = 0.58, 95% CI 0.18 to 0.98; P = 0.005; GRADE: high) and 6-minute walk distance (6MWD) (MD = 38.68 m, 95% CI 22.61 to 54.75; P < 0.00001; GRADE: high). An exploratory analysis of two studies also suggested a reduction in the Physiological cost index. No significant differences were observed for GMFM-88, balance, spasticity, or functional independence. Exploratory subgroup analyses suggested larger effects on walking speed with interventions ≥ 8 weeks and identified a significant subgroup difference by robot type for 6MWD, but not for walking speed. Conclusion RAGT may improve walking speed and endurance in children with CP. Insufficient evidence exists for other pediatric CNS impairments, precluding definitive conclusions for children with SCI or ABI. Preliminary subgroup analyses indicate intervention duration and robotic device type may moderate therapeutic benefits, but require further validation. Additional high-quality trials adopting uniform outcome measures are warranted to assess a wider range of functional endpoints and delineate RAGT’s efficacy across pediatric CNS conditions other than CP.