IMPORTANCE: Cerebral palsy (CP) is the most common developmental motor disorder in children. Robot-assisted gait training (RAGT) using a wearable robot can provide intensive overground walking experience. OBJECTIVE: To investigate the effectiveness of overground RAGT in children with CP using an untethered, torque-assisted, wearable exoskeletal robot. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, single-blind randomized clinical trial was conducted from September 1, 2021, to March 31, 2023, at 5 rehabilitation institutions in Korea. Ninety children with CP in Gross Motor Function Classification System levels II to IV were randomized. INTERVENTION: The RAGT group underwent 18 sessions of RAGT during 6 weeks, whereas the control group received standard physical therapy for the same number of sessions during the same period. MAIN OUTCOME AND MEASURES: The primary outcome measure was the Gross Motor Function Measure 88 (GMFM-88) score. Secondary outcome measures were the GMFM-66, Pediatric Balance Scale, selective control assessment of the lower extremity, Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), 6-minute walking test scores (distance and oxygen consumption), muscle and fat mass via bioelectrical impedance analysis, and gait parameters measured via 3-dimensional analysis. All assessments were performed for all patients at baseline, at the end of the 6-week intervention, and after the 4-week follow-up. RESULTS: Of the 90 children (mean (SD) age, 9.51 (2.48) years; 49 (54.4%) male and 41 (45.6%) female) in the study, 78 (86.7%) completed the intervention, with 37 participants (mean (SD) age, 9.57 (2.38) years; 19 (51.4%) male) and 41 participants (mean (SD) age, 9.32 (2.37) years; 26 (63.4%) male) randomly assigned to the RAGT and control groups, respectively. Changes in the RAGT group significantly exceeded changes in the control group in GMFM-88 total (mean difference 2.64; 95% CI 0.50 to 4.78), GMFM-E (mean difference 2.70; 95% CI 0.08 to 5.33), GMFM-66 (mean difference 1.31; 95% CI 0.01 to 2.60), and PEDI-CAT responsibility domain scores (mean difference 2.52; 95% CI 0.42 to 4.63), indicating independence in daily living at postintervention assessment. At the 4-week follow-up, the RAGT group showed significantly greater improvements in balance control (mean difference 1.48; 95% CI 0.03 to 2.94) and Gait Deviation Index (mean difference 6.48; 95% CI 2.77 to 10.19) compared with the control group. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, overground RAGT using a wearable robot significantly improved gross motor function and gait pattern. This new torque-assisted wearable exoskeletal robot, based on assist-as-needed control, may complement standard rehabilitation by providing adequate assistance and therapeutic support to children with CP. TRIAL REGISTRATION: CRIS Identifier: KCT0006273.

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