## 4 Discussion  
Recently, there has been a significant increase in the use of robotic devices in neurological rehabilitation. However, the literature on their use in children with CP, specifically  
\begin{table}
\begin{tabular}{c c c c c c c c c c c c c} \hline \hline \multirow{2}{*}{**Variable**} & \multirow{2}{*}{ \begin{tabular}{c} **Intervention** \\ **Right** \\ \end{tabular}  } & \multicolumn{4}{c}{**Participant 1**} & \multicolumn{4}{c}{**Participant 2**} & \multicolumn{4}{c}{**Participant 3**} \\ \cline{2-13}  & & **Pre** & **Post** & **Pre** & **Post** & **Pre** & **Post** & **Pre** & **Post** & **Pre** & **Post** & **Pre** & **Post** \\  & & **Right** & **Right** & **Left** & **Left** & **Right** & **Right** & **Left** & **Left** & **Right** & **Right** & **Left** & **Left** \\ \hline \multirow{4}{*}{\ \begin{tabular}{c} Spasticity of \\ knee flexors \\ (Scone) \\ \end{tabular}  } & RAGT & 2 & 1 & 2 & 0 & 2 & 3 & 3 & 2 & 2 & 0 & 2 & 0 \\  & & 2 & 0 & 2 & 0 & 2 & 1 & 3 & 2 & 2 & 0 & 2 & 0 \\  & & 2 & 0 & 2 & 1 & 3 & 2 & 3 & 1 & 2 & 0 & 2 & 0 \\  & & 2 & 1 & 2 & 2 & 2 & 1 & 3 & 1 & 2 & 0 & 1 & 0 \\ \hline \multirow{4}{*}{ \begin{tabular}{c} Spasticity of \\ knee flexors \\ (Scone) \\ \end{tabular}  } & RAGT & 47 & 40 & 35 & 0 & 53 & 31 & 67 & 36 & 57 & 17 & 43 & 21 \\  & & 50 & 62 & 63 & 33 & 85 & 61 & 91 & 74 & 52 & 25 & 43 & 18 \\  & & 26 & 85 & 66 & 48 & 29 & 46 & 34 & 20 & 9 & 26  
those classified as GMFCS levels IV and V, remains scarce. Accordingly, the objective of this study was to evaluate the immediate post-intervention characteristics of four therapeutic approaches, three conventional ones, and another one including an exoskeleton, on spasticity, ROM, and heart rate in this population. The findings of the present study offer valuable insights into the effectiveness of four interventions--RAGT, aquatic therapy, warm water immersion, and supported standing--on knee spasticity, knee range of motion, and heart rate in three children with CP. Spasticity measured with the MAS was improved mainly by aquatic therapy and supported standing, while when measured by the MTS, RAGT seemed more effective. RAGT also showed the greatest improvement in popliteal angle, followed by aquatic therapy. However, due to the limited sample size, these results should be interpreted with caution, and larger sample sizes, and long-term follow-up assessments are needed to confirm the sustainability of observed immediate effects. The data indicate that all interventions led to a reduction in scores on both the MAS and MTS. The results align with findings from [PERSON] et al. [39], who reported improvements in spasticity following exercises in water as well as exercises out of the water. [PERSON] et al. [23] observed that treatment with the ATLAS 2030 exoskeleton for one month was able to reduce spasticity levels in three children with cerebral palsy. However, their sample did not consist of levels IV and V who are more affected, and they did not compare this with other treatments. [PERSON] et al. [16], concluded in their study that the reduction in spasticity after standing was short term and did not last beyond 35 min. This leads us to think that it would be interesting to conduct studies that assess the long-term effects on spasticity of the four interventions in this study. Managing spasticity is crucial in children with spastic CP since it can cause a wide variety of discomorts such as pain or hip displacement, ultimately affecting the quality of life of patients [2]. The results of the present study have shown that conventional treatments, which include dynamic standing or movement (such as aquatic therapy), improve spasticity in line with a previous study [15]. Furthermore, RAGT emerges as a promising alternative that may offer additional benefits. Spasticity is considered a velocity-dependent motor disorder characterized by an increase in muscle tone with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one component of the upper motor neuron syndrome [40].