Robot assisted therapy in pediatrics: a pilot study

Robot assisted therapy in pediatrics: a pilot study
J MAST PHD MD 1.2, B LADENHEIM PHD 1.2,
C HIPPOLYTE MA1, L MONTERROSO MA1, H KREBS PHD 3
1 Blythedale Children’s Hospital, Valhalla, NY;
2 New York Medical College, Valhalla, NY;
3 MIT, Cambridge, MA, USA

Background/Objectives: Robot assisted therapy has been shown to increase mobility in adults following stroke (Kwakkel et al, 2008), Neurorehab & Neural Repair 22:2:111-12). Gains have been shown to be long-lasting and replicable. Given the plasticity of the child’s nervous system, we expect that children should show gains equal to if not greater than those seen in adults. Only two uncontrolled studies have involved children and both have shown positive results (e.g., Fasoli et al, 2008, Amer J of Rehab 87:11:929-936). Here we report the pilot results of an on-going controlled study comparing the impact of passive versus active patient participation, delineating the role of visual feedback and intent.
Design: Randomized controlled trial. Therapists performing evaluations were blinded to the study groups.
Participants and Setting: six patients, age 7-18, with upper extremity spasticity as a result of acquired brain injury more than 5 years ago, were randomly assigned to either the active or the passive participant group. Inclusion criteria included injury having occurred at least 3 months prior and the ability to play a simple video game. The study was conducted at a pediatric specialty hospital.
Materials/Methods: Each subject had 16(twice weekly) 45 minute sessions using the MIT-MANUS for planar shoulder-and-elbow therapy. Active participants grasped the robot handle to move a cursor to targets with robotic assistance as needed. If the patient could not hold the handle, his/her hand was placed in a cradle attached to the handle. Passive participants watched an unrelated video, while the robot moved their hand towards all targets. Mobility and functionality in each subject was evaluated before and after robot assisted therapy, using the pediatric evaluation of disability inventory (PEDI) self-care scale, the upper extremity fugl-meyer motor assessment scale (F-M) and the Modified Ashworth Spasticity Scale as primary outcome measures. Subjects were also evaluated with the Joint Range of Motion, the Muscle Strength, the SHUEE and two parent surveys.
Results: Increased mobility and functional gains were seen in both groups for almost all of the measures; however active participants showed a greater degree of improvement in most measures. This difference was particularly robust as measured by the F-M (13% gain v. 1% gain), the PEDI, the Modified Ashworth and Muscle Strength.
Conclusions/Significance: This pilot project considers the role of active participation in robot-assisted therapy; visual feedback and patient intent appear to be important factors. These results can have wide-reaching implications for pediatric rehabilitation. Reduction in impairment at an early age may not only produce direct motor gains, but may also influence development and decrease the lifetime morbidity associated with spasticity such as orthopedic surgeries and durable medical equipment needs.

 
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