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Li B, Arcemont S, Lobo MA. Identification of Users' Needs for Pediatric Upper Extremity Exoskeletons. Pediatr Phys Ther 2024; 36:329-336. [PMID: 38869475 DOI: 10.1097/pep.0000000000001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
PURPOSE Identify users' needs for pediatric upper extremity (UE) exoskeletons and how users would like exoskeletons to serve their needs. METHODS Qualitative study design with semi-structured interviews performed with families who are English-speaking with a child aged 3 to 16 years with a chronic need for UE assistance to perform activities. Content analysis was conducted for the responses. RESULTS Twenty-two parents and 12 children among 21 families participated. Families identified key personal care, function and mobility, manual interaction, academic, recreational, and social activities they would like devices to support. Families rated the importance of a variety of design factors. Families using UE wearable assistive devices noted that they better met their functional needs relative to other needs. Families provided design suggestions for future exoskeletons, including preferences for attachment mechanisms, fasteners, and control systems. CONCLUSIONS This study provides important information to guide the prescription and design of UE exoskeletons for pediatric populations.
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Affiliation(s)
- Bai Li
- Department of Physical Therapy and Biomechanics & Movement Science Program (Li and Lobo), University of Delaware, Newark, Delaware; Exercise Science Program, University of Delaware (Arcemont), Newark, Delaware
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Dabiri Golchin M, Ripat J, Verdonck M. Assistive technology to facilitate children's play: a scoping review. Disabil Rehabil Assist Technol 2024:1-11. [PMID: 38166593 DOI: 10.1080/17483107.2023.2298825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Play is a fundamental human right and one of the most important occupations in children's lives. Fewer opportunities exist for children with physical disabilities (CWPD) to play. This study aimed to conduct a scoping review of published peer-reviewed literature on using AT to enable "play-for-the-sake-of-play" by CWPD. METHOD The review was conducted using a widely accepted scoping review methodology. Literature searches were conducted from January 2000 to March 2022 using MEDLINE, Central, CINAHL, ERIC, Scopus, and EMBASE. Pairs of reviewers used an online systematic review system to manage title, abstract, and full-text screening. Excel was used for data extraction and charting. Data was charted based on type of AT, play types according to LUDI definitions, and level of evidence. RESULTS The search yielded 5250 papers after the removal of duplicates. Title and abstract screening identified 58 studies for full-text screening. The final sample included 31 papers. Seven types of AT were identified in studies: power mobility, virtual reality, robots, adaptations for upper limb differences, switch-adapted games, augmentative and alternative communication devices, and mobility aids. Twenty-three papers addressed cognitive play, seven addressed social play, and one addressed both cognitive and social play. Most studies used case study, descriptive, or repeated measures designs. CONCLUSION There is limited evidence regarding the use of AT to support play-for-the-sake-of-play in CWPD. Given the importance of play, further research using rigorous methodologies and the development of assistive technology dedicated to promoting play-for-the-sake-of-play is warranted.
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Affiliation(s)
- Minoo Dabiri Golchin
- Department of Occupational Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Jacquie Ripat
- Department of Occupational Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Michèle Verdonck
- Department of Occupational Therapy, School of Health, University of the Sunshine Coast, Sippy Downs, Australia
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Cachecho S, Fąfara A, Lacombe F, Bussières A, Dahan-Oliel N. Current rehabilitation practice for the evaluation and treatment of children with arthrogryposis: an international survey. Disabil Rehabil 2024; 46:96-104. [PMID: 36582123 DOI: 10.1080/09638288.2022.2161644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 12/06/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To describe the current practices in rehabilitation for the evaluation and treatment of children with arthrogryposis multiplex congenita (AMC). MATERIALS AND METHODS Rehabilitation practitioners worldwide with at least 2 years of experience with AMC were invited to complete an electronic survey on the evaluations and treatments used with children with AMC within five areas: muscle and joint function, self-care, mobility, pain, participation and psychosocial wellbeing. RESULTS Sixty five participants from nine countries completed the survey. Participants completed the sections applicable to their practice. Number of participants within each area varied between 24 and 53. Over 80% of participants used non-standardized evaluations across areas while <50% used patient-reported or standardized measures. Stretching of upper and lower limbs was reported by >80% across ages and clinical presentation severity. Strengthening reported by >70% was mainly used among children >3 years old with less severe contractures. Other interventions used across areas included orthotics (>70%), positioning (>80%), activity-based training (>80%), assistive devices for self-care (>50%) and mobility (>80%), and energy conservation (>70%). Over 70% of participants were involved in perioperative rehabilitation. CONCLUSION Knowledge of current pediatric rehabilitation practice in AMC, together with empirical evidence, may guide clinical decision-making and identify avenues for future research.
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Affiliation(s)
| | - Alicja Fąfara
- Institue of Physiotherapy, Jagiellonian University, Krakow, Poland
| | | | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Noemi Dahan-Oliel
- Shriners Hospital for Children, Montreal, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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Li B, Cunha AB, Lobo MA. Effectiveness and Users' Perceptions of Upper Extremity Exoskeletons and Robot-Assisted Devices in Children with Physical Disabilities: Systematic Review. Phys Occup Ther Pediatr 2023; 44:336-379. [PMID: 37635151 DOI: 10.1080/01942638.2023.2248241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 08/29/2023]
Abstract
AIM Systematically determine the effectiveness and users' perceptions of upper extremity (UE) exoskeletons and robot-assisted devices for pediatric rehabilitation. METHODS PubMed/Medline, Web of Science, Scopus, and Cochrane Library were searched for studies with "exoskeletons"/"robot-assisted devices", children with disabilities, effectiveness data, and English publication. Intervention effectiveness outcomes were classified within components of the International Classification of Functioning, Disability, and Health, Children and Youth Version (ICF-CY). Secondary data (users' perceptions; implementation setting) were extracted. Risk of bias and methodological quality were assessed. Descriptive analyses were performed. RESULTS Seventy-two articles were included. Most evaluated body structure and function and activity outcomes with less emphasis on participation. Most effects across all ICF-CY levels were positive. Devices were primarily evaluated in clinical or laboratory rather than natural environments. Perceptions about device effectiveness were mostly positive, while those about expression, accessibility, and esthetics were mostly negative. A need for increased rigor in research study design was detected. CONCLUSIONS Across populations, devices, settings, interventions, and dosing schedules, UE exoskeletons and robot-assisted devices may improve function, activity, and perhaps participation for children with physical disabilities. Future work should transition devices into natural environments, design devices and implementation strategies to address users' negative perceptions, and increase research rigor.
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Affiliation(s)
- Bai Li
- Department of Physical Therapy, Biomechanics & Movement Science Program, University of Delaware, Newark, DE, USA
| | - Andrea B Cunha
- Department of Physical Therapy, Biomechanics & Movement Science Program, University of Delaware, Newark, DE, USA
- Department of Physical Therapy, Munroe Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michele A Lobo
- Department of Physical Therapy, Biomechanics & Movement Science Program, University of Delaware, Newark, DE, USA
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Babik I, Cunha AB, Lobo MA. A model for using developmental science to create effective early intervention programs and technologies to improve children's developmental outcomes. ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2022; 62:231-268. [PMID: 35249683 DOI: 10.1016/bs.acdb.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Children born with a variety of environmental or medical risk factors may exhibit delays in global development. Very often, such delays are identified at preschool or school age, when children are severely overdue for effective early interventions that can alleviate the delays. This chapter proposes a conceptual model of child development to inform the creation of interventions and rehabilitative technologies that can be provided very early in development, throughout the first year of life, to optimize children's future developmental outcomes. The model suggests that early sensorimotor skills are antecedent and foundational for future motor, cognitive, language, and social development. As an example, this chapter describes how children's early postural control and exploratory movements facilitate the development of future object exploration behaviors that provide enhanced opportunities for learning and advance children's motor, cognitive, language, and social development. An understanding of the developmental pathways in the model can enable the design of effective intervention programs and rehabilitative technologies that target sensorimotor skills in the first year of life with the goal of minimizing or ameliorating the delays that are typically identified at preschool or school age. Specific examples of early interventions and rehabilitative technologies that have effectively advanced children's motor and cognitive development by targeting early sensorimotor skills and behaviors are provided.
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Affiliation(s)
- Iryna Babik
- Department of Psychological Science, Boise State University, Boise, ID, United States
| | - Andrea B Cunha
- Department of Physical Therapy, Biomechanics & Movement Science Program, University of Delaware, Newark, DE, United States
| | - Michele A Lobo
- Department of Physical Therapy, Biomechanics & Movement Science Program, University of Delaware, Newark, DE, United States.
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Babik I, Cunha AB, Lobo MA. Assistive and Rehabilitative Effects of the Playskin Lift TM Exoskeletal Garment on Reaching and Object Exploration in Children With Arthrogryposis. Am J Occup Ther 2021; 75:7501205110p1-7501205110p10. [PMID: 33399059 PMCID: PMC7784035 DOI: 10.5014/ajot.2020.040972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Children with arthrogryposis multiplex congenita are often delayed in their development of reaching and object exploration, which can place them at risk for associated delays in motor and cognitive development. OBJECTIVE To evaluate the longitudinal assistive and rehabilitative effects of the Playskin Lift™ (hereinafter Playskin), a novel exoskeletal garment, on reaching and object exploration abilities in children with arthrogryposis. DESIGN Single-case ABA design with a 1-mo baseline, 4-mo intervention, and 1-mo postintervention. SETTING Home environment. PARTICIPANTS Seventeen children with arthrogryposis (ages 6-35 mo at first visit; 5 boys). INTERVENTION Participants used the Playskin daily for 30 to 45 min while participating in structured intervention activities to encourage reaching for objects across play spaces larger than they were typically able to. OUTCOMES AND MEASURES Participants were tested biweekly throughout the study with and without the Playskin using a systematic reaching assessment. Coding of reaching and object exploration behavior was performed using OpenSHAPA software; statistical analyses were conducted using Hierarchical Linear and Nonlinear Modeling software. Feasibility of the Playskin for daily home intervention was evaluated with a parent perception questionnaire. RESULTS Positive assistive effects (improved performance when wearing the Playskin within sessions) and rehabilitative effects (improved independent performance after the Playskin intervention) were observed with increased active range of motion, expanded reaching space, improved grasping with the ventral side of the open hand, and greater complexity and multimodality and intensity of object exploration. CONCLUSIONS AND RELEVANCE The Playskin may be a feasible, effective assistive and rehabilitative device to advance object interaction and learning in young children with arthrogryposis. WHAT THIS ARTICLE ADDS The novel exoskeletal Playskin garment improves reaching and object exploration in young children with arthrogryposis.
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Affiliation(s)
- Iryna Babik
- Iryna Babik, PhD, is Assistant Professor, Department of Psychological Science, Boise State University, Boise, Idaho
| | - Andrea Baraldi Cunha
- Andrea Baraldi Cunha, PT, PhD, is Research Associate, Department of Physical Therapy and Biomechanics and Movement Science Program, University of Delaware, Newark
| | - Michele A Lobo
- Michele A. Lobo, PT, PhD, is Associate Professor, Department of Physical Therapy and Biomechanics and Movement Science Program, University of Delaware, Newark;
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Simpson C, Huerta B, Sketch S, Lansberg M, Hawkes E, Okamura A. Upper Extremity Exomuscle for Shoulder Abduction Support. ACTA ACUST UNITED AC 2020. [DOI: 10.1109/tmrb.2020.3012471] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
PURPOSE OF REVIEW The orthopaedic treatment of children with arthrogryposis multiplex congenita has evolved steadily over the past two decades. Interrelated factors have spurred this on, including better appreciation of the functional potential of persons with arthrogryposis, development of newer procedures specific for the arthrogrypotic deformities, and outcomes studies that provide understanding of the overall capabilities of adults with arthrogryposis and follow-up to determine which treatments were beneficial and which were not. This article briefly sketches out of some of these advances and indicates areas that need further development. RECENT FINDINGS Outcome studies show that the majority of adults with arthrogryposis are ambulatory but less than half are fully independent. Adults frequently experience ongoing pain, particularly foot and back pain, limiting ambulation and standing. Advancements in the upper extremity treatment include improving elbow function, wrist repositioning, and improving thumb positioning. In the lower extremities, correction of hip and knee contractures leads to improved ambulatory potential, and treating clubfeet with serial casting decreases poor outcomes. SUMMARY Clinical evaluation, both physical examination and assessment of the patient's needs, are important in directing treatment in arthrogryposis. Further outcomes studies are needed to continue to refine procedures and define the appropriate candidates.
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Elfassy C, Cachecho S, Snider L, Dahan-Oliel N. Participation among Children with Arthrogryposis Multiplex Congenita: A Scoping Review. Phys Occup Ther Pediatr 2020; 40:610-636. [PMID: 32299279 DOI: 10.1080/01942638.2020.1754319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM To explore what is currently known regarding participation among children and youth with arthrogryposis multiplex congenita (AMC) using empirical studies, gray literature, and YouTube videos. The secondary objectives included identifying activity types, outcome measures used, interventions provided, and barriers and facilitators to participation. METHOD Empirical studies and gray literature were searched through electronic databases and videos were searched on YouTube. Articles and videos pertaining to participation and youth with AMC were included by two reviewers. Data regarding activity types, location, outcomes measures, interventions, and barriers and facilitators to participation was extracted. Data was critically appraised using specific evaluation criteria. RESULT Eleven empirical studies, six gray literature articles and 71 videos met the inclusion criteria. The most common activity types reported in the empirical studies and YouTube videos were active-physical, social, and skill-based activities. Outcome measures included evaluations and questionnaires, none of which were designed to address participation. Interventions did not target participation although the environments could affect participation. CONCLUSION The paucity of research indicates a need for future studies of participation in this population. Interventions should target participation and address environmental barriers. Videos provide insight for clinicians, youth, and families to help promote participation in the natural environment.
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Affiliation(s)
- Caroline Elfassy
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Clinical Research Department, Shriners Hospital for Children, Montreal, Canada
| | - Sarah Cachecho
- Clinical Research Department, Shriners Hospital for Children, Montreal, Canada
| | - Laurie Snider
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Noemi Dahan-Oliel
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Clinical Research Department, Shriners Hospital for Children, Montreal, Canada
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