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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] [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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Behboodi A, DeSantis C, Lubsen J, Lee SCK. A Mechanized Pediatric Elbow Joint Powered by a De-Based Artificial Skeletal Muscle. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:4930-4935. [PMID: 33019094 DOI: 10.1109/embc44109.2020.9176332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To increase the acceptability of exoskeletons, there is growing attention toward finding an alternative soft actuator that can safely perform at close vicinity of the human body. In this study, we investigated the capability of the dielectric elastomer actuators (DEAs), for muscle-like actuation of rehabilitation robots. First, an artificial skeletal muscle was configured using commercially available stacked DEAs arranged in a 3x4 array of three parallel fibers consisting of four DEAs connected in series. The shortening and force generation capabilities of this artificial muscle were then measured. An alternate 3x5 version of this muscle was mounted on the forearm of an upper extremity phantom model to actuate its elbow joint. The actuation capability of this muscle was then tested under various tensile loads, 1 N to 4 N, placed at the center of mass of the forearm+hand of the phantom model. The active range of motion and angular velocity of the phantom model's tip of the hand were measured using a motion capture system. The 3×4 artificial muscle produced 30.47 N of force and 5.3 mm of maximum shortening. The 3x5 artificial muscle was capable of actuating the elbow flexion 19.5º with 16.2 º/s angular velocity in the sagittal plane, under a 1 N tensile load. The active range of motion was substantially reduced as the tensile loads increased, which limits the capability of these muscles in the current upper extremity exoskeleton design.
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Exploring the Unmet Need for Technology to Promote Motor Ability in Children Younger Than 5 Years of Age: A Systematic Review. Arch Rehabil Res Clin Transl 2020; 2:100051. [PMID: 33543078 PMCID: PMC7853335 DOI: 10.1016/j.arrct.2020.100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To (1) identify types of technology that promote motor ability in children younger than 5 years of age, (2) report on the type of support these devices provide, and (3) evaluate their potential for use in the community (outside of the laboratory or clinic). Data Sources A literature search of PubMed was conducted in February 2019 using specific terms, including child, rehabilitation, movement, and instrumentation. Study Selection The search yielded 451 peer-reviewed articles, which were screened by multiple reviewers. Articles that described the use of devices for the purpose of motor rehabilitation and/or assistance (regardless of device type or body part targeted) in the age range of 0-5 years were eligible for inclusion. Data Extraction In conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, final stage data extraction consisted of full text readings where each article was reviewed twice by 3 independent reviewers. Data Synthesis About half of the devices available (46%) for children younger than 5 years of age are orthotics and corrective casting devices. There are more facilitative (ie, power mobility devices) than inhibitive (ie, casting) technologies being used. Approximately 60% of the devices are designed for use by a single body part. Walking is the most common motor skill addressed. Although most of the devices were used to some degree outside of the laboratory or clinic, most of the devices available are considered investigative and are not available for commercial purchase. Conclusions Many types of pediatric devices to assist movement exist, but the current scope of employed devices is limited. There is a need for developing technology that allows for, if not supports, high-dosage, early, and variable motor practice that can take place in community settings.
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Babik I, Cunha AB, Lobo MA. Play with objects in children with arthrogryposis: Effects of intervention with the Playskin Lift™ exoskeletal garment. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2019; 181:393-403. [PMID: 31232529 PMCID: PMC10740315 DOI: 10.1002/ajmg.c.31719] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/08/2019] [Accepted: 06/11/2019] [Indexed: 11/07/2022]
Abstract
Children with arthrogryposis multiplex congenita (AMC) often exhibit arm movement impairments that can negatively impact activities of daily living, such as reaching, object exploration, object play, and self-care. This study evaluated the effects of intervention involving the Playskin Lift™ (Playskin) exoskeletal garment on arm function during object play for children with AMC. Seventeen children with AMC (5 males; 6-35 months at the beginning of the study) were tested in their homes biweekly with and without the Playskin throughout a 1-month Baseline, 4-month Intervention, and 1-month Post-Intervention. Within sessions (assistive effects), children contacted and manipulated objects more while wearing the Playskin; they also showed greater intensity, complexity, and variability of behaviors performed during free play, as well as increased play space and reduced number of compensatory arm and trunk flings to facilitate reaching. Across time (rehabilitative effects), children significantly improved their visual-manual coupling as well as their ability to lift objects from a surface and to manipulate objects using one hand; in addition, children exhibited greater multimodality, variability, and intensity of their play behaviors. Current results suggest the Playskin Lift™ may serve as an effective assistive and rehabilitative device to improve play for children with arm movement impairments.
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Affiliation(s)
- Iryna Babik
- Department of Psychological Science, Boise State University, Boise, Idaho
| | - Andrea B. Cunha
- Biomechanics & Movement Science Program, Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Michele A. Lobo
- Biomechanics & Movement Science Program, Department of Physical Therapy, University of Delaware, Newark, Delaware
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Wagner LV, Cherry JS, Sawatzky BJ, Fąfara A, Elfassy C, Eriksson M, Montpetit K, Bucci T, Donohoe M. Rehabilitation across the lifespan for individuals with arthrogryposis. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 181:385-392. [PMID: 31397084 DOI: 10.1002/ajmg.c.31729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 11/12/2022]
Abstract
Arthrogryposis multiplex congenita (AMC) can be a perplexing diagnosis that consists of limited range of motion (ROM) and decreased muscle strength in multiple joints. The person with AMC often possesses a certain tenacity and "spunk" that assists them with adjusting and adapting to the realities of daily life. The rehabilitation process assists the individual with AMC in achieving and maintaining the maximal active and passive range of motion and strength in order to participate in activities of daily living (ADL) throughout the developmental stages. The result of this life-long process is greatly impacted by collaboration among the multidisciplinary teams. Ultimately, rehabilitation should focus on three levels of treatment: (a) body structure, (b) activity, and (c) participation. This article describes rehabilitation across the lifespan-focusing on the therapeutic needs in the infant, toddler, school age and teenage/adult years-while also highlighting opportunities for improvement.
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Affiliation(s)
- Lisa V Wagner
- Shriners Hospitals for Children, Greenville, South Carolina
| | | | | | - Alicja Fąfara
- Jagiellonian University Medical College, University Children's Hospital, Krakow, Poland
| | - Caroline Elfassy
- Shriners Hospitals for Children - Canada, McGill University, Montreal, Quebec, Canada
| | | | - Kathleen Montpetit
- Shriners Hospitals for Children - Canada, McGill University, Montreal, Quebec, Canada
| | - Tricia Bucci
- Shriners Hospitals for Children, Greenville, South Carolina
| | - Maureen Donohoe
- Alfred I. DuPont Hospital for Children, Wilmington, Delaware
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9
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Gagnon M, Caporuscio K, Veilleux LN, Hamdy R, Dahan-Oliel N. Muscle and joint function in children living with arthrogryposis multiplex congenita: A scoping review. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 181:410-426. [PMID: 31350946 DOI: 10.1002/ajmg.c.31726] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/10/2019] [Indexed: 11/05/2022]
Abstract
Arthrogryposis multiplex congenita (AMC) is characterized by congenital joint contractures present in two or more body areas. Lack of fetal movement is the underlying cause of AMC, which can lead to abnormal connective tissue surrounding the joint resulting in stiffness and muscle atrophy. Treatment aims at improving function and mobility through surgical and/or conservative interventions. A scoping review was conducted to explore the existing knowledge of the evaluation and treatment of muscle and joint function in children with AMC. Three search engines were included and identified 1,271 articles. Eighty-seven studies met the selection criteria and were included in this review. All included studies focused on joints, 30 of which also assessed the muscle. Assessment most often included the position of the contractures (n = 72), as well as range of motion (n = 66). Interventions to improve muscle and joint function were reported in 82 of the 87 papers and included surgery (n = 70) and conservative interventions (n = 74) with bony surgery (i.e., osteotomy) the most common surgery and rehabilitation the most common conservative intervention. Recurrences of contractures were mentioned in 46 of the 68 studies providing a follow-up. Future studies should use validated measures to assess muscle and joint function, and conservative interventions should be described in greater detail and to include a longer follow-up.
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Affiliation(s)
- Marianne Gagnon
- Shriners Hospital for Children-Canada, Montreal, Québec, Canada.,Department of Surgery, Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | - Kevin Caporuscio
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | - Louis-Nicolas Veilleux
- Shriners Hospital for Children-Canada, Montreal, Québec, Canada.,Department of Surgery, Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | - Reggie Hamdy
- Shriners Hospital for Children-Canada, Montreal, Québec, Canada.,Department of Surgery, Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | - Noémi Dahan-Oliel
- Shriners Hospital for Children-Canada, Montreal, Québec, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Québec, Canada
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Oishi S, Agranovich O, Zlotolow D, Wall L, Stutz C, Pajardi G, Novelli C, Abdel Ghani H, Jester A, Vuillermin C, James M, Manske MC, Beckwith T. Treatment and outcomes of arthrogryposis in the upper extremity. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 181:363-371. [DOI: 10.1002/ajmg.c.31722] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/23/2019] [Accepted: 06/11/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Scott Oishi
- Texas Scottish Rite Hospital for Children Dallas Texas
| | - Olga Agranovich
- The Turner Scientific Research Institute for Children's Orthopedics Saint Petersburg Russia
| | - Dan Zlotolow
- Shriners Hospitals for Children Philadelphia Pennsylvania
| | - Lindley Wall
- Department of Orthopedic Surgery, Washington University Saint Louis Missouri
| | - Chris Stutz
- Texas Scottish Rite Hospital for Children Dallas Texas
| | - Giorgio Pajardi
- Department of Clinical Sciences and Community Health, The University of Milan Milan Italy
| | - Chiara Novelli
- Department of Clinical Sciences and Community Health, The University of Milan Milan Italy
| | | | - Andrea Jester
- Department of SurgeryIndiana University Indianapolis Indiana
| | - Carley Vuillermin
- Boston Children's Hospital, Harvard Medical School Boston Massachusetts
| | - Michelle James
- Shriners Hospital for Children Northern California Sacramento California
| | - Mary C. Manske
- Shriners Hospital for Children Northern California Sacramento California
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Lobo MA, Hall ML, Greenspan B, Rohloff P, Prosser LA, Smith BA. Wearables for Pediatric Rehabilitation: How to Optimally Design and Use Products to Meet the Needs of Users. Phys Ther 2019; 99:647-657. [PMID: 30810741 PMCID: PMC6545272 DOI: 10.1093/ptj/pzz024] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 12/03/2018] [Indexed: 01/21/2023]
Abstract
This article will define "wearables" as objects that interface and move with users, spanning clothing through smart devices. A novel design approach merging information from across disciplines and considering users' broad needs will be presented as the optimal approach for designing wearables that maximize usage. Three categories of wearables applicable to rehabilitation and habilitation will be explored: (1) inclusive clothing (eg, altered fit, fasteners); (2) supportive wearables (eg, orthotics, exoskeletons); and (3) smart wearables (eg, with sensors for tracking activity or controlling external devices). For each category, we will provide examples of existing and emerging wearables and potential applications for assessment and intervention with a focus on pediatric populations. We will discuss how these wearables might change task requirements and assist users for immediate effects and how they might be used with intervention activities to change users' abilities across time. It is important for rehabilitation clinicians and researchers to be engaged with the design and use of wearables so they can advocate and create better wearables for their clients and determine how to most effectively use wearables to enhance their assessment, intervention, and research practices.
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Affiliation(s)
| | - Martha L Hall
- Biomechanics and Movement Science Program, University of Delaware
| | - Ben Greenspan
- Biomechanics and Movement Science Program, University of Delaware
| | - Peter Rohloff
- Wuqu’ Kawoq (Maya Health Alliance), Santiago Sacatepéquez, Guatemala
| | - Laura A Prosser
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Beth A Smith
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
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Babik I, Cunha AB, Moeyaert M, Hall ML, Paul DA, Mackley A, Lobo MA. Feasibility and Effectiveness of Intervention With the Playskin Lift Exoskeletal Garment for Infants at Risk. Phys Ther 2019; 99:666-676. [PMID: 31155661 PMCID: PMC6545275 DOI: 10.1093/ptj/pzz035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 01/01/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Infants born preterm and/or with brain injury often exhibit delays in the development of reaching and object exploration, increasing their risk of associated delays in cognitive development. OBJECTIVE The objective of this study was to longitudinally evaluate feasibility of use of the novel Playskin Lift exoskeletal garment (Playskin; developed and trademarked by Dr. Lobo's Super Suits FUNctional Fashion and Wearable Technology Program at the University of Delaware, Newark, DE, USA), the assistive and rehabilitative effects of intervention with the garment on reaching and object exploration ability, and to relate changes in reaching and object exploration to changes in cognition during intervention for infants at risk for developmental delays. DESIGN A multiple baseline single-case design with 1- to 2-month Baseline, 4-month Intervention, and 1-month Postintervention phases was implemented. METHODS Ten infants born preterm and/or with brain injury, mean [SD] age 2.2 [1.3] months at the beginning of the study, were assessed biweekly throughout the study both with and without the Playskin Lift. Assessments included a Reaching Assessment and the cognitive subscale of the Bayley Scales of Infant and Toddler Development. Reaching and object exploration behaviors were coded from videos of the Reaching Assessment. Results were analyzed using multilevel modeling in SAS. RESULTS The Playskin Lift improved infants' reaching ability, hand orientation for grasp and object exploration, and multimodal object exploration when worn within sessions, especially during the Intervention phase. The garment also improved independent reaching and object exploration across time during the Intervention phase, with retention of gains in the Postintervention phase. Improvement in reaching ability was positively related to changes in cognitive outcomes during the Intervention phase. LIMITATIONS Limitations included modest sample size and the potential confounds of development and experience with time. CONCLUSIONS The Playskin Lift can serve as a feasible, effective, and accessible assistive and rehabilitative device to advance reaching, object exploration, and cognition for infants at risk for future delays.
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Affiliation(s)
- Iryna Babik
- Biomechanics & Movement Science Program, Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Andrea B Cunha
- Biomechanics & Movement Science Program, Department of Physical Therapy, University of Delaware
| | - Mariola Moeyaert
- Division of Educational Psychology & Methodology, State University of New York at Albany, Albany, New York
| | - Martha L Hall
- Biomechanics & Movement Science Program, Department of Physical Therapy, University of Delaware
| | - David A Paul
- Departments of Pediatrics and Neonatology, Christiana Care Health System, Newark, Delaware
| | - Amy Mackley
- Departments of Pediatrics and Neonatology, Christiana Care Health System
| | - Michele A Lobo
- Biomechanics & Movement Science Program, 210K CHS Building, 540 S. College Avenue, University of Delaware, Newark, DE 19713 (USA),Address all correspondence to Dr Lobo at:
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Babik I, Movva N, Baraldi Cunha A, Lobo MA. Development of self-feeding behavior in children with typical development and those with arm movement impairments. Dev Psychobiol 2019; 61:1191-1203. [PMID: 31001820 DOI: 10.1002/dev.21861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 11/05/2022]
Abstract
Self-feeding is a critical self-care skill that unites motor abilities (e.g., grasping and transporting utensils/food to the mouth) and cognitive abilities (e.g., using a spoon as a tool). This cross-sectional study assessed self-feeding behavior in a sample of 38 children with typical development (TD) and compared it between 18 of those children and 18 age- and sex-matched peers with arm movement impairments (MI). Children were assessed with a bowl of cereal and two spoons presented in four different orientations. Results suggested that children with MI were less successful than their TD peers in both motor aspects (e.g., grasp and transport of food and utensils) and cognitive aspects (correct grasp across spoon orientations) of self-feeding. Novel findings highlight: (a) interesting differences in visual attention between children with TD or MI; (b) the role of hand-preference in the correct grasping of the spoon(s) and effective self-feeding; (c) the positive relation between motor and cognitive aspects of self-feeding; and (d) that greater variability of self-feeding behavior relates to improved performance of cognitive aspects of the task. These results identify challenging components of self-feeding for children with MI that should be targeted by early interventions and assistive technologies aimed at increasing self-feeding independence.
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Affiliation(s)
- Iryna Babik
- Biomechanics & Movement Science Program, Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Naimisha Movva
- Department of Chronic Disease Epidemiology, Yale University, New Haven, Connecticut
| | - Andrea Baraldi Cunha
- Biomechanics & Movement Science Program, Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Michele A Lobo
- Biomechanics & Movement Science Program, Department of Physical Therapy, University of Delaware, Newark, Delaware
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Hall ML, Lobo MA. Design and development of the first exoskeletal garment to enhance arm mobility for children with movement impairments. Assist Technol 2018; 30:251-258. [PMID: 28541832 PMCID: PMC9835012 DOI: 10.1080/10400435.2017.1320690] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Children with a variety of diagnoses have impairments that limit their arm function. Despite the fact that arm function is important for early learning and activities of daily living, there are few tools to assist movement for these children, and existing devices have challenges related to cost, accessibility, comfort, and aesthetics. In this article, we describe the design process and development of the first garment-based exoskeleton to assist arm movement in young children with movement impairments: the Playskin LiftTM. We outline our design process, which contrasts with the traditional medical model in that it is interdisciplinary, user-centered, and addresses the broad needs of users, rather than device function alone. Then we report the results of field-testing with the initial prototype with respect to our design metrics on a toddler with significant bilateral arm movement impairments. Finally, we summarize our ongoing development aimed at increasing comfort, aesthetics, and accessibility of the garment. The interdisciplinary, user-centered approach to assistive technology design presented here can result in innovative and impactful design solutions that translate to the real world.
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Affiliation(s)
- Martha L. Hall
- Department of Fashion & Apparel Studies, University of Delaware, Newark, Delaware, USA,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA,Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
| | - Michele A. Lobo
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA,Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
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