Combined Ankle/Knee Stretching and Pivoting Stepping Training for Children With Cerebral Palsy

Electromechanical and Robotic Devices for Gait and Balance Rehabilitation of Children with Neurological Disability: A Systematic Review

In the last two decades, a growing interest has been focused on gait and balance robot-assisted rehabilitation in children with neurological disabilities. Robotic devices allow the implementation of intensive, task-specific training fostering functional recovery and neuroplasticity phenomena. However, limited attention has been paid to the protocols used in this research framework. This systematic review aims to provide an overview of the existing literature on robotic systems for the rehabilitation of gait and balance in children with neurological disabilities and their rehabilitation applications. The literature search was carried out independently and synchronously by three authors on the following databases: MEDLINE, Cochrane Library, PeDro, Institute of Electrical and Electronics Engineers, ScienceDirect, and Google Scholar. The data collected included three subsections referring to clinical, technical, and regulatory aspects. Thirty-one articles out of 81 found on the primary literature search were included in the systematic review. Most studies involved children with cerebral palsy. Only one-third of the studies were randomized controlled trials. Overall, 17 devices (nine end-effector systems and eight exoskeletons) were investigated, among which only 4 (24%) were bore the CE mark. Studies differ on rehabilitation protocols duration, intensity, and outcome measures. Future research should improve both rehabilitation protocols’ and devices’ descriptions.

Robotic devices for paediatric rehabilitation: a review of design features

Children with physical disabilities often have limited performance in daily activities, hindering their physical development, social development and mental health. Therefore, rehabilitation is essential to mitigate the adverse effects of the different causes of physical disabilities and improve independence and quality of life. In the last decade, robotic rehabilitation has shown the potential to augment traditional physical rehabilitation. However, to date, most robotic rehabilitation devices are designed for adult patients who differ in their needs compared to paediatric patients, limiting the devices' potential because the paediatric patients' needs are not adequately considered. With this in mind, the current work reviews the existing literature on robotic rehabilitation for children with physical disabilities, intending to summarise how the rehabilitation robots could fulfil children's needs and inspire researchers to develop new devices. A literature search was conducted utilising the Web of Science, PubMed and Scopus databases. Based on the inclusion-exclusion criteria, 206 publications were included, and 58 robotic devices used by children with a physical disability were identified. Different design factors and the treated conditions using robotic technology were compared. Through the analyses, it was identified that weight, safety, operability and motivation were crucial factors to the successful design of devices for children. The majority of the current devices were used for lower limb rehabilitation. Neurological disorders, in particular cerebral palsy, were the most common conditions for which devices were designed. By far, the most common actuator was the electric motor. Usually, the devices present more than one training strategy being the assistive strategy the most used. The admittance/impedance method is the most popular to interface the robot with the children. Currently, there is a trend on developing exoskeletons, as they can assist children with daily life activities outside of the rehabilitation setting, propitiating a wider adoption of the technology. With this shift in focus, it appears likely that new technologies to actuate the system (e.g. serial elastic actuators) and to detect the intention (e.g. physiological signals) of children as they go about their daily activities will be required.

Plane Dependent Subject-Specific Neuromuscular Training for Knee Rehabilitation

Knee injuries at risk of post-traumatic knee osteoarthritis (PTOA) and knee osteoarthritis (OA) are closely associated with knee transverse plane and/or frontal plane instability and excessive loading. However, most existing training and rehabilitation devices involve mainly movements in the sagittal plane. An offaxis elliptical training system was developed to train and evaluate neuromuscular control about the off-axes (knee varus/valgus and tibial rotation) as well as the main flexion/extension axis (sagittal movements). Effects of the offaxis elliptical training system in improving either transverse or frontal neuromuscular control depending on subjects' need (Pivoting group, Sliding group) were demonstrated through 6-week subject-specific neuromuscular training in subjects with knee injuries at risk of PTOA or medial knee osteoarthritis. The combined pivoting and sliding group, named as offxis group demonstrated significant reduction in pivoting instability, minimum pivoting angle, and sliding instability. The pivoting group showed more reduction in pivoting instability, maximum and minimum pivoting angle than the sliding group. On the other hand, the sliding group showed more reduction in sliding instability, maximum and minimum sliding distance than the pivoting group. Based on these findings, the offaxis elliptical trainer system can potentially be used as a therapeutic and research tool to train human subjects for plane-dependent improvements in their neuromuscular control during functional weight-bearing stepping movements.