Adapted Motor-Assisted Elliptical for Rehabilitation of Children With Physical Disabilities

Many children with physical disabilities experience difficulty using traditional exercise equipment for gait rehabilitation and fitness training, and the clinician resources required to deliver intensive overground or treadmill-based therapies are infrequently available in most clinics, hospitals, and school settings. This work describes design and testing of a comprehensive set of modifications that enabled children to use a commercially available robotic exercise device (i.e., Intelligently Controlled Assistive Rehabilitation Elliptical (ICARE)) initially developed to address walking and fitness goals of adults with physical disabilities and chronic conditions. Fifteen children (3–11 years old) concurrently enrolled in physical therapy due to varied neurologic conditions were recruited with their parent(s) to evaluate the safety, comfort, and usability of the adult ICARE and pediatric-modified ICARE. After children tried each device, feedback was recorded. To assess feasibility, each child then participated in up to ten sessions (two to five sessions per week; average session length: 38 min, range 21–66 min) using the pediatric-modified ICARE. Parents, on average, perceived that the pediatric-modified ICARE was significantly safer, more comfortable and usable than the adult ICARE. Children's perceptions of the pediatric-modified ICARE were similar, although not statistically significant. Children used the prototype device during 133 sessions for over 3800 min and more than 162,000 cycles. In conclusion, this study demonstrated the feasibility of using the pediatric-modified ICARE with children as young as 3 years old as an adjunct to ongoing therapy.

Walking and Fitness Improvements in a Child With Diplegic Cerebral Palsy Following Motor-Assisted Elliptical Intervention

PURPOSE

To quantify effects of motor-assisted elliptical (Intelligently Controlled Assistive Rehabilitation Elliptical [ICARE]) training on walking and fitness of a child with cerebral palsy (CP).

KEY POINTS

A 12-year-old boy with walking limitations due to spastic diplegic CP (Gross Motor Function Classification System II) participated in 24 sessions of primarily moderate- to vigorous-intensity ICARE exercise. Fitness improvements were evidenced clinically across sessions by the child's capacity to train for longer periods, at faster speeds, and while overriding motor's assistance. Postintervention, the child walked faster with greater stability and endurance and more rapidly completed the modified Time Up and Go test.

CONCLUSION

The child's fitness and gait improved following engagement in a moderate- to vigorous-intensity gait-like exercise intervention.

RECOMMENDATIONS FOR CLINICAL PRACTICE

Integration of moderate- to vigorous-intensity motor-assisted elliptical training can promote simultaneous gains in fitness and function for children with CP.

Kinematic and muscle demand similarities between motor-assisted elliptical training and walking: Implications for pediatric gait rehabilitation

Many children with physical disabilities and special health care needs experience barriers to accessing effective therapeutic technologies to improve walking and fitness in healthcare and community environments. The expense of many robotic and exoskeleton technologies hinders widespread use in most clinics, school settings, and fitness facilities. A motor-assisted elliptical trainer that is being used to address walking and fitness deficits in adults was modified to enable children as young as three years of age to access the technology (Pedi-ICARE). We compared children's kinematic and muscle activation patterns during walking and training on the Pedi-ICARE. Eighteen children walked (self-selected comfortable speed), Pedi-ICARE trained with motor-assistance at self-selected comfortable speed (AAC), and trained while over-riding motor-assistance (AAC+). Coefficient of multiple correlations (CMCs) compared lower extremity kinematic profiles during AAC and AAC+ to gait. Repeated measures ANOVAs identified muscle demand differences across conditions. CMCs revealed strong similarities at the hip and knee between each motor-assisted elliptical condition and gait. Ankle CMCs were only moderate. Muscle demands were generally lowest during AAC. Over-riding the motor increased hip and knee muscle demands. The similarity of motion patterns between Pedi-ICARE conditions and walking suggest the device could be used to promote task-specific training to improve walking. The capacity to manipulate muscle demands using different motor-assistance conditions highlights Pedi-ICARE's versatility in addressing a wide range of children's abilities.