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Bales I, Zhang H. A six degrees-of-freedom cable-driven robotic platform for head-neck movement. Sci Rep 2024; 14:8750. [PMID: 38627418 PMCID: PMC11021449 DOI: 10.1038/s41598-024-59349-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
This paper introduces a novel cable-driven robotic platform that enables six degrees-of-freedom (DoF) natural head-neck movements. Poor postural control of the head-neck can be a debilitating symptom of neurological disorders such as amyotrophic lateral sclerosis and cerebral palsy. Current treatments using static neck collars are inadequate, and there is a need to develop new devices to empower movements and facilitate physical rehabilitation of the head-neck. State-of-the-art neck exoskeletons using lower DoF mechanisms with rigid linkages are limited by their hard motion constraints imposed on head-neck movements. By contrast, the cable-driven robot presented in this paper does not constrain motion and enables wide-range, 6-DoF control of the head-neck. We present the mechatronic design, validation, and control implementations of this robot, as well as a human experiment to demonstrate a potential use case of this versatile robot for rehabilitation. Participants were engaged in a target reaching task while the robot applied both assistive and resistive moments on the head during the task. Our results show that neck muscle activation increased by 19% when moving the head against resistance and decreased by 28-43% when assisted by the robot. Overall, these results provide a scientific justification for further research in enabling movement and identifying personalized rehabilitation for motor training. Beyond rehabilitation, other applications such as applying force perturbations on the head to study sensory integration and applying traction to achieve pain relief may benefit from the innovation of this robotic platform which is capable of applying controlled 6-DoF forces/moments on the head.
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Affiliation(s)
- Ian Bales
- Robotics Center and Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, 84112, USA
| | - Haohan Zhang
- Robotics Center and Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, 84112, USA.
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Rastgar Koutenaei F, Noorizadeh Dehkordi S, Amini M, ShahAli S. Effect of Swiss Ball Stabilization Training on Trunk Control, Abdominal Muscle Thickness, Balance, and Motor Skills of Children With Spastic Cerebral Palsy: A Randomized, Superiority Trial. Arch Phys Med Rehabil 2023; 104:1755-1766. [PMID: 37442218 DOI: 10.1016/j.apmr.2023.05.011] [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: 02/09/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES To compare the effects of Swiss ball stabilization training (SBST) and stable surface stabilization training (SSST) on the trunk control, abdominal muscle thickness, balance, and motor skills of children with spastic cerebral palsy (CWSCP). DESIGN Single-blind, randomized superiority trial. SETTING General Community and Referral Center. PARTICIPANTS Thirty CWSCP, aged 6-12 years, with Gross Motor Function Classification System levels I-III were randomly assigned to the SBST and SSST groups (N=30). INTERVENTIONS The participants were randomized to receive either SBST or SSST for 5 weeks, 3 days a week. OUTCOME MEASURES The Trunk Control Measurement Scale (TCMS), abdominal muscle thickness, Pediatric Balance Scale (PBS), standing and walking sections of Gross Motor Function Measure (GMFM-88), and mobility section of the Pediatric Evaluation of Disability Inventory (PEDI) were assessed. RESULTS After 5 weeks of the intervention and 9 weeks of follow-up, the SBST group showed statistically significant improvements in the TCMS, GMFM-88, PEDI, thickness of the internal oblique muscle at rest and contraction, and thickness of the transverse abdominis muscle at rest and contraction compared with the SSST group (P<.0001). Contrarily, the thickness of the external oblique muscle increased statistically significantly in the SSST group compared with the SBST group after 5 weeks of the intervention and 9 weeks of follow-up both at rest (P<.0001 and P=.0001, respectively) and contraction (P=.015 and P=.017, respectively). No statistically significant difference was found between the groups regarding the PBS score after 5 weeks of intervention. CONCLUSION The SBST could improve the trunk control, balance, and motor skills of CWSCP and increase the thickness of local abdominal muscles. Also, SBST was more effective than SSST for CWSCP.
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Affiliation(s)
- Forouzan Rastgar Koutenaei
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shohreh Noorizadeh Dehkordi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Malek Amini
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam ShahAli
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Bertoncelli CM, Bertoncelli D, Bagui SS, Bagui SC, Costantini S, Solla F. Identifying Postural Instability in Children with Cerebral Palsy Using a Predictive Model: A Longitudinal Multicenter Study. Diagnostics (Basel) 2023; 13:2126. [PMID: 37371021 DOI: 10.3390/diagnostics13122126] [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: 04/26/2023] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Insufficient postural control and trunk instability are serious concerns in children with cerebral palsy (CP). We implemented a predictive model to identify factors associated with postural impairments such as spastic or hypotonic truncal tone (TT) in children with CP. We conducted a longitudinal, double-blinded, multicenter, descriptive study of 102 teenagers with CP with cognitive impairment and severe motor disorders with and without truncal tone impairments treated in two specialized hospitals (60 inpatients and 42 outpatients; 60 males, mean age 16.5 ± 1.2 years, range 12 to 18 yrs). Clinical and functional data were collected between 2006 and 2021. TT-PredictMed, a multiple logistic regression prediction model, was developed to identify factors associated with hypotonic or spastic TT following the guidelines of "Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis". Predictors of hypotonic TT were hip dysplasia (p = 0.01), type of etiology (postnatal > perinatal > prenatal causes; p = 0.05), male gender, and poor manual (p = 0.01) and gross motor function (p = 0.05). Predictors of spastic TT were neuromuscular scoliosis (p = 0.03), type of etiology (prenatal > perinatal > postnatal causes; p < 0.001), spasticity (quadri/triplegia > diplegia > hemiplegia; p = 0.05), presence of dystonia (p = 0.001), and epilepsy (refractory > controlled, p = 0.009). The predictive model's average accuracy, sensitivity, and specificity reached 82%. The model's accuracy aligns with recent studies on applying machine learning models in the clinical field.
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Affiliation(s)
- Carlo Marioi Bertoncelli
- Department of Computer Science, Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, FL 32514, USA
- EEAP H Germain and Department of Pediatric Orthopaedic Surgery, Lenval Foundation, University Pediatric Hospital of Nice, 06000 Nice, France
- Department of Information Engineering, Computer Science and Mathematics, University of L'Aquila, 67100 L'Aquila, Italy
| | - Domenico Bertoncelli
- Department of Computer Science, Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, FL 32514, USA
- Department of Information Engineering, Computer Science and Mathematics, University of L'Aquila, 67100 L'Aquila, Italy
| | - Sikha S Bagui
- Department of Computer Science, Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, FL 32514, USA
| | - Subhash C Bagui
- Department of Computer Science, Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, FL 32514, USA
| | - Stefania Costantini
- Department of Information Engineering, Computer Science and Mathematics, University of L'Aquila, 67100 L'Aquila, Italy
| | - Federico Solla
- EEAP H Germain and Department of Pediatric Orthopaedic Surgery, Lenval Foundation, University Pediatric Hospital of Nice, 06000 Nice, France
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López-Ruiz J, Estrada-Barranco C, Martín-Gómez C, Egea-Gámez RM, Valera-Calero JA, Martín-Casas P, López-de-Uralde-Villanueva I. Trunk Control Measurement Scale (TCMS): Psychometric Properties of Cross-Cultural Adaptation and Validation of the Spanish Version. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20065144. [PMID: 36982053 PMCID: PMC10049461 DOI: 10.3390/ijerph20065144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 06/01/2023]
Abstract
The aim of this study was to develop a Spanish Version of the Trunk Measurement Scale (TCMS-S) to analyze its validity and reliability and determine the Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC) in children with Cerebral Palsy (CP). Participants were assessed twice 7-15 days apart with the TCMS-S and once with the Gross Motor Function Measurement-88 (GMFM-88), Pediatric Disability Inventory-Computer Adaptive Test (PEDI-CAT), Cerebral Palsy Quality of Life (CPQoL), and Gross Motor Classification System (GMFCS). Internal consistency was evaluated using Cronbach's alpha, and the intraclass correlation (ICC) and kappa coefficients were used to investigate the agreement between the assessments. Finally, 96 participants with CP were included. The TCMS-S showed excellent internal consistency (Cronbach's alpha = 0.95 [0.93 to 0.96]); was highly correlated with the GMFM-88 (rho = 0.816) and the "mobility" subscale of the PEDI-CAT (rho = 0.760); showed a moderate correlation with the "feeling about functioning" CPQoL subscale (rho = 0.576); and differentiated between the GMFCS levels. Excellent test-retest agreement was found for the total and subscale scores (ICC ≥ 0.94 [0.89 to 0.97). For the total TCMS-S score, an SEM of 1.86 and an MDC of 5.15 were found. The TCMS-S is a valid and reliable tool for assessing trunk control in children with CP.
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Affiliation(s)
- Javier López-Ruiz
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea of Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (J.L.-R.); (C.E.-B.)
- Doctoral Program in Healthcare, Faculty of Nursing, Physiotherapy and Podiatry. University Complutense of Madrid, 28040 Madrid, Spain
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.A.V.-C.); (I.L.-d.-U.-V.)
| | - Cecilia Estrada-Barranco
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea of Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (J.L.-R.); (C.E.-B.)
| | | | - Rosa M. Egea-Gámez
- Spinal Unit, Department of Orthopedic Surgery and Traumatology, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
| | - Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.A.V.-C.); (I.L.-d.-U.-V.)
- InPhysio Research Group, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Patricia Martín-Casas
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.A.V.-C.); (I.L.-d.-U.-V.)
- InPhysio Research Group, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.A.V.-C.); (I.L.-d.-U.-V.)
- InPhysio Research Group, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Vojta Approach Affects Neck Stability and Static Balance in Sitting Position of Children With Hypotonia. Int Neurourol J 2021; 25:S90-95. [PMID: 34844391 PMCID: PMC8654318 DOI: 10.5213/inj.2142344.172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose In this study, the effect of the Vojta approach on neck stability and static balance in children with hypotonia was studied. Methods Seventeen children with hypotonia were randomly divided into the Vojta approach group (n=9) and the general physical therapy group (n=8). Each group was applied intervention for 30 minutes per session, 3 times a week, for a total of 4 weeks. Ultrasonography was used to measure deep neck flexor muscle thickness, craniovertebral angle (CVA) to measure neck alignment along the spine segment, and Balancia software program to measure static balance. Results In the Vojta approach group, the deep neck flexor muscle thickness was significantly increased (P<0.05), and the CVA was significantly improved (P<0.05). In addition, path area among static balance was significantly improved (P<0.05). Conclusions The Vojta approach can be suggested as an effective intervention method for improving neck stability and static balance in children with hypotonia.
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Acar G, Ejraei N, Turkdoğan D, Enver N, Öztürk G, Aktaş G. The Effects of Neurodevelopmental Therapy on Feeding and Swallowing Activities in Children with Cerebral Palsy. Dysphagia 2021; 37:800-811. [PMID: 34173063 DOI: 10.1007/s00455-021-10329-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/08/2021] [Indexed: 12/01/2022]
Abstract
This study investigated the effect of the structured Neurodevelopmental Therapy Method-Bobath (NDT-B) approach on the feeding and swallowing activity of patients with cerebral palsy (CP) and feeding difficulties. In addition to feeding and oral motor intervention strategies (OMIS), and nutrition-related caregiver training (NRCT), and the NDT-B, which was structured to increase trunk and postural control, was added to the therapy program. Forty patients with CP, with a mean age of 3.25 ± 0.927 years, were classified using the Gross Motor Function Classification System, Eating and Drinking Ability Classification System, and Mini-Manual Ability Classification System. The patients were randomly assigned into two groups as OMIS + NRCT (n = 20) and OMIS + NRCT + NDT-B (n = 20). The program was applied for 6 weeks, 2 days/week, for 45 min. The patients were evaluated using the Trunk Impairment Scale, Schedule for Oral Motor Assessment, and the Pediatric Quality of Life Inventory before and after 6 weeks. The trunk control of the OMIS + NRCT + NDT-B group was superior to the other group (P = 0.026). Although there was an improvement in the groups according to the subcategories of SOMA, the OMIS + NRCT + NDT-B group was superior in the trainer cup and puree subcategories of SOMA (P = 0.05). A significant correlation was observed between trunk control and oral motor functions in children with CP, and the eating function of children in the OMIS + NRCT + NDT-B group further improved. NDT-B-based neck and trunk stabilization exercises should be added to the treatment programs.Trial Registration NCT04403113.
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Affiliation(s)
- Gönül Acar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Basibuyuk, Basibuyuk Cd. No:9, Maltepe, Istanbul, 34854, Turkey
| | - Nasim Ejraei
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Basibuyuk, Basibuyuk Cd. No:9, Maltepe, Istanbul, 34854, Turkey.
| | - Dilşad Turkdoğan
- Department of Child Health and Diseases, Department of Pediatric Neurology, Marmara University Istanbul Pendik Training and Research Hospital, Istanbul, Turkey
| | - Necati Enver
- Department of Otolaryngology, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Gülten Öztürk
- Department of Child Health and Diseases, Department of Pediatric Neurology, Marmara University Istanbul Pendik Training and Research Hospital, Istanbul, Turkey
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Reddy S, Balaji GK. Dynamic Surface Exercise Training in Improving Trunk Control and Gross Motor Functions among Children with Quadriplegic Cerebral Palsy: A Single Center, Randomized Controlled Trial. J Pediatr Neurosci 2021; 15:214-219. [PMID: 33531934 PMCID: PMC7847094 DOI: 10.4103/jpn.jpn_88_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 11/18/2019] [Indexed: 11/14/2022] Open
Abstract
Background: Dynamic surface provides proprioceptive and vestibular feedback with optimal level of arousal. The activities on unstable environment have greater sensorimotor experiences. There is a lack of evidence examining the benefits of dynamic surface exercise training (DSET) among the children with spastic quadriplegic cerebral palsy (CP). Aim: The aim of the study was to analyze the effect of dynamic surface exercises on trunk control and gross motor functions in children with quadriplegic CP. Materials and Methods: A total of 30 children with spastic quadriplegic CP with Gross Motor Function Classification System of levels III and IV were recruited by the simple random sampling method (random number generator) to participate in this randomized controlled study. Recruited children were randomly divided into two groups, DSET group and standard physiotherapy training group. Both the groups received active training program lasting for 60 min, 4 days/week for 6 weeks. Gross Motor Function Measure (GMFM)-88 and Pediatric Balance Scale (PBS) scores were recorded at baseline, and at the end of 6-week post-intervention. Results: Total 30 children with quadriplegic CP with mean age 6.64 ± 2.15 years in experimental group and 6.50 ±1.59 years in control group participated in the study. Experimental group showed a significant difference for GMFM and PBS scores between pre- and post-intervention with P < 0.005. A significant difference was observed in GMFM scores between experimental and control group with P < 0.005. Conclusion: Six-week dynamic surface exercise therapy along with standard physiotherapy was effective in improving trunk control and gross motor function performance among children with spastic quadriplegic CP aged 6–12 years.
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Affiliation(s)
- Sravan Reddy
- Chitkara School of Health Sciences, Chitkara University, Punjab, India
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van der Linden ML, Corrigan O, Tennant N, Verheul MHG. Cluster analysis of impairment measures to inform an evidence-based classification structure in RaceRunning, a new World Para Athletics event for athletes with hypertonia, ataxia or athetosis. J Sports Sci 2020; 39:159-166. [PMID: 33337948 DOI: 10.1080/02640414.2020.1860360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
RaceRunning enables athletes with limited or no walking ability to propel themselves independently using a three-wheeled frame that has a saddle, handle bars and a chest plate. For RaceRunning to be included as a para athletics event, an evidence-based classification system is required. This study assessed the impact of trunk control and lower limb impairment measures on RaceRunning performance and evaluated whether cluster analysis of these impairment measures produces a valid classification structure for RaceRunning. The Trunk Control Measurement Scale (TCMS), Selective Control Assessment of the Lower Extremity (SCALE), the Australian Spasticity Assessment Scale (ASAS), and knee extension were recorded for 26 RaceRunning athletes. Thirteen male and 13 female athletes aged 24 (SD = 7) years participated. All impairment measures were significantly correlated with performance (rho = 0.55-0.74). Using ASAS, SCALE, TCMS and knee extension as cluster variables in a two-step cluster analysis resulted in two clusters of athletes. Race speed and the impairment measures were significantly different between the clusters (p < 0.001). The findings of this study provide evidence for the utility of the selected impairment measures in an evidence-based classification system for RaceRunning athletes.
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Affiliation(s)
| | - Orla Corrigan
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, UK
| | - Nicola Tennant
- Cerebral Palsy International Sports and Recreation Association, Glasgow, UK
| | - Martine H G Verheul
- Human Performance Science Research Group, Institute for Sport, Physical Education & Health Sciences, University of Edinburgh, Edinburgh, UK
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