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Gröble S, van Hedel HJA, Keller JW, Ammann-Reiffer C. Differences in gait parameters when crossing real versus projected everyday life obstacles in healthy children and adolescents. Sci Rep 2023; 13:7848. [PMID: 37188711 DOI: 10.1038/s41598-023-34276-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/27/2023] [Indexed: 05/17/2023] Open
Abstract
Practicing complex everyday life walking activities is challenging in paediatric neurorehabilitation, although it would prepare patients more comprehensively for the requirements of daily life. Floor projections allow simulation and training of such situations in therapy. Twenty healthy youths aged 6-18 years stepped over a tree trunk and balanced over kerbstones in a real and projected condition. Spatiotemporal and kinematic parameters of the two conditions were compared by equivalence analysis, using the medians of the differences between the two conditions with their bootstrapped 95% confidence intervals. Velocity, step and stride length, step width, and single support time were generally equivalent between the two conditions. Knee and hip joint angles and toe clearance decreased substantially during the execution phase of the projected tree trunk condition. The largest differences were found at the end of the execution phase in both tasks for the ankle joints. As spatiotemporal parameters were equivalent between the conditions, floor projections seem suitable to train precise foot placement. However, differences in knee and hip joint kinematics and toe clearance revealed that floor projections are not applicable for obstacles with a vertical extension. Therefore, exercises aiming at knee and hip flexion improvement should favourably be trained with real objects.
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Affiliation(s)
- Sabrina Gröble
- Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern am Albis, Switzerland.
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
- Department of Health Sciences and Technology, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland.
- Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland.
| | - Hubertus J A van Hedel
- Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern am Albis, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Jeffrey W Keller
- Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern am Albis, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
- Federal Office of Public Health FOPH, Schwarzenburgstrasse 157, 3003, Bern, Switzerland
| | - Corinne Ammann-Reiffer
- Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern am Albis, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
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2
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Castelli E, Beretta E, De Tanti A, Arduini F, Biffi E, Colazza A, Di Pede C, Guzzetta A, Lucarini L, Maghini I, Mandalà M, Nespoli M, Pavarelli C, Policastro F, Polverelli M, Rossi A, Sgandurra G, Boldrini P, Bonaiuti D, Mazzoleni S, Posteraro F, Benanti P, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Morone G, Petrarca M, Picelli A, Senatore M, Turchetti G, Saviola D, Turchetti G. Robot-assisted rehabilitation for children with neurological disabilities: Results of the Italian consensus conference CICERONE. NeuroRehabilitation 2022; 51:665-679. [PMID: 36530098 DOI: 10.3233/nre-220036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The use of robotic technologies in pediatric rehabilitation has seen a large increase, but with a lack of a comprehensive framework about their effectiveness. OBJECTIVE An Italian Consensus Conference has been promoted to develop recommendations on these technologies: definitions and classification criteria of devices, indications and limits of their use in neurological diseases, theoretical models, ethical and legal implications. In this paper, we present the results for the pediatric age. METHODS A systematic search on Cochrane Library, PEDro and PubMed was performed. Papers published up to March 1st, 2020, in English, were included and analyzed using the methodology of the Centre for Evidence-Based Medicine in Oxford, AMSTAR2 and PEDro scales for systematic reviews and RCT, respectively. RESULTS Some positives aspects emerged in the area of gait: an increased number of children reaching the stance, an improvement in walking distance, speed and endurance. Critical aspects include the heterogeneity of the studied cases, measurements and training protocols. CONCLUSION Many studies demonstrate the benefits of robotic training in developmental age. However, it is necessary to increase the number of trials to achieve greater homogeneity between protocols and to confirm the effectiveness of pediatric robotic rehabilitation.
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Affiliation(s)
| | - Elena Beretta
- IRCCS Eugenio Medea, La Nostra Famiglia, Ponte Lambro, Italy
| | - Antonio De Tanti
- KOS-CARE, Santo Stefano Rehabilitation, Cardinal Ferrari Center, Parma, Italy
| | | | - Emilia Biffi
- IRCCS Eugenio Medea, La Nostra Famiglia, Ponte Lambro, Italy
| | | | - Chiara Di Pede
- IRCCS Eugenio Medea, La Nostra Famiglia, Ponte Lambro, Italy
| | - Andrea Guzzetta
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy.,Dipartimento di Neuroscienze dello Sviluppo, IRCCS Stella Maris, Pisa, Italy
| | | | - Irene Maghini
- Department of Women's and Children's Health, Pediatric Pain and Palliative Care Service, University of Padua, Padua, Italy
| | - Martina Mandalà
- IRCCS Santa Maria Nascente - Fondazione Don C. Gnocchi, Milan, Italy
| | | | - Claudia Pavarelli
- Servizio di Neuropsichiatria Infanzia e dell'Adolescenza (NPIA), Vignola, Italy
| | - Francesca Policastro
- Dipartimento Scienze Mediche e Chirurgiche, Università degli Studi di Trieste, Trieste, Italy
| | - Marco Polverelli
- Dipartimento Riabilitazione, Azienda Ospedaliera Nazionale SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Andrea Rossi
- ASST Spedali Civili di Brescia, Ospedale dei Bambini, Brescia, Italy
| | - Giuseppina Sgandurra
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy.,Dipartimento di Neuroscienze dello Sviluppo, IRCCS Stella Maris, Pisa, Italy
| | - Paolo Boldrini
- Italian Society of Physical Medicine and Rehabilitation, (SIMFER), Rome, Italy
| | - Donatella Bonaiuti
- Italian Society of Physical Medicine and Rehabilitation, (SIMFER), Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital - AUSL12, Viareggio, Italy
| | | | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- Rehabilitation Unit, ULSS (Local Health Autority) Euganea, Camposampietro Hospital, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | | | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | - Donatella Saviola
- KOS-CARE, Santo Stefano Rehabilitation, Cardinal Ferrari Center, Parma, Italy
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3
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van Dellen F, Labruyère R. Settings matter: a scoping review on parameters in robot-assisted gait therapy identifies the importance of reporting standards. J Neuroeng Rehabil 2022; 19:40. [PMID: 35459246 PMCID: PMC9034544 DOI: 10.1186/s12984-022-01017-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 04/04/2022] [Indexed: 12/02/2022] Open
Abstract
Background Lokomat therapy for gait rehabilitation has become increasingly popular. Most evidence suggests that Lokomat therapy is equally effective as but not superior to standard therapy approaches. One reason might be that the Lokomat parameters to personalize therapy, such as gait speed, body weight support and Guidance Force, are not optimally used. However, there is little evidence available about the influence of Lokomat parameters on the effectiveness of the therapy. Nevertheless, an appropriate reporting of the applied therapy parameters is key to the successful clinical transfer of study results. The aim of this scoping review was therefore to evaluate how the currently available clinical studies report Lokomat parameter settings and map the current literature on Lokomat therapy parameters. Methods and results A systematic literature search was performed in three databases: Pubmed, Scopus and Embase. All primary research articles performing therapy with the Lokomat in neurologic populations in English or German were included. The quality of reporting of all clinical studies was assessed with a framework developed for this particular purpose. We identified 208 studies investigating Lokomat therapy in patients with neurologic diseases. The reporting quality was generally poor. Less than a third of the studies indicate which parameter settings have been applied. The usability of the reporting for a clinical transfer of promising results is therefore limited. Conclusion Although the currently available evidence on Lokomat parameters suggests that therapy parameters might have an influence on the effectiveness, there is currently not enough evidence available to provide detailed recommendations. Nevertheless, clinicians should pay close attention to the reported therapy parameters when translating research findings to their own clinical practice. To this end, we propose that the quality of reporting should be improved and we provide a reporting framework for authors as a quality control before submitting a Lokomat-related article. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01017-3.
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Affiliation(s)
- Florian van Dellen
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Tannenstrasse 1, 8092, Zurich, Switzerland. .,Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern am Albis, Switzerland. .,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
| | - Rob Labruyère
- Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
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Gonzalez A, Garcia L, Kilby J, McNair P. Robotic devices for paediatric rehabilitation: a review of design features. Biomed Eng Online 2021; 20:89. [PMID: 34488777 PMCID: PMC8420060 DOI: 10.1186/s12938-021-00920-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/06/2021] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Alberto Gonzalez
- BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Lorenzo Garcia
- BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Jeff Kilby
- BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Peter McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
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5
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The Effectiveness of Robot- vs. Virtual Reality-Based Gait Rehabilitation: A Propensity Score Matched Cohort. Life (Basel) 2021; 11:life11060548. [PMID: 34208009 PMCID: PMC8230650 DOI: 10.3390/life11060548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 01/05/2023] Open
Abstract
Robot assisted gait training (RAGT) and virtual reality plus treadmill training (VRTT) are two technologies that can support locomotion rehabilitation in children and adolescents affected by acquired brain injury (ABI). The literature provides evidence of their effectiveness in this population. However, a comparison between these methods is not available. This study aims at comparing the effectiveness of RAGT and VRTT for the gait rehabilitation of children and adolescents suffering from ABI. This is a prospective cohort study with propensity score matching. Between October 2016 and September 2018, all patients undergoing an intensive gait rehabilitation treatment based on RAGT or VRTT were prospectively observed. To minimize selection bias associated with the study design, patients who underwent RAGT or VRTT were retrospectively matched for age, gender, time elapsed from injury, level of impairment, and motor impairment using propensity score in a matching ratio of 1:1. Outcome measures were Gross Motor Function Mesure-88 (GMFM-88), six-min walking test (6MWT), Gillette Functional Assessment Questionnaire (FAQ), and three-dimensional gait analysis (GA). The FAQ and the GMFM-88 had a statistically significant increase in both groups while the 6MWT improved in the RAGT group only. GA highlighted changes at the proximal level in the RAGT group, and at the distal district in the VRTT group. Although preliminary, this work suggests that RAGT and VRTT protocols foster different motor improvements, thus recommending to couple the two therapies in the paediatric population with ABI.
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Spivak MR, Chan JR, Cooper MS, Petrucci C, Sheridan AM, Tang TY, Wright FV, Ryan JL. Reliability of the Revised Motor Learning Strategies Rating Instrument and Its Role in Describing the Motor Learning Strategy Content of Physiotherapy Sessions in Paediatric Acquired Brain Injury. Physiother Can 2021; 73:381-390. [DOI: 10.3138/ptc-2020-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | | | | | | | | | | | - F. Virginia Wright
- Department of Physical Therapy
- Rehabilitation Sciences Institute, University of Toronto
- Bloorview Research Institute, Toronto, Ont
| | - Jennifer L. Ryan
- Rehabilitation Sciences Institute, University of Toronto
- Bloorview Research Institute, Toronto, Ont
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7
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Burnfield JM, Cesar GM, Buster TW. Feasibility of motor-assisted elliptical to improve walking, fitness and balance following pediatric acquired brain injury: A case series. J Pediatr Rehabil Med 2021; 14:539-551. [PMID: 33935119 DOI: 10.3233/prm-200717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Walking, fitness, and balance deficits are common following acquired brain injury (ABI). This study assessed feasibility, acceptability, and usefulness of a modified motor-assisted elliptical (ICARE) in addressing walking, fitness, and balance deficits in children with chronic ABIs. METHODS Three children (> 5 years post-ABI) completed 24 ICARE exercise sessions (exercise time, speed, and time overriding motor-assistance gradually increased) to promote mass repetition of gait-like movements and challenge cardiorespiratory fitness. Parents' and children's perceptions of ICARE's safety, comfort, workout, and usability were assessed. Cardiovascular response, gait and balance outcomes were assessed. RESULTS No adverse events occurred. Parent's Visual Analogue Scale (VAS) scores of perceived device safety (range 80-99), workout (range 99-100), and usability (range 75-100) were high, while comfort were 76-80 given commercial harness fit and arm support. Children's VAS scores all exceeded 89. Comfortable walking velocity, 2-Minute Walk Test, fitness, and Pediatric Balance Scale scores improved post-training, with many outcomes surpassing established minimal clinically important differences. CONCLUSION Following engagement in moderate- to vigorous-intensity exercise promoting repetitive step-like movements on a specially adapted motor-assisted elliptical, three children with chronic ABI demonstrated improvements in walking, fitness and balance. Future research in community-based environments with a larger cohort of children with ABI is needed.
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Affiliation(s)
- Judith M Burnfield
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Guilherme M Cesar
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Thad W Buster
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
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Minimum Clinically Important Difference of Gross Motor Function and Gait Endurance in Children with Motor Impairment: A Comparison of Distribution-Based Approaches. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2794036. [PMID: 32509855 PMCID: PMC7246400 DOI: 10.1155/2020/2794036] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/18/2020] [Accepted: 04/22/2020] [Indexed: 01/17/2023]
Abstract
Objective The minimum clinically important difference (MCID) is a standard way of measuring clinical relevance. The objective of this work was to establish the MCID for the 6-minute walking test (6minWT) and the Gross Motor Function Measure (GMFM-88) in pediatric gait disorders. Methods A cohort, pretest-posttest study was conducted in a hospitalized care setting. A total of 182 patients with acquired brain injury (ABI) or cerebral palsy (CP) performed 20 robot-assisted gait training sessions complemented with 20 sessions of physical therapy over 4 weeks. Separate MCIDs were calculated using 5 distribution-based approaches, complemented with an anonymized survey completed by clinical professionals. Results The MCID range for the 6minWT was 20-38 m in the ABI cohort, with subgroup ranges of 20-36 m for GMFCS I-II, 23-46 m for GMFCS III, and 24-46 m for GMFCS IV. MCIDs for the CP population were 6-23 m, with subgroup ranges of 4-28 m for GMFCS I-II, 9-19 m for GMFCS III, and 10-27 m for GMFCS IV. For GMFM-88 total score, MCID values were 1.1%-5.3% for the ABI cohort and 0.1%-3.0% for the CP population. For dimension “D” of the GMFM, MCID ranges were 2.3%-6.5% and 0.8%-5.2% for ABI and CP populations, respectively. For dimension “E,” MCID ranges were 2.8%-6.5% and 0.3%-4.9% for ABI and CP cohorts, respectively. The survey showed a large interquartile range, but the results well mimicked the distribution-based methods. Conclusions This study identified for the first time MCID ranges for 6minWT and GMFM-88 in pediatric patients with neurological impairments, offering useful insights for clinicians to evaluate the impact of treatments. Distribution-based methods should be used with caution: methods based on pre-post correlation may underestimate MCID when applied to patients with small improvements over the treatment period. Our results should be complemented with estimates obtained using consensus- and anchor-based approaches.
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Tanner L, Keppner K, Lesmeister D, Lyons K, Rock K, Sparrow J. Cancer Rehabilitation in the Pediatric and Adolescent/Young Adult Population. Semin Oncol Nurs 2020; 36:150984. [DOI: 10.1016/j.soncn.2019.150984] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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10
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Motor Improvement in Adolescents Affected by Ataxia Secondary to Acquired Brain Injury: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8967138. [PMID: 31886263 PMCID: PMC6899307 DOI: 10.1155/2019/8967138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/01/2019] [Accepted: 08/10/2019] [Indexed: 11/23/2022]
Abstract
Aim To assess changes in locomotion and balance in adolescents affected by ataxia secondary to acquired brain injury after a rehabilitation treatment with physiotherapy and the Gait Real-time Analysis Interactive Lab (GRAIL), an immersive virtual reality platform. Methods 11 ataxic adolescents (16(5) years old, 4.7(6.7) years from injury) underwent 20 45-minute sessions with GRAIL plus 20 45-minute sessions of physiotherapy in one month. Patients were assessed before and after rehabilitation with functional scales and three-dimensional multiple-step gait analysis. Results Results showed significant improvements in ataxia score assessed by the Scale for the Assessment and Rating of Ataxia, in dimension D and E of Gross Motor Function Measure, in walking endurance and in balance abilities. Moreover, the training fostered significant changes at hip, knee, and ankle joints, and the decrease of gait variability, toward healthy references. Interpretation In spite of the pilot nature of the study, data suggest that training with immersive virtual reality and physiotherapy is a promising approach for ataxic gait rehabilitation, even in chronic conditions.
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11
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Ghai S, Ghai I. Virtual Reality Enhances Gait in Cerebral Palsy: A Training Dose-Response Meta-Analysis. Front Neurol 2019; 10:236. [PMID: 30984095 PMCID: PMC6448032 DOI: 10.3389/fneur.2019.00236] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/22/2019] [Indexed: 01/26/2023] Open
Abstract
Virtual-reality-based training can influence gait recovery in children with cerebral palsy. A consensus concerning its influence on spatiotemporal gait parameters and effective training dosage is still warranted. This study analyzes the influence of virtual-reality training (relevant training dosage) on gait recovery in children with cerebral palsy. A search was performed by two reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines on nine databases: PEDro, EBSCO, PubMed, Cochrane, Web of Science, EMBASE, ICI, Scopus, and PROQUEST. Of 989 records, 16 studies involving a total of 274 children with cerebral palsy met our inclusion criteria. Eighty-eight percent of the studies reported significant enhancements in gait performance after training with virtual reality. Meta-analyses revealed positive effects of virtual-reality training on gait velocity (Hedge's g = 0.68), stride length (0.30), cadence (0.66), and gross motor function measure (0.44). Subgroup analysis reported a training duration of 20–30 min per session, ≤4 times per week across ≥8 weeks to allow maximum enhancements in gait velocity. This study provides preliminary evidence for the beneficial influence of virtual-reality training in gait rehabilitation for children with cerebral palsy.
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Affiliation(s)
- Shashank Ghai
- Institute for Sports Science, Leibniz University Hannover, Hannover, Germany
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12
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Ricklin S, Meyer-Heim A, van Hedel HJA. Dual-task training of children with neuromotor disorders during robot-assisted gait therapy: prerequisites of patients and influence on leg muscle activity. J Neuroeng Rehabil 2018; 15:82. [PMID: 30223840 PMCID: PMC6142352 DOI: 10.1186/s12984-018-0426-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 09/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Walking in daily life is complex entailing various prerequisites such as leg strength, trunk stability or cognitive and motor dual task (DT) activities. Conventional physiotherapy can be complemented with robot-assisted gait therapy (RAGT) and exergames to enhance the number of step repetitions, feedback, motivation, and additional simultaneously performed tasks besides walking (e.g., dual-task (DT) activities). Although DT gait training leads to improvements in daily ambulation in adult patient groups, no study has evaluated RAGT with a DT exergame in children with neurological gait disorders. Therefore, we investigated children's functional and cognitive prerequisites to walk physiologically during RAGT with a DT exergame and analysed the influence of DT on leg muscle activity. METHODS Children and adolescents (6-18 years) with neurological gait disorders completed RAGT with and without a DT exergame in this quasi-experimental study. We assessed several measures on the body function and activity domains (according to the International Classification of Functioning, Disability, and Health (ICF)) and determined whether these measures could distinguish well between children who walked physiologically during the DT RAGT or not. We measured leg muscle activity with surface electrodes to identify changes in EMG-amplitudes and -patterns. RESULTS Twenty-one children participated (7 females, 6.5-17.3 years, Gross Motor Function Classification System (GMFCS) levels I-IV). Most activity measures distinguished significantly between participants performing the DT exergame physiologically or not with moderate to good sensitivity (0.8 ≤ sensitivity≤1.0) and specificity (0.5 ≤ specificity≤0.9). Body function measures differentiated less well. Despite that the EMG-amplitudes of key stance muscles were significantly lower during DT versus no DT exergaming, the mean activation patterns of all muscles correlated high (ρ > 0.75) between the conditions. CONCLUSION This study is the first that investigated effects of a DT exergame during RAGT in children with neurological gait disorders. Several performance measures could differentiate well between patients who walked with physiological versus compensatory movements while performing the DT exergame. While the DT exergame affected the leg muscle activity amplitudes, it did not largely affect the activity patterns of the muscles.
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Affiliation(s)
- Sandra Ricklin
- Rehabilitation Centre Affoltern am Albis, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland. .,Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland. .,Children's Research Centre, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland. .,Physiotherapist in Robotics of Lower Extremity and in the Gait Laboratory Research Associate Paediatric Rehab Research Group Rehabilitation Centre for Children and Adolescents, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.
| | - Andreas Meyer-Heim
- Rehabilitation Centre Affoltern am Albis, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland
| | - Hubertus J A van Hedel
- Rehabilitation Centre Affoltern am Albis, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland
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Robotically-driven orthoses exert proximal-to-distal differential recovery on the lower limbs in children with hemiplegia, early after acquired brain injury. Eur J Paediatr Neurol 2018; 22:652-661. [PMID: 29650492 DOI: 10.1016/j.ejpn.2018.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 03/15/2018] [Accepted: 03/18/2018] [Indexed: 11/24/2022]
Abstract
Robotically-driven orthoses (RDO) are promising for treating gait impairment in children with hemiplegia after acquired brain injury (ABI). Despite this, existing literature on the employment of RDO in ABI is scanty, and cohorts' age spans throughout the adult age, with no specific focus on the developmental age. We aim to compare a treatment solely based on conventional physiotherapy (CP) with a program combining RDO training with CP, and to examine the effect of time following ABI on recovery. A prospective two-cohorts study was conducted in a rehabilitation hospital. Post-acute and chronic children with hemiplegia due to ABI underwent either: (i) 20 sessions of RDO plus 20 sessions of CP (n = 29), or (ii) 40 of CP (n = 12). Gross Motor Function Measures (GMFM), Functional Assessment Questionnaire (FAQ), 6 Minutes Walk Test and gait analysis (GA) parameters were recorded before and after training. Over all the patients in RDO + CP group, all GMFM domains and FAQ improved after RDO training (p < 0.05). The unaffected limb showed significantly decreased stance, increased step length and reduced anteroposterior center of pressure oscillation; the affected side increased the stride length. ROM hip and knee flex-extension increased bilaterally (p < 0.05 for all). RDO training during the acute/subacute post-injury phase increased motor functional abilities, cadence and velocity of gait (p < 0.05). We conclude that RDO imposes a proximal-to-distal differential effect on the lower limbs, with the hip joint being the most stimulated. RDO training fostered recovery, increasing the quality of gait on the unaffected side. Planning RDO early in the rehabilitation course of pediatric ABI is advantageous. RDO + CP may extend rehabilitation efficacy to the proximal segment of leg and to gait velocity.
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Beretta E, Cesareo A, Maghini C, Turconi AC, Reni G, Strazzer S, Biffi E. An Immersive Virtual Reality Platform to Enhance Walking Ability of Children with Acquired Brain Injuries. Methods Inf Med 2018; 56:119-126. [DOI: 10.3414/me16-02-0020] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 11/21/2016] [Indexed: 11/09/2022]
Abstract
SummaryBackground: Acquired brain injury (ABI) may result in lifelong impairment of physical, cognitive, and psychosocial functions. Several rehabilitative treatments are often needed to support walking recovery, thus participants’ engagement becomes a crucial aspect, especially when patients are children. In the last few years, traditional physiotherapy (PT) has been flanked by innovative technologies for rehabilitation in the fields of robotics and Virtual Reality (VR). Preliminary results have shown interesting perspectives in the use of a VR system, the GRAIL (Gait Real-time Analysis Interactive Lab), in improving walking abilities in a small group of children with ABI, although further insights are needed about its use as rehabilitative tool in the pediatric population.Objectives: To evaluate the efficacy of a rehabilitation treatment on a GRAIL system for the improvement of walking abilities, in a group of children suffering from ABI.Methods: 12 children with ABI (study group – SG; mean age = 12.1 ± 3.8 years old) underwent a 10-session treatment with the GRAIL, an instrumented multi-sensor platform based on immersive VR for gait training and rehabilitation in engaging VR environments. Before (T0) and at the end of the treatment (T1), the participants were assessed by means of functional scales (Gross Motor Function Measure (GMFM), Functional Assessment Questionnaire (FAQ), 6-Minute Walk Test (6minWT) and the 3D-Gait Analysis, over ground (OGA) and on GRAIL (GGA).Results: All the participants completed the rehabilitative treatment. The functional evaluations showed an improvement in Gross Motor abilities (GMFM-88, p = 0.008), especially in standing (GMFM-D, p = 0.007) and walking (GMFM-E, p = 0.005), an increase of the endurance (6minWT, p = 0.002), and enhanced autonomy in daily life activities (FAQ, p = 0.025). OGA identified a significant decrease of the Gillette Gait Index for the impaired side and a general increase of symmetry. GGA showed improvements in spatiotemporal parameters and joints range of motion that moved towards normality and symmetry recovery.Conclusions: A 10-session treatment with GRAIL on children with ABI led to improvements in their walking abilities and enhanced their engagement during the training. This is desirable when long life impairments are faced and children’s motor functions have to be regained and it supports the leading role that VR might have in the rehabilitation field.
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Wade SL, Narad ME, Shultz EL, Kurowski BG, Miley AE, Aguilar JM, Adlam ALR. Technology-assisted rehabilitation interventions following pediatric brain injury. J Neurosurg Sci 2017; 62:187-202. [PMID: 29154509 DOI: 10.23736/s0390-5616.17.04277-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Following traumatic brain injury (TBI), children experience a variety of physical, motor, speech, and cognitive deficits that can have a long-term detrimental impact. The emergence and popularity of new technologies has led to research into the development of various apps, gaming systems, websites, and robotics that might be applied to rehabilitation. The objective of this narrative review was to describe the current literature regarding technologically-assisted interventions for the rehabilitation of motor, neurocognitive, behavioral, and family impairments following pediatric TBI. EVIDENCE ACQUISITION We conducted a series of searches for peer-reviewed manuscripts published between 2000 and 2017 that included a technology-assisted component in the domains of motor, language/communication, cognition, behavior, social competence/functioning, family, and academic/school-based functioning. EVIDENCE SYNTHESIS Findings suggested several benefits of utilizing technology in TBI rehabilitation including facilitating engagement/adherence, increasing access to therapies, and improving generalizability across settings. There is fairly robust evidence regarding the efficacy of online family problem-solving therapy in improving behavior problems, executive functioning, and family functioning. There was less compelling, but still promising, evidence regarding the efficacy other technology for motor deficits, apps for social skills, and computerized programs for cognitive skills. Overall, many studies were limited in the rigor of their methodology due to small heterogeneous samples and lack of control groups. CONCLUSIONS Technology-assisted interventions have the potential to enhance pediatric rehabilitation after TBI. Future research is needed to further support their efficacy with larger controlled trials and to identify characteristics of children who are most likely to benefit.
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Affiliation(s)
- Shari L Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA -
| | - Megan E Narad
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Emily L Shultz
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Brad G Kurowski
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Aimee E Miley
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jessica M Aguilar
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Peri E, Turconi AC, Biffi E, Maghini C, Panzeri D, Morganti R, Pedrocchi A, Gagliardi C. Effects of dose and duration of Robot-Assisted Gait Training on walking ability of children affected by cerebral palsy. Technol Health Care 2017; 25:671-681. [DOI: 10.3233/thc-160668] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Elisabetta Peri
- Neuroengineering and Medical Robotic Laboratory, Electronics, Information and Bioengineering Department, Politecnico di Milano, Milan, Italy
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | | | - Emilia Biffi
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Cristina Maghini
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Daniele Panzeri
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Roberta Morganti
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Alessandra Pedrocchi
- Neuroengineering and Medical Robotic Laboratory, Electronics, Information and Bioengineering Department, Politecnico di Milano, Milan, Italy
| | - Chiara Gagliardi
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
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Aurich-Schuler T, Grob F, van Hedel HJA, Labruyère R. Can Lokomat therapy with children and adolescents be improved? An adaptive clinical pilot trial comparing Guidance force, Path control, and FreeD. J Neuroeng Rehabil 2017; 14:76. [PMID: 28705170 PMCID: PMC5513325 DOI: 10.1186/s12984-017-0287-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 06/28/2017] [Indexed: 12/14/2022] Open
Abstract
Background Robot-assisted gait therapy is increasingly being used in pediatric neurorehabilitation to complement conventional physical therapy. The robotic device applied in this study, the Lokomat (Hocoma AG, Switzerland), uses a position control mode (Guidance Force), where exact positions of the knee and hip joints throughout the gait cycle are stipulated. Such a mode has two disadvantages: Movement variability is restricted, and patients tend to walk passively. Kinematic variability and active participation, however, are crucial for motor learning. Recently, two new control modes were introduced. The Path Control mode allows the patient to walk within a virtual tunnel surrounding the ideal movement trajectory. The FreeD was developed to support weight shifting through mediolaterally moveable pelvis and leg cuffs. The aims of this study were twofold: 1) To present an overview of the currently available control modes of the Lokomat. 2) To evaluate if an increase in kinematic variability as provided by the new control modes influenced leg muscle activation patterns and intensity, as well as heart rate while walking in the Lokomat. Methods In 15 adolescents with neurological gait disorders who walked in the Lokomat, 3 conditions were compared: Guidance Force, Path Control, and FreeD. We analyzed surface electromyographic (sEMG) activity from 5 leg muscles of the more affected leg and heart rate. Muscle activation patterns were compared with norm curves. Results Several muscles, as well as heart rate, demonstrated tendencies towards a higher activation during conditions with more kinematic freedom. sEMG activation patterns of the M.rectus femoris and M.vastus medialis showed the highest similarity to over-ground walking under Path Control, whereas walking under FreeD led to unphysiological muscle activation in the tested sample. Conclusions Results indicate that especially Path Control seems promising for adolescent patients undergoing neurorehabilitation, as it increases proximal leg muscle activity while facilitating a physiological muscle activation. Therefore, this may be a solution to increase kinematic variability and patients’ active participation in robot-assisted gait training. Electronic supplementary material The online version of this article (doi:10.1186/s12984-017-0287-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tabea Aurich-Schuler
- Rehabilitation Center Affoltern am Albis, Children's University Hospital Zurich, Muehlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland. .,Children's Research Center, Children's University Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.
| | - Fabienne Grob
- Rehabilitation Center Affoltern am Albis, Children's University Hospital Zurich, Muehlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.,Children's Research Center, Children's University Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, Vladimir-Prelog-Weg 1-5/10, CH-8093, Zürich, Switzerland
| | - Hubertus J A van Hedel
- Rehabilitation Center Affoltern am Albis, Children's University Hospital Zurich, Muehlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.,Children's Research Center, Children's University Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland
| | - Rob Labruyère
- Rehabilitation Center Affoltern am Albis, Children's University Hospital Zurich, Muehlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.,Children's Research Center, Children's University Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland
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