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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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2
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Muacevic A, Adler JR, Varma A, Sharma NS, Vagha JD, Naqvi WM, Besekar S. Pediatric Patients With Hemiplegia: A Systematic Review of a Randomized Controlled Trial. Cureus 2023; 15:e34074. [PMID: 36843815 PMCID: PMC9946895 DOI: 10.7759/cureus.34074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/23/2023] [Indexed: 01/24/2023] Open
Abstract
Hemiplegia is the medical term for paralysis of one side of the body. It results in muscular wasting on the affected side, impairs gait, reduces motor abilities, and causes instability and a loss of grasping capacity. The patient's quality of life is impacted by hemiplegia because it impairs brain and spinal cord functions. Consequently, a range of therapeutic options, including physical therapy, medical health management, and other multidisciplinary care, are accessible. The effects of treatments on juvenile patients with hemiplegia who are participating in a randomized controlled trial (RCT) are examined in this systematic review. Using the Boolean operator "AND," the research process entailed searching for keywords like "Hemiplegia" and "Pediatrics." Based on the inclusion and exclusion criteria, a total of six RCTs were included in the study. According to the study's findings, hemiplegic patients benefited from Kinesio taping (KT), botulinum toxin type-A (BoNT-A), hyaluronic acid injections, and bimanual treatment.
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ERTURAN S, BURAK M, ELBASAN B. Eylem Gözlem Terapisi ile Unilateral Serebral Palsili Çocuklarda Üst Ekstremite Fonksiyonelliğinin Geliştirilmesi. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.38079/igusabder.1094792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Eylem Gözlem Terapisi (EGT) hareketlerin izlenmesi sonrası aynı hareketlerin taklit edilmesi ile merkezi sinir sistemi restorasyonunu destekleyen nörorehabilitasyon temelli bir tedavi yaklaşımıdır. Serebral palsi, parkinson, inme, ortopedik yaralanmalar, alzheimer ve konuşma bozuklukları gibi pek çok hastalıkta, fonksiyonu gerçekleştiren nöral yapıları aktive etmek için nörofizyolojik mekanizmadan yararlanan yeni bir rehabilitasyon yaklaşımı olarak bilinir. Sağlıklı bireylerde ve nörolojik veya ortopedik etkilenimi olan bireylerde yapılan araştırmalar; EGT uygulamasının gözlemcinin motor sisteminde kolaylaştırmayı indüklediği ve eylem-algı eşleştirme mekanizmasını desteklediği bilinir. Bu derleme, Serebral Palsi (SP) tanılı çocuklarda üst ekstremiteye yönelik uygulanan EGT programlarının kullanımı ve etkinliği ile ilgili mevcut bilgileri gözden geçirmek amacıyla planlanmıştır. EGT kullanımının farklı koşullara kolayca adapte edilebilmesi, nöral plasitisiteyi destekleyerek motor öğrenmeyi fasilite etmesi ve ekonomik olması nedeniyle, SP’li çocukların üst ekstremite rehabilitasyonunda kullanımının uygun olduğu; ancak protokol, süre ve uygulama şekli açısından optimal uygulama prensiplerinin belirlenebilmesi için daha detaylı çalışmalara ihtiyaç olduğu düşünülmektedir.
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Affiliation(s)
- Sinem ERTURAN
- GAZİ ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ, FİZYOTERAPİ VE REHABİLİTASYON BÖLÜMÜ
| | - Mustafa BURAK
- GAZİ ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ, FİZYOTERAPİ VE REHABİLİTASYON BÖLÜMÜ
| | - Bülent ELBASAN
- GAZİ ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ, FİZYOTERAPİ VE REHABİLİTASYON BÖLÜMÜ
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4
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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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Montoro-Cárdenas D, Cortés-Pérez I, Ibancos-Losada MDR, Zagalaz-Anula N, Obrero-Gaitán E, Osuna-Pérez MC. Nintendo ® Wii Therapy Improves Upper Extremity Motor Function in Children with Cerebral Palsy: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12343. [PMID: 36231643 PMCID: PMC9566093 DOI: 10.3390/ijerph191912343] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Nintendo® Wii-based therapy (NWT) is a non-immersive virtual reality therapy used to recover upper extremity (UE) motor function in children with cerebral palsy (CP). We aimed primarily to elucidate the effectiveness of NWT in improving UE motor and functional impaired abilities in children with CP, compared to conventional therapy or no intervention. The secondary aim was to assess if NWT is more effective when used alone or combined with conventional therapy. METHODS A systematic review with meta-analysis was conducted from a bibliographic search in PubMed, Scopus, PEDro, Web of Science, and CINHAL, ending in October 2021, in accordance with PRISMA guidelines. We included randomized controlled trials that compared NWT vs. conventional therapy or no intervention in terms of their impact on different UE impaired abilities (grip strength, tip grip strength, UE dissociated movements, functional capacity in daily living activities, gross and fine motor dexterity, and grasping ability) in children with CP. Effect size was calculated with standardized mean difference (SMD) and its 95% confidence interval (95% CI). RESULTS Nine studies (276 participants) were included. NWT is more effective than conventional therapy at improving grip strength (SMD = 0.5, 95% CI 0.08, 0.91), tip grip strength (SMD = 0.95, 95% CI 0.3, 1.61), and grasping ability (SMD = 0.72, 95%CI 0.14, 1.3). NWT is more effective than conventional therapy at improving functional capacity in daily living activities (SMD = 0.83, 95% CI 0.07, 1.56). For fine manual dexterity, NWT was better than no intervention (SMD = 3.12, 95% CI 1.5, 4.7). CONCLUSIONS Our results indicate that NWT is effective at improving various UE impaired motor skills in children with CP.
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A Review on Recent Advances of Cerebral Palsy. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:2622310. [PMID: 35941906 PMCID: PMC9356840 DOI: 10.1155/2022/2622310] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 12/04/2022]
Abstract
This narrative review summarizes the latest advances in cerebral palsy and identifies where more research is required. Several studies on cerebral palsy were analyzed to generate a general idea of the prevalence of, risk factors associated with, and classification of cerebral palsy (CP). Different classification systems used for the classification of CP on a functional basis were also analyzed. Diagnosis systems used along with the prevention techniques were discussed. State-of-the-art treatment strategies for CP were also analyzed. Statistical distribution was performed based on the selected studies. Prevalence was found to be 2-3/1000 lives; the factors that can be correlated are gestational age and birth weight. The risk factors identified were preconception, prenatal, perinatal, and postnatal categories. According to the evidence, CP is classified into spastic (80%), dyskinetic (15%), and ataxic (5%) forms. Diagnosis approaches were based on clinical investigation and neurological examinations that include magnetic resonance imaging (MRI), biomarkers, and cranial ultrasound. The treatment procedures found were medical and surgical interventions, physiotherapy, occupational therapy, umbilical milking, nanomedicine, and stem cell therapy. Technological advancements in CP were also discussed. CP is the most common neuromotor disability with a prevalence of 2-3/1000 lives. The highest contributing risk factor is prematurity and being underweight. Several preventions and diagnostic techniques like MRI and ultrasound were being used. Treatment like cord blood treatment nanomedicine and stem cell therapy needs to be investigated further in the future to apply in clinical practice. Future studies are indicated in the context of technological advancements among cerebral palsy children.
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Kuroda MM, Iwasaki N, Yoshikawa K, Takeuchi R, Mataki Y, Nakayama T, Nakayama J, Ohguro H, Tokeji K, Mutsuzaki H. Voluntary-assisted Upper Limb Training for Severe Cerebral Palsy Using Robotics Devices and Neuromuscular Electrical Stimulation: Three Case Reports. Prog Rehabil Med 2022; 7:20220050. [PMID: 36188138 PMCID: PMC9475054 DOI: 10.2490/prm.20220050] [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] [Received: 11/27/2021] [Accepted: 08/23/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Constraint-induced movement therapy (CIMT) improves the motor function of paralyzed
upper limbs of adults after stroke. However, in patients with severe spastic cerebral
palsy (CP), the use of CIMT is not warranted. Our aim was to investigate the feasibility
and effectiveness of repetitive voluntary-assisted upper limb training (VAUT) for three
patients with severe CP using a combination of robotics [Hybrid Assistive Limb (HAL)]
and functional electrical stimulation [Integrated Volitional Control Electrical
Stimulation (IVES)]. Case: Three patients with CP were enrolled. Patients 1, 2, and 3 were 8-, 19-, and
18-year-old males, respectively. Patient 1 had spastic hemiplegia, while patients 2 and
3 had spastic quadriplegia. VAUT using single-joint HAL was performed for 1 or 2
sessions/month for 50 min/session over an 8-month period for 9–13 sessions in total. One
patient’s voluntary hand movement was insufficient, affecting his upper limb exercise
performance; therefore, IVES was required in addition to HAL. Outcome measures included
motor function of the upper limbs and use of paralyzed hands, which were measured before
and after intervention. No adverse events were observed during VAUT. After intervention,
the Action Research Arm Test scores showed improvements in all three patients. The
Children’s Hand-use Experience Questionnaire showed improvements in two patients. Discussion: The use of VAUT, together with new systems such as HAL and IVES, for severe CP is safe
and may be effective. Our study suggested that upper limb function can be improved for
patients with severe CP.
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Affiliation(s)
- Mayumi Matsuda Kuroda
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Nobuaki Iwasaki
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Ryoko Takeuchi
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Yuki Mataki
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Tomohiro Nakayama
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Junko Nakayama
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Haruka Ohguro
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Kayo Tokeji
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
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Dobri SCD, Samdup D, Scott SH, Davies TC. Differentiating Motor Coordination in Children with Cerebral Palsy and Typically Developing Populations Through Exploratory Factor Analysis of Robotic Assessments. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:5936-5939. [PMID: 34892470 DOI: 10.1109/embc46164.2021.9630740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
General motor and executive functions are integral for tasks of daily living and are typically assessed when quantifying impairment of an individual. Robotic tasks offer highly repeatable and objective measures of motor and cognitive function. Additionally, robotic tasks and measures have been used successfully to quantify impairment of children with cerebral palsy (CP). Many robotic tasks include multiple performance parameters, so interpretation of results and identification of impairment can be difficult, especially when multiple tasks are completed. This study used exploratory factor analysis to investigate a potential set of quantitative models of motor and cognitive function in children, and compare performance of participants with CP to these models. The three calculated factors achieved strong differentiation between participants with mild CP and the typically developing population. This demonstrates the feasibility of these factors to quantify impairment and track improvements related to therapies.Clinical Relevance- This establishes a method to differentiate atypical motor performance related to CP using a robotic reversed visually guided reaching task.
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Emeli V, Howard A. Motivating Spontaneous Infant Kicking Motions through Long Term Learning Utilizing a Robotic Mobile System. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4518-4521. [PMID: 34892222 DOI: 10.1109/embc46164.2021.9630193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Our research investigates methods and systems to allow for early detection of motor impairment in infants and innovative interventions with the goal of improving longterm outcomes. A robotic baby mobile is utilized to motivate spontaneous kicking motions, which is used as a marker for predicting the potential of motor development delays. Our previous work investigated how the different stimuli modalities of a baby mobile can encourage infant kicking. We utilized a 3D camera system to detect the kicking motions, as well as recorded specific metrics of each kicking episode. In this work, we investigate the possibility of an infant having a preference of baby mobile stimuli that results in increased and sustained kicking motions. This preference is learned over multiple sessions with one infant and utilizes a Markov Decision Process to develop a policy.
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Dobri SC, Ready HM, Davies TC. Tools and Techniques Used With Robotic Devices to Quantify Upper-Limb Function in Typically Developing Children: A Systematic Review. Rehabil Process Outcome 2021; 9:1179572720979013. [PMID: 34497471 PMCID: PMC8282163 DOI: 10.1177/1179572720979013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/16/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Robotic devices have been used to quantify function, identify impairment, and rehabilitate motor function extensively in adults, but less-so in younger populations. The ability to perform motor actions improves as children grow. It is important to quantify this rate of change of the neurotypical population before attempting to identify impairment and target rehabilitation techniques. Objectives: For a population of typically developing children, this systematic review identifies and analyzes tools and techniques used with robotic devices to quantify upper-limb motor function. Since most of the papers also used robotic devices to compare function of neurotypical to pathological populations, a secondary objective was introduced to relate clinical outcome measures to identified robotic tools and techniques. Methods: Five databases were searched between February 2019 and August 2020, and 226 articles were found, 19 of which are included in the review. Results: Robotic devices, tasks, outcome measures, and clinical assessments were not consistent among studies from different settings but were consistent within laboratory groups. Fifteen of the 19 articles evaluated both typically developing and pathological populations. Conclusion: To optimize universally comparable outcomes in future work, it is recommended that a standard set of tasks and measures is used to assess upper-limb motor function. Standardized tasks and measures will facilitate effective rehabilitation.
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Affiliation(s)
- Stephan Cd Dobri
- Department of Mechanical and Materials Engineering, Queen's University, Canada
| | - Hana M Ready
- Department of Mechanical and Materials Engineering, Queen's University, Canada
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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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Sung-U S, Nisa BU, Yotsumoto K, Tanemura R. Effectiveness of robotic-assisted therapy for upper extremity function in children and adolescents with cerebral palsy: a systematic review protocol. BMJ Open 2021; 11:e045051. [PMID: 33980527 PMCID: PMC8118031 DOI: 10.1136/bmjopen-2020-045051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The application of advanced technologies in paediatric rehabilitation to improve performance and enhance everyday functioning shows considerable promise. The aims of this systematic review are to investigate the effectiveness of robotic-assisted therapy for upper extremity function in children and adolescents with cerebral palsy and to extend the scope of intervention from empirical evidence. METHODS AND ANALYSIS Multiple databases, including MEDLINE (Ovid), PubMed, CINAHL, Scopus, Web of Science, Cochrane Library and IEEE Xplore, will be comprehensively searched for relevant randomised controlled trials and non-randomised studies. The grey literature will be accessed on the ProQuest Dissertations & Theses Global database, and a hand search from reference lists of previous articles will be performed. The papers written in English language will be considered, with no limitation on publication date. Two independent reviewers will identify eligible studies, evaluate the level of evidence (the Oxford Centre for Evidence-Based Medicine) and appraise methodological quality and risk of bias (the Standard quality assessment criteria for evaluating primary research papers from a variety of fields (QualSyst tool); the Grading of Recommendations Assessment, Development and Evaluation). Data will be appropriately extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. A narrative synthesis will be provided to summarise the results, and a meta-analysis will be conducted if there is sufficient homogeneity across outcomes. PROSPERO REGISTRATION NUMBER CRD42020205818. ETHICS AND DISSEMINATION Ethical approval is not required for this study. The findings will be disseminated via a peer-reviewed journal and international conferences.
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Affiliation(s)
- Sasithorn Sung-U
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
- Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Mueang Chiang Mai, Chiang Mai, Thailand
| | - Badur Un Nisa
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
| | - Kayano Yotsumoto
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
| | - Rumi Tanemura
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
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Immersive Virtual Environments and Wearable Haptic Devices in rehabilitation of children with neuromotor impairments: a single-blind randomized controlled crossover pilot study. J Neuroeng Rehabil 2020; 17:144. [PMID: 33115487 PMCID: PMC7594483 DOI: 10.1186/s12984-020-00771-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 10/12/2020] [Indexed: 11/21/2022] Open
Abstract
Background The past decade has seen the emergence of rehabilitation treatments using virtual reality. One of the advantages in using this technology is the potential to create positive motivation, by means of engaging environments and tasks shaped in the form of serious games. The aim of this study is to determine the efficacy of immersive Virtual Environments and weaRable hAptic devices (VERA) for rehabilitation of upper limb in children with Cerebral Palsy (CP) and Developmental Dyspraxia (DD). Methods A two period cross-over design was adopted for determining the differences between the proposed therapy and a conventional treatment. Eight children were randomized into two groups: one group received the VERA treatment in the first period and the manual therapy in the second period, and viceversa for the other group. Children were assessed at the beginning and the end of each period through both the Nine Hole Peg Test (9-HPT, primary outcome) and Kinesiological Measurements obtained during the performing of similar tasks in a real setting scenario (secondary outcomes). Results All subjects, not depending from which group they come from, significantly improved in both the performance of the 9-HPT and in the parameters of the kinesiological measurements (movement error and smoothness). No statistically significant differences have been found between the two groups. Conclusions These findings suggest that immersive VE and wearable haptic devices is a viable alternative to conventional therapy for improving upper extremity function in children with neuromotor impairments. Trial registration ClinicalTrials, NCT03353623. Registered 27 November 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03353623
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14
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Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, Langdon K, Namara MM, Paton MC, Popat H, Shore B, Khamis A, Stanton E, Finemore OP, Tricks A, Te Velde A, Dark L, Morton N, Badawi N. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Curr Neurol Neurosci Rep 2020; 20:3. [PMID: 32086598 PMCID: PMC7035308 DOI: 10.1007/s11910-020-1022-z] [Citation(s) in RCA: 401] [Impact Index Per Article: 100.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012-2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019. RECENT FINDINGS Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy. We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research.
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Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia.
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Michael Fahey
- Department of Paediatric Neurology, Monash Health, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Megan Finch-Edmondson
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Claire Galea
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Ashleigh Hines
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Katherine Langdon
- Department of Paediatric Rehabilitation, Kids Rehab WA, Perth Children's Hospital, Perth, Australia
| | - Maria Mc Namara
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Madison Cb Paton
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Himanshu Popat
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Benjamin Shore
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amanda Khamis
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Emma Stanton
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Olivia P Finemore
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Alice Tricks
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Anna Te Velde
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Leigha Dark
- Allied and Public Helath, Faculty of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Natalie Morton
- Allied and Public Helath, Faculty of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- School of Allied Health, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
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15
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Kuo FL, Lee HC, Hsiao HY, Lin JC. Robotic-assisted hand therapy for improvement of hand function in children with cerebral palsy: a case series study. Eur J Phys Rehabil Med 2020; 56:237-242. [PMID: 31939267 DOI: 10.23736/s1973-9087.20.05926-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Most types of robot-assisted training (RT) have been used in Cerebral Palsy (CP) patients only focus on proximal upper extremity. Few of study investigated the effect of distal upper extremity training. CASE REPORT Pediatric CP patients (N.=7) participated the RT sessions for 6 weeks (12 60-min sessions 2 times a week). Performance was assessed at 3 time points (pretest, posttest, and 1-month follow-up). RT significantly improved in body structure and function domains: FMA-UE scores (P=0.002). On electromyography, significant improvements in the mean brachioradialis muscle amplitude (P=0.015) and electrical agonist-antagonist muscle ratio (P=0.041) in the 1-inch cube-grasping task. The effects were maintained after 1 month. CLINICAL REHABILITATION IMPACT RT using a Gloreha device which focuses on the distal part of the upper limb benefit on body structure and function, including upper-extremity motor function, brachioradialis muscle recruitment, and coordination in children with cerebral palsy.
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Affiliation(s)
- Fen-Ling Kuo
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Chieh Lee
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Han-Yun Hsiao
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jui-Chi Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan -
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16
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Abstract
Smaller, smarter, more portable rehabilitation technology has the potential to improve the ability of individuals with cerebral palsy to perform activities and increase participation. Robotics and virtual reality may improve movement by maximizing exercise dose, providing feedback, and motivating users. Augmentative and alternative communication technology is facilitating communication. Robots can help with self-care and provide encouragement and instruction in rehabilitation programs. Mobile applications can provide education and resources. Conducting high-quality research to validate technological advances in our field has been a major focus of researchers and advocacy groups.
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17
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Bockbrader MA, Francisco G, Lee R, Olson J, Solinsky R, Boninger ML. Brain Computer Interfaces in Rehabilitation Medicine. PM R 2019; 10:S233-S243. [PMID: 30269808 DOI: 10.1016/j.pmrj.2018.05.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/22/2018] [Accepted: 05/31/2018] [Indexed: 12/24/2022]
Abstract
One innovation currently influencing physical medicine and rehabilitation is brain-computer interface (BCI) technology. BCI systems used for motor control record neural activity associated with thoughts, perceptions, and motor intent; decode brain signals into commands for output devices; and perform the user's intended action through an output device. BCI systems used for sensory augmentation transduce environmental stimuli into neural signals interpretable by the central nervous system. Both types of systems have potential for reducing disability by facilitating a user's interaction with the environment. Investigational BCI systems are being used in the rehabilitation setting both as neuroprostheses to replace lost function and as potential plasticity-enhancing therapy tools aimed at accelerating neurorecovery. Populations benefitting from motor and somatosensory BCI systems include those with spinal cord injury, motor neuron disease, limb amputation, and stroke. This article discusses the basic components of BCI for rehabilitation, including recording systems and locations, signal processing and translation algorithms, and external devices controlled through BCI commands. An overview of applications in motor and sensory restoration is provided, along with ethical questions and user perspectives regarding BCI technology.
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Affiliation(s)
- Marcia A Bockbrader
- Department of Physical Medicine & Rehabilitation, The Ohio State University, 480 Medical Center Dr, Columbus, OH 43210; and Neurological Institute, Ohio State University Wexner Medical Center, Columbus, OH(∗).
| | - Gerard Francisco
- Department of Physical Medicine & Rehabilitation, The University of Texas, Houston, TX(†)
| | - Ray Lee
- Department of Orthopaedic and Rehabilitation, Schwab Rehabilitation Hospital, University of Chicago, Chicago, IL(‡)
| | - Jared Olson
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO(§)
| | - Ryan Solinsky
- Spaulding Rehabilitation Hospital, Boston; and Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA(¶)
| | - Michael L Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh; and VA Pittsburgh Health Care System, Pittsburgh, PA(#)
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18
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Dehem S, Montedoro V, Brouwers I, Edwards MG, Detrembleur C, Stoquart G, Renders A, Heins S, Dehez B, Lejeune T. Validation of a robot serious game assessment protocol for upper limb motor impairment in children with cerebral palsy. NeuroRehabilitation 2019; 45:137-149. [PMID: 31498135 DOI: 10.3233/nre-192745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The ROBiGAME project aims to implement serious games on robots to rehabilitate upper limb (UL) motor function in children with cerebral palsy (CP). Serious game characteristics (target position, level of assistance/resistance, level of force) are typically adapted based on the child's assessment before and continuously during the game (measuring UL working area, kinematics and muscle strength). OBJECTIVE This study developed an UL robotic motor assessment protocol to configure the serious game. METHODS Forty-nine healthy children and 20 CP children participated in the study. The clinical assessment consisted of the child's UL length and isometric force. The robot assessment consisted of the child's UL working area (WA), the UL isometric and isokinetic force in three directions and the UL kinematics during a pointing task toward targets placed at different distances. RESULTS Results showed that WA and UL isometric force were moderately to highly correlated with clinical measures. Ratios between the UL isokinetic force generated on three directions were established. The velocity and straightness indexes of all children increased when they had to reach to targets placed more distant. CONCLUSIONS This protocol can be integrated into different serious games in order to continuously configure the game characteristics to a child's performance. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov (NCT02543424), 12 August 2015.
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Affiliation(s)
- Stéphanie Dehem
- Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Brussels, Belgium.,Université Catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Vincenza Montedoro
- Université Catholique de Louvain, Psychological Sciences Research Institute, Louvain-La-Neuve, Belgium.,Université Catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Isaline Brouwers
- Cliniques Universitaires Saint-Luc, Service de Médecine Physique et Réadaptation, Brussels, Belgium
| | - Martin Gareth Edwards
- Université Catholique de Louvain, Psychological Sciences Research Institute, Louvain-La-Neuve, Belgium.,Université Catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Christine Detrembleur
- Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Brussels, Belgium.,Université Catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Gaëtan Stoquart
- Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Brussels, Belgium.,Cliniques Universitaires Saint-Luc, Service de Médecine Physique et Réadaptation, Brussels, Belgium.,Université Catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Anne Renders
- Cliniques Universitaires Saint-Luc, Service de Médecine Physique et Réadaptation, Brussels, Belgium
| | - Sophie Heins
- Université Catholique de Louvain, Centre de Recherche en Energie et Mecatronique (CEREM), Louvain-la-Neuve, Belgium.,Université Catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Bruno Dehez
- Université Catholique de Louvain, Centre de Recherche en Energie et Mecatronique (CEREM), Louvain-la-Neuve, Belgium.,Université Catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Thierry Lejeune
- Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Brussels, Belgium.,Cliniques Universitaires Saint-Luc, Service de Médecine Physique et Réadaptation, Brussels, Belgium.,Université Catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium
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19
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Devices and Protocols for Upper Limb Robot-Assisted Rehabilitation of Children with Neuromotor Disorders. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9132689] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neuromotor disorders negatively affect the sensorimotor system, limiting the ability to perform daily activities autonomously. Rehabilitation of upper limb impairments is therefore essential to improve independence and quality of life. In the last two decades, there has been a growing interest in robot-assisted rehabilitation as a beneficial way to promote children recovery process. However, a common understanding of the best drivers of an effective intervention has not been reached yet. With this aim, the current study reviewed the existing literature on robot-assisted rehabilitation protocols for upper extremities in children, with the goal of examining the effects of robotic therapy on their sensorimotor recovery process. A literature search was conducted in several electronic database to identify the studies related to the application of robotic therapy on upper limbs in the pediatric population. We analyzed three reviews and 35 studies that used 14 different robotic devices, and an overview of their characteristics, applications in the clinical setting and results is provided. Besides, the potential benefits of robot-assisted assessment and therapy are discussed to identify the key factors yielding positive outcomes in children. Finally, this review aim to lay the foundations for more effective neuroplasticity-enhancement protocols and elicit insights into robot-based approaches.
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20
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Hernández HA, Khan A, Fay L, Roy JS, Biddiss E. Force Resistance Training in Hand Grasp and Arm Therapy: Feasibility of a Low-Cost Videogame Controller. Games Health J 2018; 7:277-287. [PMID: 30106641 DOI: 10.1089/g4h.2017.0193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To design and evaluate a low-cost gaming station that supports force resistance training in pediatric arm/hand grasp therapies through mainstream videogame play. METHODS The gaming station was developed through an iterative participatory design process and includes a force feedback game controller (Novint Falcon), custom grips, arm/wrist supports, and software to interface with mainstream games and manage difficulty settings in the controller. The station was tested for usability and feasibility with six therapists and six children with cerebral palsy, 7-16 years of age, attending weekly therapy sessions over 12 weeks. Pre- and post-assessments of perceived performance and satisfaction on self-identified goals were measured on the Canadian Occupational Performance Measure (COPM). RESULTS The gaming station was considered highly usable by therapists with a score of 76.7 (standard deviation [SD] = 6.1) on the System Usability Scale. Overall, children enjoyed the games, achieved high repetition rates for wrist extensions and arm movements, and all made clinically significant progress on therapy goals. Increases of 3.13 (SD = 1.69) on the performance scale and 2.97 (SD = 0.98) on the satisfaction scale were reported on the COPM. Conclusiion: In-clinic force resistance training for development of upper limb functional capacities is feasible using low-cost video game components adapted to therapy through a participatory design process.
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Affiliation(s)
- Hamilton A Hernández
- 1 Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Ontario, Canada .,2 Institute of Biomaterials & Biomedical Engineering, University of Toronto , Toronto, Ontario, Canada
| | - Ajmal Khan
- 1 Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Ontario, Canada
| | - Linda Fay
- 3 Holland Bloorview Kids Rehabilitation Hospital , Toronto, Ontario, Canada
| | - Jean-Sébastien Roy
- 4 Department of Rehabilitation, Faculty of Medicine, Université Laval , Quebec City, Quebec, Canada .,5 Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute , Quebec City, Quebec, Canada
| | - Elaine Biddiss
- 1 Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Ontario, Canada .,2 Institute of Biomaterials & Biomedical Engineering, University of Toronto , Toronto, Ontario, Canada
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21
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Chen Y, Garcia-Vergara S, Howard AM. Effect of feedback from a socially interactive humanoid robot on reaching kinematics in children with and without cerebral palsy: A pilot study. Dev Neurorehabil 2018; 21:490-496. [PMID: 28816558 DOI: 10.1080/17518423.2017.1360962] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To examine whether children with or without cerebral palsy (CP) would follow a humanoid robot's (i.e., Darwin) feedback to move their arm faster when playing virtual reality (VR) games. METHODS Seven children with mild CP and 10 able-bodied children participated. Real-time reaching was evaluated by playing the Super Pop VRTM system, including 2-game baseline, 3-game acquisition, and another 2-game extinction. During acquisition, Darwin provided verbal feedback to direct the child to reach a kinematically defined target goal (i.e., 80% of average movement time in baseline). Outcome variables included the percentage of successful reaches ("% successful reaches"), movement time (MT), average speed, path, and number of movement units. RESULTS All games during acquisition and extinction had larger "%successful reaches," faster speeds, and faster MTs than the 2 games during baseline (p < .05). CONCLUSION Children with and without CP could follow the robot's feedback for changing their reaching kinematics when playing VR games.
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Affiliation(s)
- Yuping Chen
- a Department of Physical Therapy , Georgia State University , Atlanta , GA , USA
| | - Sergio Garcia-Vergara
- b School of Electrical and Computer Engineering , Georgia Institute of Technology , Atlanta , GA , USA
| | - Ayanna M Howard
- b School of Electrical and Computer Engineering , Georgia Institute of Technology , Atlanta , GA , USA
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22
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Singh H, Unger J, Zariffa J, Pakosh M, Jaglal S, Craven BC, Musselman KE. Robot-assisted upper extremity rehabilitation for cervical spinal cord injuries: a systematic scoping review. Disabil Rehabil Assist Technol 2018; 13:704-715. [PMID: 29334467 DOI: 10.1080/17483107.2018.1425747] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstact Purpose: To provide an overview of the feasibility and outcomes of robotic-assisted upper extremity training for individuals with cervical spinal cord injury (SCI), and to identify gaps in current research and articulate future research directions. MATERIALS AND METHODS A systematic search was conducted using Medline, Embase, PsycINFO, CCTR, CDSR, CINAHL and PubMed on June 7, 2017. Search terms included 3 themes: (1) robotics; (2) SCI; (3) upper extremity. Studies using robots for upper extremity rehabilitation among individuals with cervical SCI were included. Identified articles were independently reviewed by two researchers and compared to pre-specified criteria. Disagreements regarding article inclusion were resolved through discussion. The modified Downs and Black checklist was used to assess article quality. Participant characteristics, study and intervention details, training outcomes, robot features, study limitations and recommendations for future studies were abstracted from included articles. RESULTS Twelve articles (one randomized clinical trial, six case series, five case studies) met the inclusion criteria. Five robots were exoskeletons and three were end-effectors. Sample sizes ranged from 1 to 17 subjects. Articles had variable quality, with quality scores ranging from 8 to 20. Studies had a low internal validity primarily from lack of blinding or a control group. Individuals with mild-moderate impairments showed the greatest improvements on body structure/function and performance-level measures. This review is limited by the small number of articles, low-sample sizes and the diversity of devices and their associated training protocols, and outcome measures. CONCLUSIONS Preliminary evidence suggests robot-assisted interventions are safe, feasible and can reduce active assistance provided by therapists. Implications for rehabilitation Robot-assisted upper extremity training for individuals with cervical spinal cord injury is safe, feasible and can reduce hands-on assistance provided by therapists. Future research in robotics rehabilitation with individuals with spinal cord injury is needed to determine the optimal device and training protocol as well as effectiveness.
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Affiliation(s)
- Hardeep Singh
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada
| | - Janelle Unger
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada
| | - José Zariffa
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,c Institute of Biomaterials and Biomedical Engineering , University of Toronto , Toronto , ON , Canada
| | - Maureen Pakosh
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada
| | - Susan Jaglal
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,d Department of Physical Therapy , University of Toronto , Toronto , ON , Canada.,e Department of Health Policy, Management and Evaluation , University of Toronto , Toronto , ON , Canada
| | - B Catharine Craven
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,f Division of Physical Medicine and Rehabilitation, Faculty of Medicine , University of Toronto , Toronto , ON , Canada
| | - Kristin E Musselman
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,d Department of Physical Therapy , University of Toronto , Toronto , ON , Canada
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23
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Keller JW, van Hedel HJA. Weight-supported training of the upper extremity in children with cerebral palsy: a motor learning study. J Neuroeng Rehabil 2017; 14:87. [PMID: 28854939 PMCID: PMC5577664 DOI: 10.1186/s12984-017-0293-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 08/03/2017] [Indexed: 11/29/2022] Open
Abstract
Background Novel neurorehabilitation technologies build upon treatment principles derived from motor learning studies. However, few studies have investigated motor learning with assistive devices in children and adolescents with Cerebral Palsy (CP). The aim of this study was to investigate whether children with CP who trained with weight support in a playful, virtual environment would improve upper extremity task performance (i.e. skill acquisition), transfer, and retention, three aspects that indicate whether motor learning might have occurred or not. Methods Eleven children with CP (mean age 13.3 years, standard deviation 3.4 years), who were mildly to moderately impaired, participated. They played in the Armeo® Spring the exergame Moorhuhn with their more affected arm during 3 days (70 min pure play time). For this within-subject design, kinematic assessments, the Box and Block Test, and five items of the Melbourne Assessment were administered twice during a baseline week (one week before the intervention), directly before and after the intervention, and one day after the training phase (retention). Results The average exergame score improved from 209.55 to 339.73 (p < 0.001, Cohen’s d = 1.80), indicating skill acquisition. The change in the Box and Block test improved from 0.45 (baseline week) to 3.95 (intervention week; p = 0.008, d = 1.59) indicating skill transfer. The kinematic assessments and the Melbourne items did not change. Improvement in game score and Box and Bock Test persisted one day later (retention). Conclusions We found evidence indicating the successful acquisition, transfer, and retention of upper extremity skills in children with CP. We therefore infer that motor learning occurred when children with CP trained their more affected arm with weight-support in a playful, virtual environment.
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Affiliation(s)
- Jeffrey W Keller
- Rehabilitation Center Affoltern am Albis, University Children's Hospital Zurich, Mühlebergstrasse 104, -8910, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Human Movement Sciences and Sports, ETH Zurich, Zurich, Switzerland.,Doctoral Program Clinical Science, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Hubertus J A van Hedel
- Rehabilitation Center Affoltern am Albis, University Children's Hospital Zurich, Mühlebergstrasse 104, -8910, Affoltern am Albis, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
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24
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Wilcox BJ, Wilkins MM, Basseches B, Schwartz JB, Kerman K, Trask C, Brideau H, Crisco JJ. Joint-Specific Play Controller for Upper Extremity Therapy: Feasibility Study in Children With Wrist Impairment. Phys Ther 2016; 96:1773-1781. [PMID: 27197824 PMCID: PMC5088224 DOI: 10.2522/ptj.20150493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 05/05/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Challenges with any therapeutic program for children include the level of the child's engagement or adherence. Capitalizing on one of the primary learning avenues of children, play, the approach described in this article is to develop therapeutic toy and game controllers that require specific and repetitive joint movements to trigger toy/game activation. OBJECTIVE The goal of this study was to evaluate a specially designed wrist flexion and extension play controller in a cohort of children with upper extremity motor impairments (UEMIs). The aim was to understand the relationship among controller play activity, measures of wrist and forearm range of motion (ROM) and spasticity, and ratings of fun and difficulty. DESIGN This was a cross-sectional study of 21 children (12 male, 9 female; 4-12 years of age) with UEMIs. METHODS All children participated in a structured in-clinic play session during which measurements of spasticity and ROM were collected. The children were fitted with the controller and played with 2 toys and 2 computer games for 5 minutes each. Wrist flexion and extension motion during play was recorded and analyzed. In addition, children rated the fun and difficulty of play. RESULTS Flexion and extension goal movements were repeatedly achieved by children during the play session at an average frequency of 0.27 Hz. At this frequency, 15 minutes of play per day would result in approximately 1,700 targeted joint motions per week. Play activity was associated with ROM measures, specifically supination, but toy perception ratings of enjoyment and difficulty were not correlated with clinical measures. LIMITATIONS The reported results may not be representative of children with more severe UEMIs. CONCLUSIONS These outcomes indicate that the therapeutic controllers elicited repetitive goal movements and were adaptable, enjoyable, and challenging for children of varying ages and UEMIs.
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Affiliation(s)
- Bethany J Wilcox
- B.J. Wilcox, PhD, Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, 1 Hoppin St, CORO West, Ste 404, Providence, RI 02903 (USA).
| | - Megan M Wilkins
- M.M. Wilkins, PT, DPT, Meeting Street, Providence, Rhode Island
| | - Benjamin Basseches
- B. Basseches, BS, Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital
| | - Joel B Schwartz
- J.B. Schwartz, BS, Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital
| | - Karen Kerman
- K. Kerman, MD, Department of Pediatrics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital
| | - Christine Trask
- C. Trask, PhD, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, and Department of Psychiatry, Rhode Island Hospital
| | - Holly Brideau
- H. Brideau, MS, Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital
| | - Joseph J Crisco
- J.J. Crisco, PhD, Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital
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25
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Basu AP, Pearse J, Kelly S, Wisher V, Kisler J. Early intervention to improve hand function in hemiplegic cerebral palsy. Front Neurol 2015; 5:281. [PMID: 25610423 PMCID: PMC4285072 DOI: 10.3389/fneur.2014.00281] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/09/2014] [Indexed: 01/29/2023] Open
Abstract
Children with hemiplegic cerebral palsy often have marked hand involvement with excessive thumb adduction and flexion and limited active wrist extension from infancy. Post-lesional aberrant plasticity can lead to progressive abnormalities of the developing motor system. Disturbances of somatosensory and visual function and developmental disregard contribute to difficulties with hand use. Progressive soft tissue and bony changes may occur, leading to contractures, which further limit function in a vicious cycle. Early intervention might help to break this cycle, however, the precise nature and appropriateness of the intervention must be carefully considered. Traditional approaches to the hemiplegic upper limb include medications and botulinum toxin injections to manage abnormalities of tone, and surgical interventions. Therapist input, including provision of orthoses, remains a mainstay although many therapies have not been well evaluated. There has been a recent increase in interventions for the hemiplegic upper limb, mostly aimed outside the period of infancy. These include trials of constraint-induced movement therapy (CIMT) and bimanual therapy as well as the use of virtual reality and robot-assisted therapy. In future, non-invasive brain stimulation may be combined with therapy. Interventions under investigation in the infant age group include modified CIMT and action observation therapy. A further approach which may be suited to the infant with thumb-in-palm deformity, but which requires evaluation, is the use of elastic taping. Enhanced cutaneous feedback through mechanical stimulation to the skin provided by the tape during movement has been postulated to modulate ongoing muscle activity. If effective, this would represent a low-cost, safe, widely applicable early intervention.
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Affiliation(s)
- Anna Purna Basu
- Institute of Neuroscience, Newcastle University , Newcastle upon Tyne , UK ; Department of Paediatric Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Janice Pearse
- Institute of Neuroscience, Newcastle University , Newcastle upon Tyne , UK ; Paediatric Physical Therapy, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Susan Kelly
- Paediatric Physical Therapy, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Vicki Wisher
- Paediatric Physical Therapy, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Jill Kisler
- Institute of Neuroscience, Newcastle University , Newcastle upon Tyne , UK ; Department of Paediatric Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
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