Advertisement

Clinical Application of a Robotic Ankle Training Program for Cerebral Palsy Compared to the Research Laboratory Application: Does It Translate to Practice?

      Abstract

      Objective

      To determine the clinical efficacy of an ankle robotic rehabilitation protocol for patients with cerebral palsy.

      Design

      The clinic cohort was identified from a retrospective chart review in a before-after intervention trial design and compared with a previously published prospective research cohort.

      Setting

      Rehabilitation hospital.

      Participants

      Children (N=28; mean age, 8.2±3.62y) with Gross Motor Function Classification System levels I, II, or III who were referred for ankle stretching and strengthening used a robotic ankle device in a clinic setting. Clinic results were compared with a previously published cohort of participants (N=12; mean age, 7.8±2.91y) seen in a research laboratory-based intervention protocol.

      Interventions

      Patients in the clinic cohort were seen 2 times per week for 75-minute sessions for a total of 6 weeks. The first 30 minutes of the session were spent using the robotic ankle device for ankle stretching and strengthening, and the remaining 45 minutes were spent on functional movement activities. There was no control group.

      Main Outcome Measures

      We compared pre- and postintervention measures of plantarflexor and dorsiflexor range of motion, strength, spasticity, mobility (Timed Up and Go test, 6-minute walk test, 10-m walk test), balance (Pediatric Balance Scale), Selective Control Assessment of the Lower Extremity (SCALE), and gross motor function measure (GMFM).

      Results

      Significant improvements were found for the clinic cohort in all main outcome measures except for the GMFM. These improvements were equivalent to those reported in the research cohort, except for larger SCALE test changes in the research cohort.

      Conclusions

      These findings suggest that translation of repetitive, goal-directed biofeedback training into the clinic setting is both feasible and beneficial for patients with cerebral palsy.

      Keywords

      List of abbreviations:

      CP (cerebral palsy), GMFCS (Gross Motor Function Classification System), ICF (International Classification of Functioning, Disability and Health), MDC (minimal detectable change), PBS (Pediatric Balance Scale), SCALE (Selective Control Assessment of the Lower Extremity), TUG (Timed Up and Go)
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sanger T.D.
        • Delgado M.R.
        • Gaebler-Spira D.
        • Hallett M.
        • Mink J.W.
        Classification and definition of disorders causing hypertonia in childhood.
        Pediatrics. 2003; 111: e89-e97
        • Deon L.L.
        • Gaebler-Spira D.
        Assessment and treatment of movement disorders in children with cerebral palsy.
        Orthop Clin North Am. 2010; 41: 507-517
        • Novak I.
        • McIntyre S.
        • Morgan C.
        • et al.
        A systematic review of interventions for children with cerebral palsy: state of the evidence.
        Dev Med Child Neurol. 2013; 55: 885-910
        • Lieber R.L.
        Skeletal muscle structure, function & plasticity: the physiological basis of rehabilitation.
        2nd ed. Lippincott Williams & Wilkins, Philadelphia2002
        • de Gooijer-van de Groep K.L.
        • de Vlugt E.
        • de Groot J.H.
        • et al.
        Differentiation between non-neural and neural contributors to ankle joint stiffness in cerebral palsy.
        J Neuroeng Rehabil. 2013; 10: 81
        • Wu Y.N.
        • Ren Y.
        • Goldsmith A.
        • Gaebler D.
        • Liu S.Q.
        • Zhang L.Q.
        Characterization of spasticity in cerebral palsy: dependence of catch angle on velocity.
        Dev Med Child Neurol. 2010; 52: 563-569
        • Zhao H.
        • Wu Y.N.
        • Hwang M.
        • et al.
        Changes of calf muscle-tendon biomechanical properties induced by passive-stretching and active-movement training in children with cerebral palsy.
        J Appl Physiol. 2011; 111: 435-442
        • Ross S.A.
        • Foreman M.
        • Engsberg J.R.
        Comparison of 3 different methods to analyze ankle plantarflexor stiffness in children with spastic diplegia cerebral palsy.
        Arch Phys Med Rehabil. 2011; 92: 2034-2040
        • Zhang M.
        • Davies T.C.
        • Xie S.
        Effectiveness of robot-assisted therapy on ankle rehabilitation–a systematic review.
        J Neuroeng Rehabil. 2013; 10: 30
        • Burdea G.C.
        • Cioi D.
        • Kale A.
        • Janes W.E.
        • Ross S.A.
        • Engsberg J.R.
        Robotics and gaming to improve ankle strength, motor control, and function in children with cerebral palsy–a case study series.
        IEEE Trans Neural Syst Rehabil Eng. 2013; 21: 165-173
        • Cioi D.
        • Kale A.
        • Burdea G.
        • Engsberg J.
        • Janes W.
        • Ross S.
        Ankle control and strength training for children with cerebral palsy using the Rutgers Ankle CP: a case study.
        IEEE Int Conf Rehabil Robot. 2011; 2011: 5975432
        • Fehlings D.
        • Switzer L.
        • Findlay B.
        • Knights S.
        Interactive computer play as “motor therapy” for individuals with cerebral palsy.
        Semin Pediatr Neurol. 2013; 20: 127-138
        • Wu Y.N.
        • Hwang M.
        • Ren Y.
        • Gaebler-Spira D.
        • Zhang L.Q.
        Combined passive stretching and active movement rehabilitation of lower-limb impairments in children with cerebral palsy using a portable robot.
        Neurorehabil Neural Repair. 2011; 25: 378-385
        • Palisano R.J.
        • Hanna S.E.
        • Rosenbaum P.L.
        • et al.
        Validation of a model of gross motor function for children with cerebral palsy.
        Phys Ther. 2000; 80: 974-985
        • Fowler E.G.
        • Staudt L.A.
        • Greenberg M.B.
        • Oppenheim W.L.
        Selective Control Assessment of the Lower Extremity (SCALE): development, validation, and interrater reliability of a clinical tool for patients with cerebral palsy.
        Dev Med Child Neurol. 2009; 51: 607-614
        • Mutlu A.
        • Livanelioglu A.
        • Gunel M.K.
        Reliability of goniometric measurements in children with spastic cerebral palsy.
        Med Science Monit. 2007; 13: CR323-CR329
        • Chen C.L.
        • Shen I.H.
        • Chen C.Y.
        • Wu C.Y.
        • Liu W.Y.
        • Chung C.Y.
        Validity, responsiveness, minimal detectable change, and minimal clinically important change of Pediatric Balance Scale in children with cerebral palsy.
        Res Dev Disabil. 2013; 34: 916-922
        • Thompson P.
        • Beath T.
        • Bell J.
        • et al.
        Test-retest reliability of the 10-metre fast walk test and 6-minute walk test in ambulatory school-aged children with cerebral palsy.
        Dev Med Child Neurol. 2008; 50: 370-376
        • Katalinic O.M.
        • Harvey L.A.
        • Herbert R.D.
        • Moseley A.M.
        • Lannin N.A.
        • Schurr K.
        Stretch for the treatment and prevention of contractures.
        Cochrane Database Syst Rev. 2010; : CD007455
        • Wallen M.
        • Stewart K.
        The evidence for abandoning upper limb stretch interventions in paediatric practice.
        Dev Med Child Neurol. 2013; 55: 208-209
        • Pin T.
        • Dyke P.
        • Chan M.
        The effectiveness of passive stretching in children with cerebral palsy.
        Dev Med Child Neurol. 2006; 48: 855-862
        • Franki I.
        • Desloovere K.
        • De Cat J.
        • et al.
        The evidence-base for basic physical therapy techniques targeting lower limb function in children with cerebral palsy: a systematic review using the International Classification of Functioning, Disability and Health as a conceptual framework.
        J Rehabil Med. 2012; 44: 385-395
        • Gorter J.W.
        • Becher J.
        • Oosterom I.
        • et al.
        ‘To stretch or not to stretch in children with cerebral palsy'.
        Dev Med Child Neurol. 2007; 49 (author reply 799): 797-800
        • Taylor N.F.
        • Dodd K.J.
        • Damiano D.L.
        Progressive resistance exercise in physical therapy: a summary of systematic reviews.
        Phys Ther. 2005; 85: 1208-1223
        • Sandlund M.
        • Dock K.
        • Hager C.K.
        • Waterworth E.L.
        Motion interactive video games in home training for children with cerebral palsy: parents' perceptions.
        Disabil Rehabil. 2012; 34: 925-933
        • Snapp-Childs W.
        • Casserly E.
        • Mon-Williams M.
        • Bingham G.P.
        Active prospective control is required for effective sensorimotor learning.
        PLoS One. 2013; 8: e77609
        • Fasoli S.E.
        • Ladenheim B.
        • Mast J.
        • Krebs H.I.
        New horizons for robot-assisted therapy in pediatrics.
        Am J Phys Med Rehabil. 2012; 91: S280-S289
        • Fowler E.G.
        • Staudt L.A.
        • Greenberg M.B.
        Lower-extremity selective voluntary motor control in patients with spastic cerebral palsy: increased distal motor impairment.
        Dev Med Child Neurol. 2010; 52: 264-269
      1. Grubich S, Trenkle J. Passive stretching and active strengthening through use of robotics, combined with functional strength training, to improve gross motor ability in children diagnosed with cerebral palsy: a clinical approach. In: Proceedings of the American Academy of Cerebral Palsy and Developmental Medicine; October 16-19, 2013; Milwaukee, WI.