The effect of random or sequential presentation of targets during robot-assisted therapy on children.

BACKGROUND Robot assisted upper extremity therapy has been shown to be effective in adult stroke patients and in children with cerebral palsy (CP) and other acquired brain injuries (ABI). The patient's active involvement is a factor in its efficacy. However, this demands focused attention during training sessions, which can be a challenge for children. OBJECTIVE To compare results of training requiring two different levels of focused attention. Differences in short term performance and retention of gains as a function of training protocol as measured by the Fugl-Meyer (FM) were predicted. METHODS Thirty-one children with CP or ABI were randomly divided into two groups. All received 16 one hour sessions of robot-assisted therapy (twice a week for 8 weeks) where they moved a robot handle to direct a cursor on the screen toward designated targets. One group had targets presented sequentially in clockwise fashion, the other presented in random order. Thus, one group could anticipate the position of each target, the other could not. RESULTS Both groups showed significant functional improvement after therapy, but no significant difference between groups was observed. CONCLUSIONS Assist-as-needed robotic training is effective in children with CP or ABI with small non-significant differences attributed to attentional demand.