Home-Based Versus Laboratory-Based Robotic Ankle Training for Children With Cerebral Palsy: A Pilot Randomized Comparative Trial.

OBJECTIVE To examine the outcomes of home-based robot-guided therapy and compare it to laboratory-based robot-guided therapy for the treatment of impaired ankles in children with cerebral palsy. DESIGN A randomized comparative trial design comparing a home-based training group and a laboratory-based training group. SETTING Home versus laboratory within a research hospital. PARTICIPANTS Children (N=41) with cerebral palsy who were at Gross Motor Function Classification System level I, II, or III were randomly assigned to 2 groups. Children in home-based and laboratory-based groups were 8.7±2.8 (n=23) and 10.7±6.0 (n=18) years old, respectively. INTERVENTIONS Six-week combined passive stretching and active movement intervention of impaired ankle in a laboratory or home environment using a portable rehabilitation robot. MAIN OUTCOME MEASURES Active dorsiflexion range of motion (as the primary outcome), mobility (6-minute walk test and timed Up and Go test), balance (Pediatric Balance Scale), Selective Motor Control Assessment of the Lower Extremity, Modified Ashworth Scale (MAS) for spasticity, passive range of motion (PROM), strength, and joint stiffness. RESULTS Significant improvements were found for the home-based group in all biomechanical outcome measures except for PROM and all clinical outcome measures except the MAS. The laboratory-based group also showed significant improvements in all the biomechanical outcome measures and all clinical outcome measures except the MAS. There were no significant differences in the outcome measures between the 2 groups. CONCLUSIONS These findings suggest that the translation of repetitive, goal-directed, biofeedback training through motivating games from the laboratory to the home environment is feasible. The benefits of home-based robot-guided therapy were similar to those of laboratory-based robot-guided therapy.

[1]  Mingming Zhang,et al.  Effectiveness of robot-assisted therapy on ankle rehabilitation – a systematic review , 2013, Journal of NeuroEngineering and Rehabilitation.

[2]  D. Cioi,et al.  Robotics and Gaming to Improve Ankle Strength, Motor Control, and Function in Children With Cerebral Palsy—A Case Study Series , 2013, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[3]  Yupeng Ren,et al.  Changes of calf muscle-tendon biomechanical properties induced by passive-stretching and active-movement training in children with cerebral palsy. , 2011, Journal of applied physiology.

[4]  A. Loeckinger,et al.  Six-minute walk test in children and adolescents. , 2007, The Journal of pediatrics.

[5]  T. Pin,et al.  The effectiveness of passive stretching in children with cerebral palsy. , 2006, Developmental medicine and child neurology.

[6]  I. Novak,et al.  A systematic review of interventions for children with cerebral palsy: state of the evidence , 2013, Developmental medicine and child neurology.

[7]  R. Nudo,et al.  Neural Substrates for the Effects of Rehabilitative Training on Motor Recovery After Ischemic Infarct , 1996, Science.

[8]  B. Dan,et al.  A report: the definition and classification of cerebral palsy April 2006 , 2007, Developmental medicine and child neurology. Supplement.

[9]  M.J. Johnson,et al.  Experimental results using force-feedback cueing in robot-assisted stroke therapy , 2005, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[10]  R. Miall,et al.  The role of proprioception and attention in a visuomotor adaptation task , 2000, Experimental Brain Research.

[11]  Richard W. Bohannon,et al.  Interrater reliability of a modified Ashworth scale of muscle spasticity. , 1987, Physical therapy.

[12]  I. Novak,et al.  Home Program Intervention Effectiveness Evidence , 2014, Physical & occupational therapy in pediatrics.

[13]  Ruud W Selles,et al.  Feedback-controlled and programmed stretching of the ankle plantarflexors and dorsiflexors in stroke: effects of a 4-week intervention program. , 2005, Archives of physical medicine and rehabilitation.

[14]  R. Dishman.  Exercise Compliance: A New View for Public Health. , 1986, The Physician and sportsmedicine.

[15]  T. Wren,et al.  Prevalence of Specific Gait Abnormalities in Children With Cerebral Palsy: Influence of Cerebral Palsy Subtype, Age, and Previous Surgery , 2005, Journal of pediatric orthopedics.

[16]  J. Gage,et al.  An update on the treatment of gait problems in cerebral palsy. , 2001, Journal of pediatric orthopedics. Part B.

[17]  Li-Qun Zhang,et al.  Intelligent stretching of ankle joints with contracture/spasticity , 2002, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[18]  E. Roth,et al.  Effects of repeated ankle stretching on calf muscle-tendon and ankle biomechanical properties in stroke survivors. , 2011, Clinical biomechanics.

[19]  Deepak Sharan,et al.  Virtual reality based therapy for post operative rehabilitation of children with cerebral palsy. , 2012, Work.

[20]  Diane L Damiano,et al.  New clinical and research trends in lower extremity management for ambulatory children with cerebral palsy. , 2009, Physical medicine and rehabilitation clinics of North America.

[21]  A. Nordez,et al.  Muscle and joint responses during and after static stretching performed at different intensities , 2015, European Journal of Applied Physiology.

[22]  C. Cans,et al.  Probability of Walking in Children With Cerebral Palsy in Europe , 2008, Pediatrics.

[23]  Yvonne W Wu,et al.  Change in ambulatory ability of adolescents and young adults with cerebral palsy , 2007, Developmental medicine and child neurology.

[24]  M. J. Taylor,et al.  Pediatric Balance Scale: A Modified Version of the Berg Balance Scale for the School‐Age Child with Mild to Moderate Motor Impairment , 2003, Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association.

[25]  J. Czerniecki,et al.  The role of ankle plantar flexor muscle work during walking. , 1998, Scandinavian journal of rehabilitation medicine.

[26]  K. Krigger.  Cerebral palsy: an overview. , 2006, American family physician.

[27]  L. Wiart,et al.  Stretching with Children with Cerebral Palsy: What Do We Know and Where Are We Going? , 2008, Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association.

[28]  Thomas Korff,et al.  Does acute passive stretching increase muscle length in children with cerebral palsy? , 2013, Clinical biomechanics.

[29]  D De Amici,et al.  Impact of the Hawthorne effect in a longitudinal clinical study: the case of anesthesia. , 2000, Controlled clinical trials.

[30]  D. Damiano,et al.  Muscle Plasticity and Ankle Control After Repetitive Use of a Functional Electrical Stimulation Device for Foot Drop in Cerebral Palsy , 2013, Neurorehabilitation and neural repair.

[31]  Yupeng Ren,et al.  Combined Passive Stretching and Active Movement Rehabilitation of Lower-Limb Impairments in Children With Cerebral Palsy Using a Portable Robot , 2011, Neurorehabilitation and neural repair.

[32]  J. Wann,et al.  Motor skill learning in cerebral palsy: movement, action and computer-enhanced therapy. , 1993, Bailliere's clinical neurology.

[33]  Scott D. Bennie,et al.  Measurements of Balance: Comparison of the Timed "Up and Go" Test and Functional Reach Test with the Berg Balance Scale , 2003 .

[34]  Richard L Lieber,et al.  Structural and functional changes in spastic skeletal muscle , 2004, Muscle & nerve.

[35]  O. Bar-or,et al.  Evaluation by Exercise Testing of the Child with Cerebral Palsy , 1998, Sports medicine.

[36]  J. Nielsen,et al.  Sensory feedback to ankle plantar flexors is not exaggerated during gait in spastic hemiplegic children with cerebral palsy. , 2014, Journal of neurophysiology.

[37]  J. Kleim,et al.  Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. , 2008, Journal of speech, language, and hearing research : JSLHR.

[38]  Diane L Damiano,et al.  Acceptability and potential effectiveness of a foot drop stimulator in children and adolescents with cerebral palsy , 2012, Developmental medicine and child neurology.

[39]  J. Vaz,et al.  Responses to static stretching are dependent on stretch intensity and duration , 2015, Clinical physiology and functional imaging.

[40]  S. Hesse,et al.  Robot-assisted arm trainer for the passive and active practice of bilateral forearm and wrist movements in hemiparetic subjects. , 2003, Archives of physical medicine and rehabilitation.

[41]  M. Lemay,et al.  Ankle range of motion is key to gait efficiency in adolescents with cerebral palsy. , 2010, Clinical biomechanics.

[42]  M. Shinohara,et al.  Acute decrease in the stiffness of resting muscle belly due to static stretching , 2015, Scandinavian journal of medicine & science in sports.

[43]  E. Roth,et al.  Biomechanic changes in passive properties of hemiplegic ankles with spastic hypertonia. , 2004, Archives of physical medicine and rehabilitation.

[44]  Yupeng Ren,et al.  Effects of robot-guided passive stretching and active movement training of ankle and mobility impairments in stroke. , 2013, NeuroRehabilitation.

[45]  H. Graham,et al.  A qualitative analysis of the benefits of strength training for young people with cerebral palsy. , 2003, Developmental medicine and child neurology.

[46]  Iona Novak,et al.  Clinical Prognostic Messages From a Systematic Review on Cerebral Palsy , 2012, Pediatrics.

[47]  Deborah Gaebler-Spira,et al.  Clinical application of a robotic ankle training program for cerebral palsy compared to the research laboratory application: does it translate to practice? , 2014, Archives of physical medicine and rehabilitation.

[48]  J. Odgaard-Jensen,et al.  Intensive training of motor function and functional skills among young children with cerebral palsy: a systematic review and meta-analysis , 2014, BMC Pediatrics.