scholarly journals ATLAS2030 Pediatric Gait Exoskeleton: Changes on Range of Motion, Strength and Spasticity in Children With Cerebral Palsy. A Case Series Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Elena Delgado ◽  
Carlos Cumplido ◽  
Jaime Ramos ◽  
Elena Garcés ◽  
Gonzalo Puyuelo ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Range Of Motion ◽  
Sagittal Plane ◽  
Case Series ◽  
Gait Training ◽  
Knee Extension ◽  
Initial State ◽  
Motor Disability ◽  
Case Series Study ◽  
Muscle Groups

Background: Cerebral Palsy (CP), the most common motor disability in childhood, affects individual's motor skills, movement and posture. This results in limited activity and a low social participation. The ATLAS2030 exoskeleton is a pediatric device that enables gait rehabilitation for children with neurological or neuromuscular pathologies with gait pathology.Purpose: To study changes in relation to range of motion (ROM), strength and spasticity in children with CP after using the ATLAS2030 gait exoskeleton.Methods and Participants: Three children (mean age 8.0 ± 2.0), two girls and one boy, two of them with GMFCS IV and one with GMFCS III, received robot-assisted gait training (RAGT) with ATLAS2030 for one month.Results: The average time of exoskeleton use was 54.7 ± 10.4 min in all sessions, and all participants were able to perform all exercises. The strength of all muscle groups was increased after the 10 sessions for the participants assessed and the limited ROM in the sagittal plane (hip and knee extension and ankle dorsiflexion) decreased after the use of the exoskeleton compared to the initial state. Spasticity was reduced at the end of the sessions after the use of the exoskeleton compared to their initial state.Conclusion: The ROM, spasticity and strength were improved after RAGT with ATLAS2030 exoskeleton in these children with CP. However, further studies with larger samples should be carried out to confirm our findings.

scholarly journals Effect of the Hybrid Assistive Limb on the Gait Pattern for Cerebral Palsy

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 673
Author(s):  
Yuki Mataki ◽  
Hirotaka Mutsuzaki ◽  
Hiroshi Kamada ◽  
Ryoko Takeuchi ◽  
Shogo Nakagawa ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Gait Analysis ◽  
Sagittal Plane ◽  
Gait Training ◽  
Gait Pattern ◽  
Walking Ability ◽  
Gait Symmetry ◽  
Motor Disability ◽  
Before And After ◽  
Hybrid Assistive Limb

Background and objectives: Cerebral palsy (CP) is the most frequent childhood motor disability. Achieving ambulation or standing in children with CP has been a major goal of physical therapy. Recently, robot-assisted gait training using the Hybrid Assistive Limb® (HAL) has been effective in improving walking ability in patients with CP. However, previous studies have not examined in detail the changes in gait pattern after HAL training for patients with spastic CP, including gait symmetry. This study aimed to evaluate the immediate effect of HAL training on the walking ability and the changes in gait pattern and gait symmetry in patients with spastic CP. Materials and Methods: We recruited 19 patients with spastic CP (13 male and six female; mean age, 15.7 years). Functional ambulation was assessed using the 10-Meter Walk Test and gait analysis in the sagittal plane before and after a single 20-min HAL intervention session. Results: The walking speed and stride length significantly increased after HAL intervention compared to the pre-intervention values. Two-dimensional gait analysis showed improvement in equinus gait, increase in the flexion angle of the swing phase in the knee and hip joints, and improvement in gait symmetry. Immediate improvements in the walking ability and gait pattern were noted after HAL training in patients with spastic CP. Conclusions: The symmetry of the joint angle of the lower limb, including the trunk, accounts for the improvement in walking ability after HAL therapy.

scholarly journals Evaluation of Individualized Functional Electrical Stimulation-Induced Acute Changes during Walking: A Case Series in Children with Cerebral Palsy

Sensors ◽  
2021 ◽  
Vol 21 (13) ◽  
pp. 4452
Author(s):  
Nicole Zahradka ◽  
Ahad Behboodi ◽  
Ashwini Sansare ◽  
Samuel C. K. Lee
Keyword(s):  
Cerebral Palsy ◽  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Case Series ◽  
Phase Detection ◽  
Lower Extremity Muscle ◽  
Children With Cerebral Palsy ◽  
Muscle Groups

Functional electrical stimulation (FES) walking interventions have demonstrated improvements to gait parameters; however, studies were often confined to stimulation of one or two muscle groups. Increased options such as number of muscle groups targeted, timing of stimulation delivery, and level of stimulation are needed to address subject-specific gait deviations. We aimed to demonstrate the feasibility of using a FES system with increased stimulation options during walking in children with cerebral palsy (CP). Three physical therapists designed individualized stimulation programs for six children with CP to target participant-specific gait deviations. Stimulation settings (pulse duration and current) were tuned to each participant. Participants donned our custom FES system that utilized gait phase detection to control stimulation to lower extremity muscle groups and walked on a treadmill at a self-selected speed. Motion capture data were collected during walking with and without the individualized stimulation program. Eight gait metrics and associated timing were compared between walking conditions. The prescribed participant-specific stimulation programs induced significant change towards typical gait in at least one metric for each participant with one iteration of FES-walking. FES systems with increased stimulation options have the potential to allow the physical therapist to better target the individual’s gait deviations than a one size fits all device.

scholarly journals Functional outcome of diaphyseal fractures of forearm in adolescents treated with TENS

2019 ◽  
Vol 5 (3) ◽  
pp. 69
Author(s):  
Divyanshu Goyal ◽  
S. L. Sharma ◽  
Laxmikant Meena ◽  
Ravindra Lamoria ◽  
Mahesh Bansal
Keyword(s):  
Range Of Motion ◽  
Functional Outcome ◽  
Case Series ◽  
Age Group ◽  
Forearm Fractures ◽  
Retrospective Case ◽  
Superficial Infection ◽  
Fractures In Children ◽  
Case Series Study ◽  
Diaphyseal Fractures

<p class="abstract"><strong>Background:</strong> A retrospective case series study was done on forearm diaphyseal fracture in adolescents treated with TENS (titanium elastic nailing system). Purpose of the study was analysis of functional outcome of TENS in forearm diaphyseal fractures in children between 12-18 year age group.</p><p class="abstract"><strong>Methods:</strong> We retrospectively evaluated 30 patients operated by same senior surgeon during the period from March 2014 to February 2015 with closed diaphyseal forearm fractures in age group 12–18 years treated with TENS in whom closed reduction could not be achieved. Nail diameter taken as 33-40% of narrowest diameter of diaphysys were introduced proximally in ulna and distally in radius under image intensifier in closed manner. Postoperatively, patients encouraged for active shoulder, elbow and finger movements and suture removal done after 2 weeks. Patients were followed up for minimum period of one year.  </p><p class="abstract"><strong>Results:</strong> In terms of union and range of motion using Anderson et al criteria 24 patients had excellent results, 4 patients had satisfactory results and one patient had poor result having non-union of ulna. Two patients had superficial infection at the nail entry site which eventually resolved. One patient lost for follow up.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that TENS in both bone forearm fractures in adolescent age group in terms of union and range of motion is a minimally invasive and effective method of fixation.</p>

scholarly journals Minimally Invasive SPML Surgery for Children with Cerebral Palsy: Program Development

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Dana L. Wild ◽  
Caroline W. Stegink-Jansen ◽  
Christine P. Baker ◽  
Kelly D. Carmichael ◽  
David A. Yngve
Keyword(s):  
Cerebral Palsy ◽  
Minimally Invasive ◽  
Phase 1 ◽  
Case Series ◽  
Functional Mobility ◽  
Phase 2 ◽  
Ankle Motion ◽  
Case Series Study ◽  
Reoperation Rates

Improvements in surgical and rehabilitation care are critical to lessen the burden of cerebral palsy (CP), the most common cause of severe physical disability in childhood. The selective percutaneous myofascial lengthening (SPML) surgical procedure is a minimally invasive method designed to improve ambulation by lengthening contracted musculoskeletal tissues. Information on surgical procedures, efficacy, and safety of SPML for children with CP is lacking. Phase 1 of our research is a “proof-of-principle” study for multisite SPML to improve functional mobility of children with CP, and Phase 2 assesses safety, reoperation rates, and efficacy over time in subsequent patient series. Phase 1 was a repeated measurement case series study of 17 children (mean age 7.6 years). One physical therapist, blinded to the surgeon’s measurements, measured bilateral knee and ankle motion before and after SPML procedures, using video recordings of a standardized gait path. Functional Mobility Scale (FMS) 5, 50, and 500 outcomes were taken pre- and postoperatively and via telephone follow-up. In Phase 2, multisite SPLM surgeries were implemented in larger successive cohorts from 2006 to 2017. Complications, reoperation rates, and efficacy were retrospectively analyzed. Phase 1 results showed improvement in the children’s knee and ankle motion while ambulating and improved FMS 5, 50, and 500 outcomes postoperatively (mean, 6.3 months). At second follow-up (mean 33.3 months), FMS 500 scores continued improvement, while FMS 5 and FMS 50 scores maintained. During Phase 2, the complication rate was 2.4%, and reoperation rates (including reoperations due to maturation) were between 8% and 13%. Improvements to correct ankle equinus were recorded in 498 cases. In conclusion, in a specialized center, single-event, multilevel SPML surgeries of children with CP safely improved ambulatory knee and ankle angle motion and daily mobility outcomes. Future educational studies of training needs for surgeons new to the approach are needed.

Cerebral palsy and rhizotomy: A 3-year follow-up evaluation with gait analysis

1991 ◽  
Vol 74 (2) ◽  
pp. 178-184 ◽  
Author(s):  
Christopher L. Vaughan ◽  
Barbara Berman ◽  
Warwick J. Peacock
Keyword(s):  
Cerebral Palsy ◽  
Gait Analysis ◽  
Range Of Motion ◽  
Stride Length ◽  
Sagittal Plane ◽  
Spastic Cerebral Palsy ◽  
Normal Range ◽  
Early Functional Outcome ◽  
Selective Posterior Rhizotomy

✓ A recent increase in the popularity of selective posterior rhizotomy for reduction of spasticity in cerebral palsy has led to a demand for more objective studies of outcome and long-term follow-up results. The authors present the results of gait analysis on 14 children with spastic cerebral palsy, who underwent selective posterior rhizotomy in 1985. Sagittal plane gait patterns were studied before surgery and at 1 and 3 years after surgery using a digital camera system. The parameters measured included the range of motion at the knee and thigh, stride length, speed of walking, and cadence. The range of motion at the knee was significantly increased at 1 year after surgery and further improved to a nearly normal range at 3 years after surgery. In contrast, postoperative measurements of thigh range exceeded normal values at 1 year, but decreased toward normal range at 3 years. While improvements in range of motion continued between Years 1 and 3, the children developed a more extended thigh and knee position, which indicated a more upright walking posture. Stride length and speed of walking also improved, while cadence remained essentially unchanged. This 3-year follow-up study, the first to examine rhizotomy using an objective approach, has provided some encouraging results regarding early functional outcome.

scholarly journals A Pediatric Knee Exoskeleton With Real-Time Adaptive Control for Overground Walking in Ambulatory Individuals With Cerebral Palsy

2021 ◽  
Vol 8 ◽  
Author(s):  
Ji Chen ◽  
Jon Hochstein ◽  
Christina Kim ◽  
Luke Tucker ◽  
Lauren E. Hammel ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Adaptive Control ◽  
Control System ◽  
Real Time ◽  
System Performance ◽  
Zero Mode ◽  
Gait Training ◽  
Knee Extension ◽  
Overground Walking ◽  
Pediatric Knee

Gait training via a wearable device in children with cerebral palsy (CP) offers the potential to increase therapy dosage and intensity compared to current approaches. Here, we report the design and characterization of a pediatric knee exoskeleton (P.REX) with a microcontroller based multi-layered closed loop control system to provide individualized control capability. Exoskeleton performance was evaluated through benchtop and human subject testing. Step response tests show the averaged 90% rise was 26 ± 0.2 ms for 5 Nm, 22 ± 0.2 ms for 10 Nm, 32 ± 0.4 ms for 15 Nm. Torque bandwidth of P.REX was 12 Hz and output impedance was less than 1.8 Nm with control on (Zero mode). Three different control strategies can be deployed to apply assistance to knee extension: state-based assistance, impedance-based trajectory tracking, and real-time adaptive control. One participant with typical development (TD) and one participant with crouch gait from CP were recruited to evaluate P.REX in overground walking tests. Data from the participant with TD were used to validate control system performance. Kinematic and kinetic data were collected by motion capture and compared to exoskeleton on-board sensors to evaluate control system performance with results demonstrating that the control system functioned as intended. The data from the participant with CP are part of a larger ongoing study. Results for this participant compare walking with P.REX in two control modes: a state-based approach that provided constant knee extension assistance during early stance, mid-stance and late swing (Est+Mst+Lsw mode) and an Adaptive mode providing knee extension assistance proportional to estimated knee moment during stance. Both were well tolerated and significantly improved knee extension compared to walking without extension assistance (Zero mode). There was less reduction in gait speed during use of the adaptive controller, suggesting that it may be more intuitive than state-based constant assistance for this individual. Future work will investigate the effects of exoskeleton assistance during overground gait training in children with neurological disorders and will aim to identify the optimal individualized control strategy for exoskeleton prescription.

scholarly journals Effect of a Combined Stretching and Strength Training Program on Gait Function in Children with Cerebral Palsy, GMFCS Level I & II: A Randomized Controlled Trial

Medicina ◽  
2019 ◽  
Vol 55 (6) ◽  
pp. 250
Author(s):  
Merete Aarsland Fosdahl ◽  
Reidun Jahnsen ◽  
Kristin Kvalheim ◽  
Inger Holm
Keyword(s):  
Cerebral Palsy ◽  
Intervention Program ◽  
Comparison Group ◽  
Sagittal Plane ◽  
Controlled Trial ◽  
Intervention Group ◽  
Knee Extension ◽  
Maintenance Program ◽  
Children With Cerebral Palsy ◽  
Gait Function

Background and objectives: Ambulant children with cerebral palsy (CP) often develop impaired gait, and reduced active knee extension is often a part of the problem. This study aimed to evaluate the effect of a combined intervention program including stretching and progressive resistance exercise (PRE) targeting active knee extension on gait function, in children with spastic CP. Materials and methods: Thirty-seven children (21 boys, 16 girls, mean age 10.2 (±2.3) years), classified by Gross Motor Function Classification System I–III, were randomized to an intervention (n = 17) and a comparison group (n = 20). The intervention group received a 16-week combined exercise program (3 sessions per week) including stretching of hamstrings and PRE targeting the lower extremities, followed by a 16-week maintenance program (1 session per week). The comparison group received care as usual. Gait function was evaluated by three-dimensional gait analysis (3DGA); knee, hip and pelvic kinematics in the sagittal plane, step length and speed, Gait Deviation Index (GDI), and Six-Minute Walk test (6MWT) at 0, 16, and 32 weeks. Results: There were no statistically significant differences between the intervention group and the comparison group for any of the gait parameters measured at 16 and 32 weeks. There was a significant increase in gait distance measured by 6MWT within both groups; however, no differences between the groups were found. Conclusion: A 16-week combined stretching and PRE program followed by a 16-week maintenance program did not improve gait function in ambulant children with CP.

Quantifying Active Ankle Range of Motion in Cerebral Palsy Following Selective Dorsal Rhizotomy

2004 ◽  
Vol 20 (1) ◽  
pp. 103-111 ◽  
Author(s):  
Jack R. Engsberg ◽  
Sandy A. Ross ◽  
Tae S. Park
Keyword(s):  
Cerebral Palsy ◽  
Physical Therapy ◽  
Range Of Motion ◽  
Repeated Measures ◽  
Sagittal Plane ◽  
Quantitative Measure ◽  
Spastic Diplegia ◽  
Additional Information ◽  
Dorsal Rhizotomy ◽  
Post Hoc

This study was conducted to determine whether an objective and quantitative measure for active ankle range of motion would be sensitive to differences between persons of able body and those with cerebral palsy (CP), and between pre- and postselective dorsal rhizotomy (SDR). Twelve children with spastic diplegia CP were tested before undergoing an SDR, and again after 8 months of intensive physical therapy (SDR group). Fourteen other children with spastic diplegia were tested initially and again 8 months following no intervention but maintaining their existing level of physical therapy (CP group). Twenty age-matched children of able body were tested once (AB group). A video system recorded active sagittal plane ankle movements as the seated child independently performed maximum dorsiflexion and plantarflexion. The data were tracked and analyzed to determine end-range dorsiflexion and plantarflexion, and total active ankle range of motion. Repeated-measures ANOVA and Tukey post hoc tests were used to test for significant differences among and between groups, p < 0. 05. Results for the SDR group indicated a significant increase in end-range dorsiflexion and total range of motion following the surgery, with no changes in any measures for the CP group. Results for both groups with CP indicated differences vs. the AB group. The measure provided additional information from what has previously been reported for active ankle range of motion. The integration of this measure with other objective measures for quantifying impairments and presurgical function may be useful in predicting post-SDR gait status and other functional activities.

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