C. Bayón

Robotic Therapies for Children with Cerebral Palsy: A Systematic Review

Title: This paper presents a systematic review of robotic devices and therapies for cerebral palsy (CP), trying to shed some light on the present literature on robot-based CP rehabilitation. Background: Recent publications have demonstrated that robot-assisted therapies may constitute an effective tool for the compensation and rehabilitation of the functional skills of people with CP. The most important robotic devices for lower and upper limb rehabilitation were selected, specifying the assisted therapies, experiments done with them, and their results in children with CP. Methods: Scientific articles were obtained by means of an extensive search in electronic databases, primarily PubMed and Scopus. Papers published from the year 2000 to 2015 were considered for inclusion. The search was performed by using the following keywords in combination: robot, Cerebral Palsy, children, and therapies. Moreover, some web pages about CP organizations were used to complete the review. Conclusions: There is still a lack of randomized clinical trials with a representative number of subjects, which makes it difficult to evaluate the impact of robot-based therapy, especially the long-term effects. The inclusion of cognitive aspects into the therapies and the design of virtual scenarios in combination with robotic devices provide promising results.

CPWalker: Robotic platform for gait rehabilitation in patients with Cerebral Palsy

Cerebral Palsy (CP) is a disorder of posture and movement due to an imperfection or lesion in the immature brain. CP is often associated to sensory deficits, cognition impairments, communication and motor disabilities, behaviour issues, seizure disorder, pain and secondary musculoskeletal problems. New strategies are needed to help to promote, maintain, and rehabilitate the functional capacity, and thereby diminish the dedication and assistance required and the economical demands that this condition represents for the patient, the caregivers and the whole society. This paper describes the conceptualization and development of the integrated CPWalker robotic platform to support novel therapies for CP rehabilitation. This platform (Smart Walker + exoskeleton) is controlled by a multimodal interface to establish the interaction of CP children with robot-based therapies. The objective of these therapies is to improve the physical skills of children with CP and similar disorders. CPWalker concept will promote the earlier incorporation of CP patients to the rehabilitation therapy and increase the level of intensity and frequency of the exercises according to the task, which will enable the maintenance of therapeutic methods in daily basis, with the intention to lead to significant improvements in the treatment outcome.

Pilot study of a novel robotic platform for gait rehabilitation in children with cerebral palsy

Several robotic platforms were recently developed aimed at improving the locomotion capacity of people with gait impairment. Most of these gait trainers are limited to treadmill training, which is not a motivating condition for children with cerebral palsy (CP). This paper presents a pilot study done with two children with spastic CP, who trained with a new robotic platform called CPWalker during five weeks. This experimental device is a novel over ground prototype for gait rehabilitation with body weight support for children with CP. After rehabilitation training, both patients improved the mean velocity, cadence and step length. Moreover, the comparison between pre and post-kinematics analysis without the robot shows specific developments for each subject depending on the focus of the therapy (mainly trunk or hip flexion-extension).

Can robotic-based top-down rehabilitation therapies improve motor control in children with cerebral palsy? A perspective on the CPWalker project

Cerebral Palsy (CP) is one of the most severe disabilities in childhood, and it demands important costs in health, education, and social services. CP is caused by damage to or abnormalities inside the developing brain that disrupt the brain’s ability to control movement and maintain posture. Furthermore, CP is often associated with sensory deficits, cognition impairments, communication and motor disabilities, behavior issues, seizure disorder, pain, and secondary musculoskeletal problems. According to the literature, motor modules are peripheral measurements related to automatic motor control. There is a lack of evidence of change in motor modules in children with CP when different treatment approaches have been evaluated. Thus, new strategies are needed to improve motor control in this population. Robotic-based therapies are emerging as an effective intervention for gait rehabilitation in motor disorders such as stroke, spinal cord injury, and CP. There is vast clinical evidence that neural plasticity is the central core of motor recovery and development, and on-going studies suggest that robot-mediated intensive therapy could be beneficial for improved functional recovery. However, current robotic strategies are focused on the peripheral neural system (PNS) facilitating the performance of repetitive movements (a bottom-up approach). Since CP affects primarily brain structures, both the PNS and the central nervous system (CNS) should to be integrated in a physical and cognitive rehabilitation therapy (a top-down approach). This paper discusses perspectives of the top-down approach based on a novel robot-assisted rehabilitative system. Accordingly, the CPWalker robotic platform was developed to support novel therapies for CP rehabilitation. This robotic platform (Smart Walker + exoskeleton) is controlled by a multimodal interface enabling the interaction of CP infants with robot-based therapies. The aim of these therapies is to improve the physical skills of infants with CP using a top-down approach, in which motor related brain activity is used to drive robotic physical rehabilitation therapies. Our hypothesis is that the CPWalker concept will promote motor learning and this improvement will lead to significant improvements in automatic motor control. Correspondence to: Sergio Lerma Lara, Health Sciences Faculty, CSEU La Salle-UAM, Madrid, Spain, Tel: +34-917401980 , Fax: +34-913571730; E-mail: Sergio.lerma@lasallecampus.es

A robot-based gait training therapy for pediatric population with cerebral palsy: goal setting, proposal and preliminary clinical implementation

BackgroundThe use of robotic trainers has increased with the aim of improving gait function in patients with limitations. Nevertheless, there is an absence of studies that deeply describe detailed guidelines of how to correctly implement robot-based treatments for gait rehabilitation. This contribution proposes an accurate robot-based training program for gait rehabilitation of pediatric population with Cerebral Palsy (CP).MethodsThe program is focused on the achievement of some specifications defined by the International Classification of Functioning, Disability and Health framework, Children and Youth version (ICF-CY). It is framed on 16 non-consecutive sessions where motor control, strength and power exercises of lower limbs are performed in parallel with a postural control strategy. A clinical evaluation with four pediatric patients with CP using the CPWalker robotic platform is presented.ResultsThe preliminary evaluation with patients with CP shows improvements in several aspects as strength (74.03 ± 40.20%), mean velocity (21.46 ± 33.79%), step length (17.95 ± 20.45%) or gait performance (e.g. 66 ± 63.54% in Gross Motor Function Measure-88 items, E and D dimensions).ConclusionsThe improvements achieved in the short term show the importance of working strength and power functions meanwhile over-ground training with postural control. This research could serve as preliminary support for future clinical implementations in any robotic device.Trial registrationThe study was carried out with the number R-0032/12 from Local Ethical Committee of the Hospital Infantil Niño Jesús. Public trial registered on March 23, 2017: ISRCTN18254257.

BCI-Based Facilitation of Cortical Activity Associated to Gait Onset After Single Event Multi-level Surgery in Cerebral Palsy

Motor rehabilitation strategies by means of neuro-modulation paradigms, taking advantage of the motor predictive characteristics of the electroencephalographic signal, are currently subject to extensive research. Such rehabilitation strategies follow a top-down approach in which targeted neurophysiological changes in the central nervous system are expected to induce functional improvement. However, such approach presents a set of specific limitations and barriers in cerebral palsy patients, given that they typically do not have a normal gait and have suffered abnormal brain development. These limitations get even more critical when Single-Event Multilevel Surgery (SEMLS) is performed. After that procedure, surgery patients must re-learn the gait patterns according to a new biomechanical structure. This chapter presents a neuro-modulation paradigm to enhance the reeducation of gait functionality immediately following SEMLS in cerebral palsy patients. The experiments were developed and tested with real patients.

The CP Walker for Strength Training in Children with Spastic Cerebral Palsy: A Training Program Proposal

Eccentric and explosive strength training have the potential to stimulate in-series sarcomere addition in children with cerebral palsy (CP), as previously seen in typically developing children. This adaptation would enable greater muscle power generation. Similarly to previously used ankle robotic therapy, we believe the CPWalker robotic platform is an optimal tool as it may deliver individualized eccentric and explosive strength training during gait and under highly controlled conditions. Thus, a proposal for an 8 week CPWalker training program for children with CP is described.

Wearable Robotic Walker for Gait Rehabilitation and Assistance in Patients with Cerebral Palsy

Cerebral Palsy (CP) is the most common cause of permanent serious physical disability in childhood. New strategies are needed to help promote, maintain, and rehabilitate the functional capacity of children with severe level of impairment. The main objective of this work is to present a Human-Robot interaction strategy for overground rehabilitation to support novel robotic-based therapies for CP rehabilitation. This strategy is implemented in a new Wearable Robotic Walker named CPWalker. In our approach, legs’ kinematics information obtained from a Laser Range Finder (LRF) sensor is used to detect the user’s locomotion intentions and drive the robotic platform. During a preliminary validation we observed that this approach enabled the robot to continuously follow the human velocity and provided body weight support during gait.