Gait Robots Help Upper Body Posture

Randomized Controlled Trial

Robotic-assisted gait training improves walking abilities in diplegic children with cerebral palsy

Wallard l, Dietrich G, Kerlirzin Y & Bredin J

European Journal of Paediatric Neurology 2017, http://dx.doi.org/10.1016/j.ejpn.2017.01.012

Link to abstract

Objective: For children with diplegic cerebral palsy, robotic-assisted gait training (RAGT) can result in improved gait and posture compared to children who receive only traditional physical therapy. Of particular interest here is dynamic equilibrium control: upper body strategies such as shoulder elevation and elbow flexion used to maintain balance while propelling forward.

The authors propose: "RAGT presents beneficial effects on improvement of postural and locomotor functions of the patient resulting in a reorganization of gait pattern and full-body kinematic illustrating the dynamic equilibrium control in gait. This would translate in a better stabilization of the head, a better control of the displacement of the arms associated with an improvement in the kinematics of the lower limb."

Process: Thirty children with diplegic cerebral palsy from 8 to 18 years of age were randomly assigned to either a treatment group or a control group. The treatment group received 40-minute sessions of Lokomat Pediatric robot-assisted walking therapy, 5 days a week for 4 weeks. Body-weight support and walking speed were altered through the sessions to match the child’s functional capacity. The control group received daily 40-minute sessions of traditional therapy.

Findings: Gross Motor Function Classification System dimensions GMFM- D (standing) and GMFM-E (walking/running/climbing) were measured and showed improvement within the treatment group, and between treatment and control groups.

Children in the treatment group demonstrated new strategies for gait with significantly reduced shoulder elevation and elbow flexion, "more appropriate control of the upper body... associated with an improvement of the lower limbs kinematics which is similar to the values observed in typically developing children."

There was no follow-up to indicate whether the effects are preserved over the long term.

Robot Gait Rehab: Systematic Review

The effectiveness of robotic-assisted gait training for paediatric gait disorders: systematic review

Lefmann S, Russo R & Hillier S

Journal of NeuroEngineering and Rehabilitation 201714:1

DOI: 10.1186/s12984-016-0214-x

Link to full text: jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-016-0214-x

Objective: to review evidence for robotic-assisted gait training (RAGT) in children and adolescents with gait disorders as a consequence of cerebral palsy; or of musculo-skeletal, neurological orthopedic origin.

Process: Six databases were searched from 1980 to October, 2016. Data were extracted using the PRISMA model. http://www.prisma-statement.org/

Outcomes: Three trials that met the standard of randomized controlled trial; two were selected. Meta-analysis of the two trials showed "weak and inconsistent evidence regarding the use of RAGT for children with gait disorders".

Studies of lower design related mostly to children with cerebral palsy; these did show improved gait attributes such as speed, standing ability and walking distance. "… a clinical recommendation to adopt RAGT in children and adolescents with gait impairment cannot be made until more consistent findings are reported in larger randomized controlled trials."

Therapy Designers and Game Designers: We Should Get Together

Perspective

Gamification in Physical Therapy: More Than Using Games

Janssen J, Vershuren O, Renger WJ, Ermers J, Ketelaar M & van Ee, R

Pediatric Physical Therapy 2017;29:95-99

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/27984481

Objective: “By reducing the gap between therapy designers (therapists) and game designers, there is a huge potential to gain more from the potential value of participant-specific games.”To apply the attractiveness, motivation and engagement of video games to therapeutic goals, the authors propose three pathways: adding game principles to therapy (gamification), adding therapeutic tools to commercial games and selecting applied games suited to the therapeutic needs of the child.

Discussion: There are parallels between game design and therapy design. A process for bringing together game designers and therapy designers to optimize therapy is proposed.

Robot-Assisted Rehabilitation

Review

The present and future of robotic technology in rehabilitation

Laut J, Porfiri M & Raghavan P.

Curr Phys Med Rehabil Rep Nov 2016

DOI: 10.1007/s40101-016-0139-0

Link to abstract: link.springer.com/article/10.1007/s40141-016-0139-0>

Robot-assisted rehabilitation can contribute to conventional therapy by delivering consistent training and by benchmarking and monitoring progress. Robots can offer efficiencies in time and over distance. They may act passively or actively, and may be “end-effector robots” which act through an handle that is gripped or provide an exo-skeleton that mimics the movements of the limb. Robot-assisted rehabilitation can function remotely through telerehabilitation, reaching clients in their homes.

Robot therapies leverage entertainment software to provide motivation and engagement with an aim to boost compliance with interventions, and, through distance technologies, may offer efficiencies to the therapist. Equipment costs and the need for therapist-friendly software that targets rehabilitation intervention goals remain challenges to wider adoption.

Add a Sensor = + Data

Pilot study

Kinecting the Moves: The kinematic potential of rehabilitation-specific gaming to inform treatment for hemiplegia

Glegg SMN, Hung CT, Valdés BA, Kim BDG, & Van der Loos HFM

International journal of child health and human development 9(3):351-360 · September 2016

Link to abstract: https://www.researchgate.net/publication/309737850_Kinecting_the_Moves_The_kinematic_potential_of_rehabilitation-specific_gaming_to_inform_treatment_for_hemiplegia

Objective: For upper extremity rehabilitation candidates, can the development of data capture and analysis systems contribute to better rehabilitation game treatment decisions?

Process: to use video games with an additional data collector (Kinect sensor) to promote bimanual therapy, improve data collection and identify therapist-relevant data. Three subjects completed a 90 minute session of game play.

Findings: “With the integration of the Kinect sensor, motion tracking data can be harvested to inform treatment program development and progression by therapists”. This paper supplements the groundwork for further rehabilitation-specific videogame development.

Getting to know VR: Using a Knowledge Translation tool for therapists

A knowledge translation intervention to enhance clinical application of a virtual reality system in stroke rehabilitation

Single Group

Levac D, Glegg SMN, Sveistrup H, Colquhoun H, Miller PA, Finestone H, DePaul V, Harris JA & Velikonja D

BMC Health Serv Res. 2016; 16: 557. Published online 2016 Oct 6. doi: 10.1186/s12913-016-1807-6

Full text: www.ncbi.nlm.nih.gov/pmc/articles/PMC5052802/

Objective: In a sample of therapists, does a Knowledge Translation (KT) tool result in pre- to post-intervention improvements in VR technology adoption?

Process: Therapists were rated on the ADOPT-VR tool (Assessing Determinants of Prospective Takeup - Virtual Reality) before and after the KT intervention which included interactive e-learning modules, hands-on workshops and experiential learning practice sessions.

Outcomes: Pre- to post-intervention changes included improvement in therapists’ sense of agency and in increased facilitating conditions. Therapist knowledge and skills for using VR also increased. Barriers to use, intention to use and actual use did not change with the KT intervention for using VR. Low perceived usability of the VR system and some IREX-specific problems represented barriers, too.

Veridicality: Blending the Virtual with the Reality in Autism Research

Authenticity in Virtual Reality for assessment and intervention in Autism: A conceptual review

Literature Review

Parsons, S

Educational Research Review 19: (2016) 138 - 157

Link to abstract http://eprints.soton.ac.uk/399407/

A challenge of behavioural research is how to create experimental, laboratory settings that relate to real world experiences. Virtual reality has the capability to provide a blend of experimental control and realistic scenarios; a characteristic is called veridicality.

This literature review looks at the way virtual reality veridicality is used to find the different factors affecting the social interactions of people with autism. The review findings fall into two main categories. Veridicality is a way of blending synthetic and realistic social scenarios to provide learning and a way that transfers knowledge and skills to the real world. It can also be a way of providing authentic but controlled social settings where responses can be assessed to help understand the autism difference.

Autism research in virtual reality will at best be made up using the best ideas of researchers, influenced by the perspective of people with autism spectrum disorder and leveraging the capabilities of veridicality.